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Original article
Cryptogenic liver cirrhosis and hepatitis E virus (HEV): Are they related?
Filiz Akyüza,
Corresponding author
akyuzfu@yahoo.com
filizakyuz@hotmail.com

Corresponding author at: Department of Internal Medicine, Division of Gastroenterohepatology, Istanbul University, Istanbul Faculty of Medicine, 34390 Capa-Istanbul, Turkey.
, Bilger Çavuşa, Binnur Pınarbaşıa, Mürvet Bozacıb, Bülent Barana, Umit Akyuzc, Ahmet Uyanıkoglua, Kadir Demira, Fatih Beşışıka, Sadakat Özdila, Güngör Boztaşa, Zeynel Mungana, Selim Badurb, Sadi Yenenb, Sabahattin Kaymakoglua
a Department of Internal Medicine, Division of Gastroenterohepatology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
b Department of Virology and Microbiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
c Department of Internal Medicine, Division of Gastroenterohepatology SağlıkBilimleri University, Fatih Sultan Mehmet Educational and Research Center, Istanbul, Turkey
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">1</span><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Hepatitis E virus &#40;HEV&#41;&#44; one of the most common causes of acute hepatitis&#44; affects 20 million people annually&#59; 3 million cases are symptomatic&#44; and 60&#44;000 are fatal <a class="elsevierStyleCrossRefs" href="#bib0130">&#91;1&#44;2&#93;</a>&#46; In the 1980s HEV was first classified as non-hepatitis A&#44; non-hepatitis B virus&#46; Waterborne HEV exposures led to epidemic outbreaks similar to those caused by hepatitis A&#46; The virus was later described by Balayan <a class="elsevierStyleCrossRef" href="#bib0140">&#91;3&#93;</a> as HEV based on the evaluation of stool specimens using the principles of immune electron microscopy <a class="elsevierStyleCrossRef" href="#bib0140">&#91;3&#93;</a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">HEV is a small&#44; enveloped&#44; single-stranded RNA virus of the <span class="elsevierStyleItalic">Hepeviridae family</span><a class="elsevierStyleCrossRefs" href="#bib0140">&#91;3&#44;4&#93;</a>&#46; According to its epidemiological characteristics and survival indicators&#44; 4 different HEV genotypes that affect humans have been described&#46; Genotypes 1 and 2 cause disease in humans only and are responsible for epidemics through faecal-oral and waterborne transmissions&#46; Genotypes 3 and 4 are more likely to infect domestic and wild pigs and cause infections in humans <a class="elsevierStyleCrossRefs" href="#bib0145">&#91;4&#8211;6&#93;</a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">HEV&#44; one of the most common causes of acute hepatitis&#44; is mostly asymptomatic although it may present with symptoms such as jaundice&#44; fatigue&#44; nausea&#44; loss of appetite and muscle and joint aches that are self-limiting in 4&#8211;6 weeks in symptomatic individuals <a class="elsevierStyleCrossRefs" href="#bib0140">&#91;3&#44;7&#93;</a>&#46; Acute HEV is usually asymptomatic&#44; but especially during pregnancy&#44; in individuals with chronic liver disease&#44; and in patients with active alcohol consumption&#44; resulting in a clinical picture of acute hepatic insufficiency <a class="elsevierStyleCrossRef" href="#bib0160">&#91;7&#93;</a>&#46; HEV not only presents a clinical picture of acute hepatitis&#44; but also causes chronic hepatitis and cirrhosis in immunocompromised patients especially in those with a history of solid organ transplantation&#44; haematological malignancies&#44; and HIV positivity <a class="elsevierStyleCrossRefs" href="#bib0165">&#91;8&#44;9&#93;</a>&#46; In addition to acute and chronic hepatitis&#44; and cirrhosis&#44; HEV can manifest as many extrahepatic clinical findings mainly neurological&#44; renal&#44; pancreatic and haematological clinical findings&#46; Neurological findings related to HEV include polyradiculopathy&#44; Guillain&#8211;Barr&#233; syndrome&#44; Bell&#39;s palsy&#44; ataxia&#44; and mental confusion which make the diagnosis difficult because liver function tests in HEV infection show only a mild hepatitis <a class="elsevierStyleCrossRefs" href="#bib0140">&#91;3&#44;8&#93;</a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">While the existence of HEV has been known for many years&#44; it is not well characterized&#44; especially in its co-existence with cirrhotic diseases&#46; In particular&#44; there are not many studies in the literature evaluating the relationship between hepatitis E&#44; which is known to be chronic in the immunosuppressed group of patients with impaired T-cell response&#44; and its relationship with cirrhosis which is now considered an immunosuppressive table as it named as cirrhosis-associated immune dysfunction&#46; We think that the investigation of the presence of HEV&#44; especially in the cirrhotic group of patients whose aetiology is not clear&#44; can provide different perspectives in the literature and open new doors to the evaluation and management of the virus&#46; In this study we examined the presence of HEV in cryptogenic cirrhotic patients&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">2</span><span class="elsevierStyleSectionTitle" id="sect0040">Materials and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">2&#46;1</span><span class="elsevierStyleSectionTitle" id="sect0045">Sample size</span><p id="par0025" class="elsevierStylePara elsevierViewall">Our study included total 56 subjects&#44; 21 healthy volunteers &#40;12 males&#41; and 35 cryptogenic cirrhosis patients &#40;19 males&#41; without malignancy&#44; HIV positivity&#44; a history of immunosuppressive drugs use and also without a history of organ transplantation&#46; To determine the sample size of our study power was defined as at least 0&#46;80 and the type 1 error was set to 0&#46;05&#46; The diagnosis of cryptogenic cirrhosis was based on clinical&#44; laboratory and radiological findings&#46; Blood samples were taken from patients diagnosed with cryptogenic liver disease after other aetiologies that could have caused chronic liver disease were excluded&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">2&#46;2</span><span class="elsevierStyleSectionTitle" id="sect0050">Patients</span><p id="par0030" class="elsevierStylePara elsevierViewall">Hepatitis B&#44; hepatitis C&#44; autoimmune aetiologies&#44; Wilson&#39;s disease&#44; haemochromatosis and alcohol consumption were excluded in patients with clinical&#44; laboratory and radiologically diagnosed cryptogenic cirrhosis&#46; Therefore&#44; hepatitis B virus surface antigen&#44; anti hepatitis C virus&#44; hepatitis B virus DNA&#44; hepatitis C virus RNA levels were evaluated in the patients&#8217; blood samples and were negative in all patients&#46; In addition&#44; in terms of causes of liver enzyme reactivation cytomegalovirus DNA and Epstein&#8211;Barr virus DNA values were negative&#46; Antinuclear autoantibodies&#44; anti-liver-kidney microsomal antibodies&#44; anti-muscle cell antibodies and antimitochondrial antibodies were evaluated to exclude autoimmune hepatitis and all were found to be negative in all patients&#46; Haemochromatosis and Wilson&#39;s disease were excluded by calculating the transferrin saturations&#44; iron parameters and ceruloplasmin levels in all cryptogenic cirrhotic patients&#46; Alpha 1 antitrypsin deficiency was evaluated using protein electrophoresis and the alpha bands of the all patients were determined to be normal&#46; Histological evaluation was not performed with biopsy&#44; which was accepted as the gold standard for the discrimination of cryptogenic cirrhosis and non alcoholic liver disease related cirrhosis&#46; Because all patients were in the cirrhotic stage&#44; non alcoholic liver disease discrimination was done by non-invasive methods&#46; Accordingly&#44; the metabolic parameters and body mass indexes of the patients were taken into consideration&#46; All biochemical parameters of the patients were also evaluated&#46; None of the patients had a history of diabetes mellitus&#46; The lipid profiles of the patients were checked and no dyslipidemia was observed when these findings were evaluated&#46; Body mass indexes of HEV RNA positive patients were determined to be &#60;30<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The patients were informed about the study and their written consents were obtained in accordance with the Declaration of Helsinki&#46; Approval of local ethical committee was also obtained&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">2&#46;3</span><span class="elsevierStyleSectionTitle" id="sect0055">Serum samples</span><p id="par0040" class="elsevierStylePara elsevierViewall">Serum samples were obtained upon admission&#44; stored at &#8722;85<span class="elsevierStyleHsp" style=""></span>&#176;C and were used for the analyses&#46; Simultaneous biochemical studies were performed on the day that the patients&#8217; serum samples were taken&#46;</p><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">2&#46;3&#46;1</span><span class="elsevierStyleSectionTitle" id="sect0060">Detection of anti-HEV antibodies</span><p id="par0045" class="elsevierStylePara elsevierViewall">HEV antibodies were analysed by the Anti HEV ELISA kit &#40;<span class="elsevierStyleItalic">anti HEV</span> ELISA&#59; Diapro Prodiagnostic Bioprobes&#44; Milano&#44; Italy&#41;&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">2&#46;3&#46;2</span><span class="elsevierStyleSectionTitle" id="sect0065">HEV RNA detection by real-time PCR</span><p id="par0050" class="elsevierStylePara elsevierViewall">HEV RNA&#44; was isolated using the QIAMP Viral RNA mini kit &#40;QIAGEN&#44; Hilden&#44; Germany&#41;&#46; The HEV RNA titres were detected with a Rotor Gene 3000 real time PCR system using GenoSen&#39;s HEV &#40;Rotor Gene&#41; Quantitative Real Time PCR Kit &#40;Genome Diagnostics Private Limited&#44; The Netherlands&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">A prior study has evaluated the sensitivity and specificity of the kits we used to measure anti-HEV immunoglobulin G &#40;IgG&#41; &#40;anti HEV ELISA&#59; Diapro Prodiagnostic Bioprobes&#44; Milano&#44; Italy&#41;&#46; This study reported that the sensitivity was 77&#46;5&#37;&#8211;98&#37; and the specificity was 96&#37; <a class="elsevierStyleCrossRef" href="#bib0175">&#91;10&#93;</a>&#46;</p></span></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">3</span><span class="elsevierStyleSectionTitle" id="sect0070">Statistical analysis</span><p id="par0060" class="elsevierStylePara elsevierViewall">Descriptive statistics for the continuous &#40;numeric&#41; variables are presented as medians&#44; means&#44; standard deviations&#44; minimums and maximums&#59; whereas the categorical variables are presented as numbers and percentages&#46; Non-parametric tests were used because the continuous variables did not have a normal distribution&#46; The Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> test was used for comparisons between the two groups&#46; Chi-square tests were used to determine the relationship between the groups and the categorical variables&#46; The level of statistical significance was set to &#40;<span class="elsevierStyleItalic">&#945;</span>&#41; 5&#37; and the SPSS &#40;IBM SPSS for Windows&#44; version 24&#41; was used for analyses&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">4</span><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0065" class="elsevierStylePara elsevierViewall">The mean ages of the patient and control groups in this study were similar&#46; The mean age of the patients was 46<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;1 years while the mean age of healthy volunteers was 37&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;7 years&#46; The mean values for AST&#44; ALT&#44; alkaline phosphatase &#40;ALP&#41;&#44; gamma glutamyltransferase &#40;GGT&#41;&#44; and total bilirubin levels of the patients were 47&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>23<span class="elsevierStyleHsp" style=""></span>IU&#47;L&#44; 34&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18<span class="elsevierStyleHsp" style=""></span>IU&#47;L&#44; 200&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>93<span class="elsevierStyleHsp" style=""></span>IU&#47;L&#44; 69&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>86<span class="elsevierStyleHsp" style=""></span>IU&#47;L&#44; and 2&#46;14<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;4<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; respectively&#46; Thirty percent of the patients were diagnosed with compensated cirrhosis and&#44; 70&#37; were diagnosed with decompensated cirrhosis&#46; The mean Child&#8211;Pugh score was 8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;5&#40;range 5&#8211;12&#41;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> summarizes the anti HEVIgG and HEV RNA findings of the control and the patient groups&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Comparisons of the biochemical parameters and the Child&#8211;Pugh scores between the HEV RNA positive and negative patient groups showed that AST&#44; ALT&#44; total bilirubin&#44; and the Child&#8211;Pugh scores were higher in the HEV RNA positive patients than in the negative group&#44; but this difference was statistically significant only for total bilirubin levels &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;03&#41;&#46; The mean values for AST&#44; ALT&#44; ALP&#44; GGT&#44; total bilirubin&#44; and the Child&#8211;Pugh scores in the HEV RNA positive and negative patient groups were 67<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>24&#46;5 vs&#46; 39<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&#46;5<span class="elsevierStyleHsp" style=""></span>IU&#47;L &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;087&#41;&#44; 42<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>22&#46;19 vs&#46; 30<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&#46;9<span class="elsevierStyleHsp" style=""></span>IU&#47;L &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;360&#41;&#44; 188<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>110&#46;9<span class="elsevierStyleHsp" style=""></span>IU&#47;L vs&#46; 206<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>94&#46;9<span class="elsevierStyleHsp" style=""></span>IU&#47;L &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;569&#41;&#44; 39<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>27&#46;7 vs&#46; 77<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>102&#46;9<span class="elsevierStyleHsp" style=""></span>IU&#47;L &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;648&#41;&#44; 3&#46;72<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;4 vs&#46; 1&#46;47<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;75<span class="elsevierStyleHsp" style=""></span>mg&#47;dL &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;03&#41; and 8&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;08 vs&#46; 8&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;8 &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;565&#41;&#44; respectively&#46; <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a> shows the comparison of the biochemical parameters and Child&#8211;Pugh scores of the HEV RNA positive and the negative groups&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Positive correlations were found between HEV RNA levels and AST &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;046&#44; <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;642&#41;&#44; and HEV RNA levels and ALT &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;049&#44; <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;632&#41; levels&#46; <a class="elsevierStyleCrossRefs" href="#fig0015">Figs&#46; 3 and 4</a> summarize the relationship between liver aminotransferases and HEV RNA levels&#46; HEV RNA positivity and serum levels were not correlated with Child&#8211;Pugh score &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> lists the clinical&#44; biochemical and demographic characteristics of the HEV RNA positive patients&#46; In <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> Odd&#39;s ratio and confidence interval for the liver enzymes in HEV RNA positivity is listed&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Biochemical values and Child&#8211;Pugh scores between anti HEVIgG positive and negative patients were compared&#46; The mean values for AST&#44; ALT&#44; ALP&#44; GGT&#44; total bilirubin and Child&#8211;Pugh scores in the anti-HEVIgG positive and negative patient groups were 51&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#46;7 vs&#46; 44&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>29&#46;22<span class="elsevierStyleHsp" style=""></span>IU&#47;L &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;522&#41;&#44; 26&#46;75<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;63 vs&#46; 39&#46;17<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>22&#46;14<span class="elsevierStyleHsp" style=""></span>IU&#47;L &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;336&#41;&#44; 190&#46;25<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>103&#46;59 vs&#46; 207&#46;83<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>96&#46;39<span class="elsevierStyleHsp" style=""></span>IU&#47;L &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;831&#41;&#44; 33<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18&#46;38 vs&#46;87&#46;33<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>109&#46;12<span class="elsevierStyleHsp" style=""></span>IU&#47;L &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;109&#41;&#44; 2&#46;64<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;76 vs&#46; 1&#46;82<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;20<span class="elsevierStyleHsp" style=""></span>mg&#47;dL &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;593&#41;&#44; 9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;31 vs&#46; 7&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;74 &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;389&#41;&#44; respectively&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The AST&#44; ALT&#44; ALP&#44; GGT&#44; total bilirubin values and Child&#8211;Pugh scores did not show statistically significant difference in the anti HEVIgG positive and negative patient groups &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">5</span><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0095" class="elsevierStylePara elsevierViewall">Although we have been familiar with HEV for more than 40 years&#44; it is obvious that little is known about the virus&#46; Many new and different effects have been demonstrated&#44; such as the development of chronicity in immunosuppressed patients&#44; its possible role in cirrhosis&#44; and its role in extrahepatic involvement that may affect the neurological&#44; haematological and gastrointestinal systems&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">HEV causes epidemic outbreaks especially in developing countries&#46; Its prevalence in Turkey has been found to vary between 3&#37; and 29&#37; in several studies <a class="elsevierStyleCrossRefs" href="#bib0180">&#91;11&#44;12&#93;</a>&#46; A meta-analysis assessed HEV seroprevalence in Europe and included 73 studies from 11 countries that evaluated 129&#44;254 individuals&#44; of whom 116&#44;043 were healthy individuals from the general population&#46; In that meta-analysis&#44; the HEV seroprevalence in healthy individuals from the general population varied between 7&#37; and 17&#37; <a class="elsevierStyleCrossRef" href="#bib0190">&#91;13&#93;</a>&#46; We also found our total anti HEVIgG positivity to be 17&#46;85&#37;&#46; Similar to studies from both Turkey and Europe&#44; the healthy group positivity rate was approximately&#44; 9&#46;5&#37;&#46; On the other hand&#44; among patients with cryptogenic cirrhosis&#44; we found that the rate of anti-HEVIgG positivity was as high as 25&#46;7&#37;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Mellgren et al&#46; <a class="elsevierStyleCrossRef" href="#bib0195">&#91;14&#93;</a> evaluated the HEV prevalence among 204 patients in Sweeden with hepatitis C infections and various stages of fibrosis and found a HEV prevalence of 30&#37;&#46; They compared this rate with the 17&#37; anti HEVIgG positivity rate which is found in blood donors in Sweden and detected a statistically significant increase&#46; One potential reason for this was considered to be the higher mean age of patients with chronic hepatitis C than the mean age of the control group&#46; In our study&#44; we found that the rate of anti HEVIgG positivity &#40;25&#46;7&#37;&#41; was higher in the cirrhotic group&#44; although the mean age of the healthy and patients group was similar&#46; Therefore&#44; we believe that the high anti HEVIgG positivity rate is associated with parameters other than age&#46; In the same study&#44; Mellgren et al&#46; <a class="elsevierStyleCrossRef" href="#bib0195">&#91;14&#93;</a> found a rate of anti HEVIgG positivity of 38&#37; in 98 patients with a Meta-analysis of Histological Data in Viral Hepatitis &#40;METAVIR&#41; fibrosis scores of F2 and above&#44; which was statistically significant <a class="elsevierStyleCrossRef" href="#bib0195">&#91;14&#93;</a>&#46; The detection of high anti HEVIgG positivity in the patient group with a high fibrosis score in that study supports the similarly high rate of anti HEVIgG positivity &#40;25&#46;7&#37;&#41; found in the cirrhotic patient group in our study&#46; In a study by Atiq et al&#46; <a class="elsevierStyleCrossRef" href="#bib0200">&#91;15&#93;</a> that evaluated the prevalence of anti-HEV IgG in patients with chronic liver disease&#44; anti-HEVIgG positivity was found in29&#46;3&#37; of the patients with chronic hepatitis&#44; regardless of its aetiology <a class="elsevierStyleCrossRef" href="#bib0200">&#91;15&#93;</a>&#46; A study by Schulz et al&#46; <a class="elsevierStyleCrossRef" href="#bib0205">&#91;16&#93;</a> in Germany found anti HEVIgG positivity in 21&#37; of 295 patients with chronic liver disease&#44; which was similar to the proportion found in those without a known liver disease &#40;24&#46;4&#37;&#41;&#46; In addition&#44; 15 &#40;23&#46;8&#37;&#41; of 62 chronic liver disease patients with anti HEVIgG positivity had a cirrhotic stage due to hepatitis B&#44; hepatitis C&#44; alcohol consumption&#44; autoimmune hepatitis&#44; secondary biliary cirrhosis and primary sclerosing cholangitis&#46; HEV RNA was not assessed in that study <a class="elsevierStyleCrossRef" href="#bib0205">&#91;16&#93;</a>&#46; A study that reported findings consistent with our data was conducted in Spain by Riveiro-Barciela et al&#46; <a class="elsevierStyleCrossRef" href="#bib0210">&#91;17&#93;</a>&#46; In that study&#44; HEV seroprevalence was 17&#46;5&#37; in cirrhotic patients and was32&#46;1&#37; in patients who developed hepatic cirrhosis after liver transplantation and 7&#46;4&#37; in patients with hepatic transplantation that did not develop cirrhosis&#46; An important finding of this study was the higher prevalence of HEV in the cirrhotic group when both immunosuppressed groups were compared <a class="elsevierStyleCrossRef" href="#bib0210">&#91;17&#93;</a>&#44; which is a more interesting finding than the association of HEV with chronicity in immunosuppressed patients&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Although the higher anti HEVIgG positivity in patients with cryptogenic cirrhosis does not indicate that HEV alone can cause cryptogenic cirrhosis&#44; it suggests that encountering HEV contributes to the fibrotic process&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">In our study HEV RNA levels were not detectable in the healthy group&#46; Among worldwide studies in which HEV RNA prevalence was investigated in healthy groups&#44; the prevalence rate was between 0&#46;08 and 0&#46;14&#37; in Germany&#44; 0&#46;04&#37; in England and between 1&#46;5 and 3&#46;7&#37; in India&#46; It was thought that the detection of measurable HEV RNA without clinical evidence of disease may have been associated with spontaneous clearance of the virus after exposure in healthy individuals <a class="elsevierStyleCrossRefs" href="#bib0215">&#91;18&#44;19&#93;</a>&#46; We detected a significantly higher HEV RNA positivity rate in patients with cryptogenic hepatic cirrhosis compared to the healthy control group&#46; Mellgren et al&#46; <a class="elsevierStyleCrossRef" href="#bib0195">&#91;14&#93;</a> while evaluating the seroprevalence of hepatitis E in 204 patients that have chronic hepatitis C infection at various fibrotic stages&#44; detected a low titre HEV RNA positivity only in one patient&#46; This patient had a cirrhotic stage and mildly elevated hepatic transaminase values were similar to those that we observed in our study <a class="elsevierStyleCrossRef" href="#bib0195">&#91;14&#93;</a>&#46; The pathogenesis of HEV in liver injury still remains unclear <a class="elsevierStyleCrossRef" href="#bib0225">&#91;20&#93;</a>&#46; Because HEV is not cytopathic&#44; it is thought that the immune response associated with cytotoxic T and natural killer cells likely plays a role in the liver injury&#46; Because the presence of HEV RNA is also an indicator of HEV replication&#44; measurable HEV RNA levels could stimulate a cytotoxic response&#44; which is a possible mechanism leading to the destruction of hepatocytes&#46; Although HEV is mostly asymptomatic throughout the world&#44; the infection it can cause a severe acute hepatitis in pregnant women and people with previously known liver diseases <a class="elsevierStyleCrossRef" href="#bib0230">&#91;21&#93;</a>&#46; Barrague et al&#46; <a class="elsevierStyleCrossRef" href="#bib0225">&#91;20&#93;</a> detected a high HEV RNA level in a patient with non-alcoholic steatohepatitis background and achieved HEV RNA clearance with ribavirin treatment&#46; That study&#44; which described a patient with chronic hepatitis E and a cirrhotic background&#44; also evaluated the immune response of the patient&#44; whose interferon &#947; response was similar to that of solid organ transplant patients who subsequently developed chronic hepatitis E <a class="elsevierStyleCrossRef" href="#bib0225">&#91;20&#93;</a>&#46; In the current guidelines ribavirin therapy is recommended for immunosuppressive patients with solid organ transplantation after the immunosuppressive medications used for chronic HEV infection are reduced&#44; if possible&#44; and if HEV RNA positivity continues for three months or longer&#46; Ribavirin and&#47;or pegylated-interferon alpha may be used for chronic hepatitis E treatment in cases of haematological disorders or HIV-related immunosuppression in addition to solid organ transplantation&#46; Ribavirin treatment should be considered in cases of severe acute hepatitis E and acute or chronic liver failure <a class="elsevierStyleCrossRef" href="#bib0235">&#91;22&#93;</a>&#46; It is still unclear how we should approach this issue in non-immunosuppressed patients and cirrhotic patients&#44; though there have been variations in our approaches to hepatitis E in recent years&#46; One important point that our study suggests relative to this issue&#44; is that in patients with cryptogenic cirrhosis with enzyme activity and HEV RNA levels can be examined to assess whether treatment has positive effects on cirrhosis progression&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">The lack of HEV RNA clearance in the cirrhotic patient group in our study may be related to the fact that cirrhosis is a disease that leads to immune dysfunction which is recently named as cirrhosis-associated immune dysfunction&#46; It may also be appropriate to assess hormonal changes&#44; such as increased oestrogen and progesterone&#44; which have been shown to be responsible for pregnancy-associated fulminant hepatitis E infection&#44; in cirrhotic patients as well <a class="elsevierStyleCrossRefs" href="#bib0240">&#91;23&#44;24&#93;</a>&#46; Hoan et al&#46; <a class="elsevierStyleCrossRef" href="#bib0250">&#91;25&#93;</a> evaluated hepatitis E virus superinfection and clinical progression in 1318 Vietnamese patients with hepatitis B related diseases such as acute hepatitis B&#44; chronic hepatitis B&#44; hepatic cirrhosis&#44; hepatocellular carcinoma or cirrhosis with hepatocellular carcinoma&#46; In this study&#44; only one patient with cirrhosis and hepatocellular carcinoma had a measurable level of HEV RNA&#46; Again&#44; the same study found that when participants were classified as Child&#8211;Pugh A&#44; B and C&#44; the anti-HEV IgG positivity rate was higher in the Child&#8211;Pugh B and C groups than inthe Child&#8211;Pugh A group in patients with cirrhosis due to hepatitis B <a class="elsevierStyleCrossRef" href="#bib0250">&#91;25&#93;</a>&#46; Similarly in our study&#44; the mean Child&#8211;Pugh score was higher in the anti HEVIgG positive patient group than the anti HEVIgG negative patient group&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Although our study evaluating HEV RNA and anti HEVIgG levels in a specific patient group consisted of a small sample size&#44; it is logical to research HEV in a group that has not been previously evaluated&#44; such as patients with cryptogenic cirrhosis&#46; Additionally we could have made better interpretations regarding the chronicity of HEV if we had measured HEV RNA levels again after 3 months&#44; as is generally recommended in the literature&#46; Another limitation of our study is the absence of HEV genotyping&#44; although genotypes 1 and 2 are most commonly seen among patients in Turkey&#46; If we had detected genotype 3&#44; which is responsible for chronicity in immunosuppressed patients&#44; we could have made better interpretations of our data&#46; It is obvious that additional studies are needed to properly evaluate the co-occurrence of HEV with clinical presentations in diseases such as acute hepatitis&#44; chronic hepatitis&#44; with or without extrahepatic involvement&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">In conclusion&#44; to the best of our knowledge&#44; this study is the first to evaluate the presence of HEV in patients with cryptogenic cirrhosis in the literature&#46; This study demonstrated that anti HEVIgG and HEV RNA positivity rates were high in patients with cryptogenic cirrhosis although the results were not statistically significant and there was a positive correlation between HEV RNA and aminotransferases&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Abbreviations</span><p id="par0135" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleDefList"><span class="elsevierStyleDefTerm">ALP</span><span class="elsevierStyleDefDescription"><p id="par0140" class="elsevierStylePara elsevierViewall">alkaline phosphatase</p></span><span class="elsevierStyleDefTerm">ALT</span><span class="elsevierStyleDefDescription"><p id="par0145" class="elsevierStylePara elsevierViewall">alanine aminotransferase</p></span><span class="elsevierStyleDefTerm">AST</span><span class="elsevierStyleDefDescription"><p id="par0150" class="elsevierStylePara elsevierViewall">aspartate aminotransferase</p></span><span class="elsevierStyleDefTerm">&#176;C</span><span class="elsevierStyleDefDescription"><p id="par0155" class="elsevierStylePara elsevierViewall">Celcius</p></span><span class="elsevierStyleDefTerm">DNA</span><span class="elsevierStyleDefDescription"><p id="par0160" class="elsevierStylePara elsevierViewall">deoxi-nucleic-acid</p></span><span class="elsevierStyleDefTerm">ELISA</span><span class="elsevierStyleDefDescription"><p id="par0165" class="elsevierStylePara elsevierViewall">enzyme-linked immunosorbent assay</p></span><span class="elsevierStyleDefTerm">GGT</span><span class="elsevierStyleDefDescription"><p id="par0170" class="elsevierStylePara elsevierViewall">gamma glutamyltransferase</p></span><span class="elsevierStyleDefTerm">HEV</span><span class="elsevierStyleDefDescription"><p id="par0175" class="elsevierStylePara elsevierViewall">hepatitis E virus</p></span><span class="elsevierStyleDefTerm">HIV</span><span class="elsevierStyleDefDescription"><p id="par0180" class="elsevierStylePara elsevierViewall">human immunodeficiency virus</p></span><span class="elsevierStyleDefTerm">IgG</span><span class="elsevierStyleDefDescription"><p id="par0185" class="elsevierStylePara elsevierViewall">immunoglobulin G</p></span><span class="elsevierStyleDefTerm">METAVIR</span><span class="elsevierStyleDefDescription"><p id="par0190" class="elsevierStylePara elsevierViewall">meta-analysis of histolgical data in viral hepatitis</p></span><span class="elsevierStyleDefTerm">PCR</span><span class="elsevierStyleDefDescription"><p id="par0195" class="elsevierStylePara elsevierViewall">polymerase chain reaction</p></span><span class="elsevierStyleDefTerm">RNA</span><span class="elsevierStyleDefDescription"><p id="par0200" class="elsevierStylePara elsevierViewall">ribonucleic acid</p></span><span class="elsevierStyleDefTerm">SPSS</span><span class="elsevierStyleDefDescription"><p id="par0205" class="elsevierStylePara elsevierViewall">Statistical Package for the Social Sciences</p></span></span></p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Financial support</span><p id="par0210" class="elsevierStylePara elsevierViewall">There is no financial support for this study to declare&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflicts of interest</span><p id="par0215" class="elsevierStylePara elsevierViewall">The authors of this research have no conflicts of interest to declare&#46;</p></span></span>"
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          "identificador" => "xres1233313"
          "titulo" => "Abstract"
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              "identificador" => "abst0005"
              "titulo" => "Introduction and Objectives"
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          "titulo" => "Introduction"
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          "titulo" => "Materials and methods"
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            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Sample size"
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              "titulo" => "Patients"
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            2 => array:3 [
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              "titulo" => "Serum samples"
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                0 => array:2 [
                  "identificador" => "sec0030"
                  "titulo" => "Detection of anti-HEV antibodies"
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                1 => array:2 [
                  "identificador" => "sec0035"
                  "titulo" => "HEV RNA detection by real-time PCR"
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          "titulo" => "Statistical analysis"
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          "titulo" => "Results"
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          "titulo" => "Discussion"
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          "identificador" => "sec0055"
          "titulo" => "Abbreviations"
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          "titulo" => "Financial support"
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          "identificador" => "sec0065"
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          "titulo" => "References"
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    "fechaRecibido" => "2018-07-26"
    "fechaAceptado" => "2019-01-25"
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          "clase" => "keyword"
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          "identificador" => "xpalclavsec1145645"
          "palabras" => array:5 [
            0 => "Hepatotropic viruses"
            1 => "Liver disease"
            2 => "Immunocompetent patients"
            3 => "Transaminases"
            4 => "Inflammation"
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    "resumen" => array:1 [
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction and Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hepatitis E virus &#40;HEV&#41; is one of the most common causes of acute hepatitis&#46; In recent years&#44; its role in the development of chronic hepatitis and cirrhosis especially in immunosuppressed patients and its wide range of extrahepatic involvement have increased the amount of research on HEV&#46; In this study we aimed to investigate the presence of HEV infection in individuals with cryptogenic cirrhosis&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Materials and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">HEV antibodies were analysed using the Anti HEV enzyme-linked immunosorbent assay &#40;ELISA&#41; kit &#40;<span class="elsevierStyleItalic">anti-HEV</span> ELISA&#59; Diapro Prodiagnostic Bioprobes&#44; Milan&#44; Italy&#41;&#46; HEV RNA was isolated with using QIAMP Viral RNA mini kit &#40;QIAGEN&#44; Hilden&#44; Germany&#41;&#46; The HEV RNA titre was detected with the Rotor Gene 3000 real time polymerase chain reaction &#40;PCR&#41; system using GenoSen&#39;s HEV &#40;Rotor Gene&#41; Quantitative Real Time PCR Kit &#40;Genome Diagnostics Private Limited&#44; the Netherlands&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Our study included 21 healthy volunteers &#40;12 males&#41; and 35 cryptogenic cirrhosis patients &#40;19 males&#41;&#46; The ages of the patients and the controls were similar &#40;46<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;1 vs&#46; 37&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;7years&#41;&#46; The mean Child&#8211;Pugh score was 8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;5&#46; The anti HEV immunoglobulin G&#40;IgG&#41; positivity rate was 9&#46;5&#37; and 25&#46;7&#37; in the control and patient groups respectively &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; HEV RNA positivity was not detected in the control group&#44; but 3 cases &#40;8&#46;6&#37;&#41; in the patient group were positive &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; The HEV RNA&#44; aspartate aminotransferase &#40;AST&#41; and alanine aminotransferase&#40;ALT&#41; levels for these 3 cases were 326&#46;461<span class="elsevierStyleHsp" style=""></span>copies&#47;mL&#44; 91<span class="elsevierStyleHsp" style=""></span>IU&#47;L and 67<span class="elsevierStyleHsp" style=""></span>IU&#47;L&#59; 480<span class="elsevierStyleHsp" style=""></span>copies&#47;mL&#44; 68<span class="elsevierStyleHsp" style=""></span>IU&#47;L and 36<span class="elsevierStyleHsp" style=""></span>IU&#47;L and 72<span class="elsevierStyleHsp" style=""></span>copies&#47;mL&#44; 42<span class="elsevierStyleHsp" style=""></span>IU&#47;L and 24<span class="elsevierStyleHsp" style=""></span>IU&#47;L respectively&#46; There were positive correlations between HEV RNA levels and AST and ALT levels &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Anti HEVIgG and HEV RNA positivity rates are high in cryptogenic cirrhosis although it is not statistically significant and there is a positive correlation between HEV RNA and aminotransferases&#46;</p></span>"
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          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Positive correlation between AST and HEV RNA titres &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;046&#44; <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;642&#41;&#46; AST&#58; aspartate aminotransferase&#44; HEV RNA&#58; hepatitis E virus ribonucleic acid&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Gender&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Weight &#40;kg&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Body mass index &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">AST &#40;IU&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ALT &#40;IU&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total bilirubin &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Diabetes mellitus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Child&#8211;Pugh score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Cirrhosis associated complication&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">181&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">93&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hepatocerebellar degeneration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">185&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">326&#44;461&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Variceal haemorrhage&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">169&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">480&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hepatic encephalopathy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">HEV RNA&#58; hepatitis E virus ribonucleic acid&#44; AST&#58; aspartate aminotransferase&#44; ALT&#58; alanin aminotransferase&#46;</p><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">CI&#58; confidence interval&#46; Bold denotes statistical significance at <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05</p>"
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col">Independent variables&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col">Dependent variables HEV RNA &#40;copy&#47;ml&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">AST &#40;IU&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1068 &#40;0&#46;981&#8211;1163&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1039 &#40;0&#46;959&#8211;1126&#41;&nbsp;\t\t\t\t\t\t\n
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hepatitis E virus&#58; advances and challenges"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "I&#46; Nimgaonkar"
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                            3 => "A&#46; Ploss"
                          ]
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                    0 => array:2 [
                      "doi" => "10.1038/nrgastro.2017.150"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nat Rev Gastroenterol Hepatol"
                        "fecha" => "2017"
                        "volumen" => "15"
                        "paginaInicial" => "96"
                        "paginaFinal" => "110"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29162935"
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              "identificador" => "bib0135"
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                  "contribucion" => array:1 [
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                      "titulo" => "Hepatitis E virus infection"
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                          "autores" => array:6 [
                            0 => "N&#46; Kamar"
                            1 => "J&#46; Izopet"
                            2 => "N&#46; Pavio"
                            3 => "R&#46; Aggarwal"
                            4 => "A&#46; Labrique"
                            5 => "H&#46; Wedemeyer"
                          ]
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                    0 => array:2 [
                      "doi" => "10.1038/nrdp.2017.86"
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                        "tituloSerie" => "Nat Rev Dis Primers"
                        "fecha" => "2017"
                        "volumen" => "3"
                        "paginaInicial" => "17086"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29154369"
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                    0 => array:2 [
                      "doi" => "10.1056/NEJMra1204512"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2012"
                        "volumen" => "367"
                        "paginaInicial" => "1237"
                        "paginaFinal" => "1244"
                        "link" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23013075"
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                      "titulo" => "Hepatitis E virus&#58; time to change the textbooks"
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                          "autores" => array:4 [
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                    0 => array:2 [
                      "doi" => "10.1159/000444468"
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                        "tituloSerie" => "Dig Dis"
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                        "volumen" => "34"
                        "paginaInicial" => "308"
                        "paginaFinal" => "316"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27170383"
                            "web" => "Medline"
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                      "titulo" => "Hepatitis E virus in industrialized countries&#58; the silent threat"
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                            0 => "P&#46; Clemente-Casares"
                            1 => "C&#46; Ramos-Romero"
                            2 => "E&#46; Ramirez-Gonzalez"
                            3 => "A&#46; Mas"
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                  "host" => array:1 [
                    0 => array:1 [
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                        "tituloSerie" => "Biomed Res Int"
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                        "paginaInicial" => "9838041"
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                ]
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              "identificador" => "bib0155"
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                    0 => array:2 [
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                          "autores" => array:2 [
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                  "host" => array:1 [
                    0 => array:2 [
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                        "tituloSerie" => "Transfus Med"
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                        "paginaInicial" => "84"
                        "paginaFinal" => "95"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28382704"
                            "web" => "Medline"
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                    0 => array:2 [
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                            0 => "S&#46; Fujiwara"
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                            2 => "K&#46; Morino"
                            3 => "K&#46; Hayasaka"
                            4 => "M&#46; Kawabata"
                            5 => "T&#46; Shimizu"
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Viral Hepat"
                        "fecha" => "2014"
                        "volumen" => "21"
                        "paginaInicial" => "78"
                        "paginaFinal" => "89"
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                    ]
                  ]
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                          "etal" => false
                          "autores" => array:3 [
                            0 => "N&#46; Kamar"
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                            2 => "H&#46;R&#46; Dalton"
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                    0 => array:2 [
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                        "tituloSerie" => "J Clin Exp Hepatol"
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                        "paginaInicial" => "134"
                        "paginaFinal" => "140"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25755487"
                            "web" => "Medline"
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                            3 => "M&#46; Leal"
                            4 => "L&#46;L&#46; Lewis-Ximenez"
                            5 => "M&#46;A&#46; Pinto"
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                        "tituloSerie" => "Biomed Res Int"
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                        "paginaInicial" => "5769201"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
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                            3 => "O&#46;M&#46; Abdalla"
                            4 => "M&#46; Abdalla"
                            5 => "G&#46;K&#46; Nasrallah"
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                        "paginaInicial" => "466"
                        "paginaFinal" => "480"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29485390"
                            "web" => "Medline"
                          ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
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                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46; Bayram"
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                            3 => "E&#46; Sozen"
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                        "paginaInicial" => "2816"
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                    ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
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                          "autores" => array:3 [
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                        "tituloSerie" => "Int J Mol Sci"
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                        "paginaFinal" => "25743"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26516843"
                            "web" => "Medline"
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                          "autores" => array:6 [
                            0 => "J&#46; Hartl"
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                            4 => "K&#46;L&#46; Woolson"
                            5 => "L&#46; Kriston"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
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                            4 => "R&#46; Wejst&#229;l"
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                    0 => array:2 [
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                        "paginaFinal" => "45"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28160727"
                            "web" => "Medline"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
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                          "autores" => array:6 [
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                            2 => "A&#46; Barrett"
                            3 => "S&#46;D&#46; Rouster"
                            4 => "K&#46;E&#46; Sherman"
                            5 => "M&#46;T&#46; Shata"
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                        "tituloSerie" => "Emerg Infect Dis"
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                        "paginaInicial" => "479"
                        "paginaFinal" => "481"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19239770"
                            "web" => "Medline"
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                0 => array:2 [
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                    0 => array:2 [
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                          "etal" => false
                          "autores" => array:6 [
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                            2 => "K&#46; Plehm"
                            3 => "C&#46; Z&#246;llner"
                            4 => "J&#46; Hofmann"
                            5 => "E&#46; Schott"
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                        "tituloSerie" => "Eur J Gastroenterol Hepatol"
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                        "paginaInicial" => "1431"
                        "paginaFinal" => "1436"
                        "link" => array:1 [
                          0 => array:2 [
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                    0 => array:2 [
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                        "paginaInicial" => "e103028"
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                0 => array:2 [
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                    0 => array:2 [
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                    0 => array:2 [
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                        "paginaFinal" => "79"
                        "link" => array:1 [
                          0 => array:2 [
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                        "paginaFinal" => "1773"
                        "link" => array:1 [
                          0 => array:2 [
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                        "paginaFinal" => "1271"
                        "link" => array:1 [
                          0 => array:2 [
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                        "paginaFinal" => "1396"
                        "link" => array:1 [
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                        "paginaFinal" => "165"
                        "link" => array:1 [
                          0 => array:2 [
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              ]
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Article information
ISSN: 16652681
Original language: English
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos