Original article
Occult liver disease: A multinational perspective
Paulina Vidal-Cevallosa, Nayelli Flores-Garcíab, Norberto C. Chávez-Tapiaa,
, Naga P. Chalasanic,
Corresponding author
nchavezt@medicasur.org.mx
Corresponding authors. E-mail addresses: nchalasa@iu.edu (N. P. Chalasani) and nchavezt@medicasur.org.mx (Norberto C. Chávez-Tapia).
Corresponding authors. E-mail addresses: nchalasa@iu.edu (N. P. Chalasani) and nchavezt@medicasur.org.mx (Norberto C. Chávez-Tapia).
Corresponding author
nchalasa@iu.edu
Corresponding authors. E-mail addresses: nchalasa@iu.edu (N. P. Chalasani) and nchavezt@medicasur.org.mx (Norberto C. Chávez-Tapia).
Corresponding authors. E-mail addresses: nchalasa@iu.edu (N. P. Chalasani) and nchavezt@medicasur.org.mx (Norberto C. Chávez-Tapia).
a Obesity and Digestive Disease Unit, Medica Sur Clinic and Foundation, Puente de Piedra 150, Toriello Guerra, 14050, Mexico City, Mexico
b Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
c Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, United States
Read
814
Timeswas read the article
185
Total PDF
629
Total HTML
Share statistics
array:22 [ "pii" => "S1665268124002746" "issn" => "16652681" "doi" => "10.1016/j.aohep.2024.101480" "estado" => "S300" "fechaPublicacion" => "2024-05-01" "aid" => "101480" "copyright" => "Fundación Clínica Médica Sur, A.C." "copyrightAnyo" => "2024" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Ann Hepatol. 2024;29:" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "itemAnterior" => array:18 [ "pii" => "S1665268123002880" "issn" => "16652681" "doi" => "10.1016/j.aohep.2023.101185" "estado" => "S300" "fechaPublicacion" => "2024-05-01" "aid" => "101185" "copyright" => "Fundación Clínica Médica Sur, A.C." "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Ann Hepatol. 2024;29:" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "From evidence to clinical practice: Bridging the gap of new liver cancer therapies in Latin America." "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0001" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1800 "Ancho" => 2833 "Tamanyo" => 513429 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0001" "detalle" => "Fig " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spara001" class="elsevierStyleSimplePara elsevierViewall">The latest Barcelona Clinic Liver Cancer staging system <a class="elsevierStyleCrossRef" href="#bib0035">[35]</a>. AFP: Alpha-fetoprotein; ALBI: Albumin to Bilirubin ratio; BCLC: Barcelona Clinic Liver Cancer; LT: Liver Transplantation; PS: performance status; SIRT: Selective Internal Radiotherapy; TACE: trans-arterial chemoembolization; TARE: trans-arterial radioembolization.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Federico Piñero, Ezequiel Mauro, Paola Casciato, Alejandro Forner" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Federico" "apellidos" => "Piñero" ] 1 => array:2 [ "nombre" => "Ezequiel" "apellidos" => "Mauro" ] 2 => array:2 [ "nombre" => "Paola" "apellidos" => "Casciato" ] 3 => array:2 [ "nombre" => "Alejandro" "apellidos" => "Forner" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665268123002880?idApp=UINPBA00004N" "url" => "/16652681/0000002900000003/v1_202404281202/S1665268123002880/v1_202404281202/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Occult liver disease: A multinational perspective" "tieneTextoCompleto" => true "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Paulina Vidal-Cevallos, Nayelli Flores-García, Norberto C. Chávez-Tapia, Naga P. Chalasani" "autores" => array:4 [ 0 => array:3 [ "nombre" => "Paulina" "apellidos" => "Vidal-Cevallos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0001" ] ] ] 1 => array:3 [ "nombre" => "Nayelli" "apellidos" => "Flores-García" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0002" ] ] ] 2 => array:4 [ "nombre" => "Norberto C." "apellidos" => "Chávez-Tapia" "email" => array:1 [ 0 => "nchavezt@medicasur.org.mx" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0001" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0001" ] ] ] 3 => array:4 [ "nombre" => "Naga P." "apellidos" => "Chalasani" "email" => array:1 [ 0 => "nchalasa@iu.edu" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0003" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0001" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Obesity and Digestive Disease Unit, Medica Sur Clinic and Foundation, Puente de Piedra 150, Toriello Guerra, 14050, Mexico City, Mexico" "etiqueta" => "a" "identificador" => "aff0001" ] 1 => array:3 [ "entidad" => "Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico" "etiqueta" => "b" "identificador" => "aff0002" ] 2 => array:3 [ "entidad" => "Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, United States" "etiqueta" => "c" "identificador" => "aff0003" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0001" "etiqueta" => "⁎" "correspondencia" => "Corresponding authors. E-mail addresses: nchalasa@iu.edu (N. P. Chalasani) and nchavezt@medicasur.org.mx (Norberto C. Chávez-Tapia)." ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">1</span><span class="elsevierStyleSectionTitle" id="cesectitle0004">Introduction</span><p id="para0001" class="elsevierStylePara elsevierViewall">Occult liver disease refers to the presence of unrecognized chronic liver disease and cirrhosis. Chronic liver disease is a significant cause of morbidity and mortality globally. However, data on prevalence of occult chronic liver disease is scarce.</p><p id="para0002" class="elsevierStylePara elsevierViewall">A considerable number of patients with compensated chronic liver disease are undiagnosed since most of them remain asymptomatic; therefore, they don´t receive appropriate management and follow up.</p><p id="para0003" class="elsevierStylePara elsevierViewall">Chronic liver disease can be caused by different etiologies such as excessive alcohol consumption, metabolic dysfunction associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD), chronic hepatitis B virus (HBV) infection, chronic hepatitis C virus (HCV) infection, hemochromatosis, ɑ-1 antitrypsin deficiency, Wilson's disease, autoimmune hepatitis, primary biliary cholangitis, and primary sclerosing cholangitis <a class="elsevierStyleCrossRef" href="#bib0001">[1]</a> amongst others. From here onwards, the terms NAFLD and MASLD will be used as originally published by the authors.</p></span><span id="sec0002" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">2</span><span class="elsevierStyleSectionTitle" id="cesectitle0005">Epidemiology</span><p id="para0004" class="elsevierStylePara elsevierViewall">Liver disease is currently the eleventh cause of death globally, accounting for >2 million deaths per year (cirrhosis, viral hepatitis, and liver cancer), representing 4% of all deaths in the world <a class="elsevierStyleCrossRef" href="#bib0002">[2]</a>. Cirrhosis can be categorized into compensated and decompensated. Compensated cirrhosis is usually asymptomatic and can last for several years until the development of overt clinical signs; it often goes undiagnosed <a class="elsevierStyleCrossRef" href="#bib0003">[3]</a>. In 2017, it was estimated that the global prevalence of compensated cirrhosis was 112 million <a class="elsevierStyleCrossRef" href="#bib0004">[4]</a> and of decompensated cirrhosis 10.6 million <a class="elsevierStyleCrossRef" href="#bib0005">[5]</a>.</p><p id="para0005" class="elsevierStylePara elsevierViewall">Alcohol consumption increases the risk of liver disease-related mortality 260-fold, it is also the leading cause of cirrhosis globally, accounting for approximately 60% of cases <a class="elsevierStyleCrossRef" href="#bib0002">[2]</a>. A recent meta-analysis estimated the global prevalence of NAFLD to be 32.4%, and has been steadily increasing over the last years <a class="elsevierStyleCrossRef" href="#bib0006">[6]</a>. Viral hepatitis B and C accounted for 1.3 million deaths in 2020, the highest prevalence of HBV was in Africa, the highest area of prevalence for HCV was Eastern Europe, followed by Central Asia <a class="elsevierStyleCrossRef" href="#bib0002">[2]</a>.</p><p id="para0006" class="elsevierStylePara elsevierViewall">There are approximately 626 million people in Latin America. Nonetheless, epidemiological data on the prevalence and mortality of cirrhosis is very limited <a class="elsevierStyleCrossRef" href="#bib0007">[7]</a>. A multinational study including 20 countries in Latin America estimated that the mortality rate of cirrhosis was 19.9 per 100,000 habitants <a class="elsevierStyleCrossRef" href="#bib0008">[8]</a>. Cirrhosis and liver cancer combined account for 3.5% of all deaths globally; noteworthy, since 1990, deaths from cirrhosis have been steadily increasing from 1.9% (1.8-2%) to 2.4% (2.3-2.6%) in 2017 <a class="elsevierStyleCrossRef" href="#bib0005">[5]</a>.</p></span><span id="sec0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">3</span><span class="elsevierStyleSectionTitle" id="cesectitle0006">Detection of occult liver disease</span><p id="para0007" class="elsevierStylePara elsevierViewall">Several studies have been conducted using different surrogate markers to identify populations at risk of chronic liver disease and to estimate the prevalence of occult liver disease. A study in Sweden, including asymptomatic patients with increased liver enzymes for at least six months, found that 52.6% had chronic liver disease of different etiologies, such as viral hepatitis, autoimmune disease, hereditary disorders, and metabolic disease <a class="elsevierStyleCrossRef" href="#bib0009">[9]</a>.</p><p id="para0008" class="elsevierStylePara elsevierViewall">A large study conducted in Italy found that 21.3% of subjects were not previously diagnosed. However, they finally were considered to have occult chronic liver disease, and specially found occult cirrhosis in 1.3% of the population using thrombocytopenia as a surrogate marker <a class="elsevierStyleCrossRef" href="#bib0010">[10]</a>. A study including patients referred for bone marrow biopsy found that 51% of patients with normal bone marrow had cirrhosis, compared to 3% of patients with abnormal bone marrow results; the most common causes were non-alcoholic steatohepatitis, excessive alcohol consumption, and HCV infection <a class="elsevierStyleCrossRef" href="#bib0011">[11]</a>.</p><p id="para0009" class="elsevierStylePara elsevierViewall">Occult cirrhosis also occurs in the elderly; a study found that the prevalence of undiagnosed cirrhosis in a series of autopsies in a geriatric hospital in Tokyo was 1.12%, and HCV infection was the leading etiology of cirrhosis <a class="elsevierStyleCrossRef" href="#bib0012">[12]</a>.</p><p id="para0010" class="elsevierStylePara elsevierViewall">A single-center retrospective cohort study including patients with compensated chronic liver disease who underwent transient elastography (TE) found a prevalence of 37% of occult cirrhosis <a class="elsevierStyleCrossRef" href="#bib0013">[13]</a>. Another study in the United Kingdom performed TE in patients with risk factors for chronic liver disease (excessive alcohol consumption and/or type 2 diabetes) found a prevalence of cirrhosis of 2.9% <a class="elsevierStyleCrossRef" href="#bib0014">[14]</a>.</p><p id="para0011" class="elsevierStylePara elsevierViewall">A study in France used TE as a tool for screening occult cirrhosis in the general population; this study included 1190 healthy subjects > 45 years attending for a medical check-up and found that 7.5% had > 8 kPa, of which 10.1% had occult cirrhosis, the most frequent cause was NAFLD <a class="elsevierStyleCrossRef" href="#bib0015">[15]</a>. To the best of our knowledge, there is no data on the prevalence of occult cirrhosis in Latin America.</p></span><span id="sec0004" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">4</span><span class="elsevierStyleSectionTitle" id="cesectitle0007">Occult hepatitis B infection</span><p id="para0012" class="elsevierStylePara elsevierViewall">Occult HBV infection (OBI) is defined by the presence of detectable HBV DNA by PCR in the serum or the liver of a patient who is otherwise negative for HBV surface antigen; it was first described in the late 1970s [<a class="elsevierStyleCrossRef" href="#bib0016">16</a>,<a class="elsevierStyleCrossRef" href="#bib0017">17</a>]. OBI can be categorized as seropositive OBI (HBV core antibody and/or HBV surface antibody positive) or seronegative OBI (HBV core antibody and HBV surface antibody negative) <a class="elsevierStyleCrossRef" href="#bib0018">[18]</a>. In Latin America, HBV prevalence ranges from 7 to 12 million people infected; the most frequent genotypes are F and H <a class="elsevierStyleCrossRef" href="#bib0019">[19]</a>.</p><p id="para0013" class="elsevierStylePara elsevierViewall">A systematic review and meta-analysis found that the prevalence of OBI in blood donors in low-endemicity countries was 0.06% (95% CI 0.00-0.26%), 0.12% (95% CI 0.04-0.23%) in intermediate-endemicity countries, and 0.98% (95% CI 0.44-1.72 %) in countries with high-endemicity <a class="elsevierStyleCrossRef" href="#bib0020">[20]</a>. This study also estimated the prevalence in high-risk groups; in low-endemicity countries, it was 5.5% (95% CI 2.9-8.7), 5.2% (95% CI 2.5-8.6%) in intermediate-endemicity countries, and 12.0% (95% CI 3.4-24.7%) in countries with high-endemicity countries (I<span class="elsevierStyleSup">2</span>=95.2%; p=0.41) <a class="elsevierStyleCrossRef" href="#bib0020">[20]</a>, they did not perform regional analysis.</p><p id="para0014" class="elsevierStylePara elsevierViewall">A study in Mexico evaluated the presence of OBI in blood donors and found a prevalence of 6.4%; genotype H was detected in 66.7% of the samples with detectable HBV DNA <a class="elsevierStyleCrossRef" href="#bib0021">[21]</a>. There is a residual risk of HBV transfusion-transmission in blood donors with OBI; factors associated with an increased risk are the volume of plasma transfused and the anti-HBV immune status of the donor and recipient; residual transmission risk has been estimated to be 3-14% <a class="elsevierStyleCrossRef" href="#bib0022">[22]</a>.</p><p id="para0015" class="elsevierStylePara elsevierViewall">Patients with human immunodeficiency virus (HIV) infection are considered at high risk of being coinfected with HBV. A study in Mexico, including patients with HIV, found that 18.4% had OBI <a class="elsevierStyleCrossRef" href="#bib0023">[23]</a>. A more recent study in Mexico found a prevalence of 36% of OBI among HIV-positive patients; all the sequences corresponded to the H genotype <a class="elsevierStyleCrossRef" href="#bib0024">[24]</a>. Another study in Africa among HIV-positive patients found a prevalence of OBI of 11.2% <a class="elsevierStyleCrossRef" href="#bib0025">[25]</a>. These studies emphasize the importance of evaluating high-risk populations for OBI.</p><p id="para0016" class="elsevierStylePara elsevierViewall">A study in China evaluated the prevalence of OBI in patients with autoimmune hepatitis and found that 23.3% of the patients had OBI with positive HBV-DNA and negative HBV surface antigen; genotype C was the most frequent (57.89%) <a class="elsevierStyleCrossRef" href="#bib0026">[26]</a>. This study highlights the importance of looking for occult viral diseases in patients receiving immunosuppressive therapy, especially in the endemic areas.</p><p id="para0017" class="elsevierStylePara elsevierViewall">Although the association between OBI and hepatocellular carcinoma has been controversial, a meta-analysis found that OBI significantly increases the risk of hepatocellular carcinoma when compared with non-infected subjects in retrospective (OR 6.08; 95% CI 3.45-10.72), and prospective studies (RR 2.86; 95% CI 1.59-4.13) <a class="elsevierStyleCrossRef" href="#bib0027">[27]</a>.</p><p id="para0018" class="elsevierStylePara elsevierViewall">A study in Japan including patients with hepatocellular carcinoma found that OBI was detected in 38% of patients with cryptogenic cirrhosis and 25.6% of patients with chronic HCV infection; fewer patients with OBI had high inflammatory activity, suggesting other factors involved in the development of hepatocellular carcinoma associated with OBI <a class="elsevierStyleCrossRef" href="#bib0028">[28]</a>.</p></span><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">5</span><span class="elsevierStyleSectionTitle" id="cesectitle0008">Occult hepatitis C virus infection</span><p id="para0019" class="elsevierStylePara elsevierViewall">Occult HCV infection (OCI) was first described in 2004, and it is defined by the presence of HCV RNA in the hepatocytes or peripheral blood mononuclear cells (PBMCs) with no detectable HCV RNA in the serum; there are two types: seronegative (anti-HCV antibody negative and serum HCV RNA negative) and, seropositive (anti-HCV antibody positive and serum HCV RNA-negative) [<a class="elsevierStyleCrossRef" href="#bib0016">16</a>,<a class="elsevierStyleCrossRef" href="#bib0029">29</a>].</p><p id="para0020" class="elsevierStylePara elsevierViewall">A study in China evaluated blood donors who were seronegative for HCV and found a prevalence of 2.2% of positive HCV RNA when tested in PBMC; all the patients had mild elevations in alanine aminotransferase <a class="elsevierStyleCrossRef" href="#bib0030">[30]</a>. In Mexico, another study was conducted using randomly selected blood donors considered eligible by the local norms; the prevalence of OCI was 3.4%; they found that homosexual relationships (OR 5.52; 95% CI 1.53-10.92; p < 0.05), and the use of acupuncture (OR 3.56; 95% CI 1.41-9.98; <span class="elsevierStyleItalic">p</span> < 0.05) were risk factors associated with OCI <a class="elsevierStyleCrossRef" href="#bib0031">[31]</a>.</p><p id="para0021" class="elsevierStylePara elsevierViewall">Populations at high risk of infection by HCV have been the focus of several studies to determine the prevalence of OCI. A study conducted in Iran demonstrated a prevalence of 3% of OCI in patients undergoing chronic hemodialysis <a class="elsevierStyleCrossRef" href="#bib0032">[32]</a>. A study including patients with HIV in Georgia found that OCI was detected in 2% of patients without evidence of liver disease, 12% of patients with cryptogenic liver disease, and 31% of patients with HIV/HBV co-infection; liver fibrosis was more frequent and with higher scores in patients with OCI compared with patients without OCI <a class="elsevierStyleCrossRef" href="#bib0033">[33]</a>.</p><p id="para0022" class="elsevierStylePara elsevierViewall">It is crucial to consider relatives of patients with chronic HCV infection for screening for OCI. A study including family members of patients with HCV infection found that 6.36% had OCI <a class="elsevierStyleCrossRef" href="#bib0034">[34]</a>. The presence of OCI has been assessed in the general population; a small study in Italy included healthy subjects who tested negative for HCV antibodies, and 3.3% were positive for HCV-RNA in PBMCs <a class="elsevierStyleCrossRef" href="#bib0035">[35]</a>.</p><p id="para0023" class="elsevierStylePara elsevierViewall">A systematic review and meta-analysis in a population of the Middle East and Eastern Mediterranean countries estimated the overall prevalence rate of OCI to be 10.04% (95% CI; 7.66-13.05%); the higher rates were assessed in patients with other chronic liver diseases (12.04%, 95% CI 5.87-23.1%), and in multi-transfused patients (8.71%; 95% CI 6.05-12.39%) <a class="elsevierStyleCrossRef" href="#bib0036">[36]</a>.</p><p id="para0024" class="elsevierStylePara elsevierViewall">A recent meta-analysis estimated the global prevalence of OCI; the pooled prevalence of seronegative OCI was estimated to be 9.6% (95% CI 6.8-12.7%, I<span class="elsevierStyleSup">2</span>= 94.7%; 95% CI 93.8-95.4%; <span class="elsevierStyleItalic">p</span> < 0.0001), the pooled prevalence of seropositive OCI was estimated to be 13.3% (95% CI 7.8-19.9%, I<span class="elsevierStyleSup">2</span>= 93.0%; 95% CI 90.8-94.7%; <span class="elsevierStyleItalic">p</span> < 0.0001) <a class="elsevierStyleCrossRef" href="#bib0037">[37]</a>.</p></span><span id="sec0006" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">6</span><span class="elsevierStyleSectionTitle" id="cesectitle0009">Liver fibrosis in HIV carriers</span><p id="para0025" class="elsevierStylePara elsevierViewall">As mentioned above, subjects positive for HIV are at an increased risk of OBI and OCI. A study found that HIV co-infection in patients with chronic HBV or HCV infection was a risk factor for occult cirrhosis (OR 3.53; 95% CI 1.85-6.76) <a class="elsevierStyleCrossRef" href="#bib0013">[13]</a>.</p><p id="para0026" class="elsevierStylePara elsevierViewall">Additionally, it has been reported that patients with HIV have a high prevalence of NAFLD, estimated between 13 and 55% in the ART era; the estimated prevalence is higher in patients with HIV/HCV co-infection (23 to 72%). <a class="elsevierStyleCrossRef" href="#bib0038">[38]</a></p><p id="para0027" class="elsevierStylePara elsevierViewall">One study performed TE in patients infected with HIV (51% were coinfected with HCV), 2.7% had occult cirrhosis, defined as preclinical compensated cirrhosis without any clinical findings, and 10.7% had overt undiagnosed cirrhosis. Moreover, the presence of occult cirrhosis increased the risk of liver-related events in these patients (aHR 7.1; 95% CI, 1.3-38.0) <a class="elsevierStyleCrossRef" href="#bib0039">[39]</a>.</p></span><span id="sec0007" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">7</span><span class="elsevierStyleSectionTitle" id="cesectitle0010">Unsuspected liver fibrosis in alcohol consumers</span><p id="para0028" class="elsevierStylePara elsevierViewall">Excessive alcohol consumption is the leading cause of cirrhosis in Argentina, Brazil, Chile, Mexico, and Peru <a class="elsevierStyleCrossRef" href="#bib0007">[7]</a>. In 2017, the estimated number of deaths from alcohol liver disease in Latin America was 54,000 <a class="elsevierStyleCrossRef" href="#bib0040">[40]</a>; alcohol abuse is the leading cause of cirrhosis (60%) in the region <a class="elsevierStyleCrossRef" href="#bib0007">[7]</a>. In 2016.</p><p id="para0029" class="elsevierStylePara elsevierViewall">In Latin America, the estimated consumption of alcohol per capita was 6.84 L of pure alcohol <a class="elsevierStyleCrossRef" href="#bib0008">[8]</a>, and alcohol-attributable fractions for all-cause disability-adjusted life years were 6.7% and 5.5% for all-cause deaths in 2016 <a class="elsevierStyleCrossRef" href="#bib0041">[41]</a>. A prospective study in the United Kingdom included patients with alcohol use disorder, excluding patients with known liver disease; 29% were categorized to have advanced fibrosis using liver fibrosis test, ELF ≥ 10.5 <a class="elsevierStyleCrossRef" href="#bib0042">[42]</a>.</p></span><span id="sec0008" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">8</span><span class="elsevierStyleSectionTitle" id="cesectitle0011">Liver fibrosis in patients with metabolic diseases</span><p id="para0030" class="elsevierStylePara elsevierViewall">In 2021 the global prevalence of diabetes was estimated to be 6.1% (5.8-6.5%), type 2 diabetes mellitus accounts for 96% (95.1-96.8%) of the cases, the age-standardized disability-adjusted life-years rate in 2021 in Latina America was 1446.1 (1240.9-1673.7) per 100,000, the highest globally, with a prevalence increase for the region of >100% from 1990 to 2021; it was estimated that by 2050 the global prevalence of diabetes will be >10% <a class="elsevierStyleCrossRef" href="#bib0043">[43]</a>.</p><p id="para0031" class="elsevierStylePara elsevierViewall">From 1980 to 2013, the proportion of adults with a body-mass index ≥ 25 kg/m2 increased from 28.8% (95% UI 28.4-29.3) to 36.9% (95% UI 36.3-37.4) in men and from 29.8% (95% UI 29.3-30.2) to 38.0% (95% UI 37.5-38.5) in women, Latin America has one of the highest prevalence globally <a class="elsevierStyleCrossRef" href="#bib0044">[44]</a>.</p><p id="para0032" class="elsevierStylePara elsevierViewall">A study in the United Kingdom found that the prevalence of occult cirrhosis is increased in patients with obesity and type 2 diabetes mellitus (OR 9.4; 95% CI 2.2-40.9) <a class="elsevierStyleCrossRef" href="#bib0014">[14]</a>. A study in Italy calculated the Fibrosis-4 index in a database of patients with type 2 diabetes and found a prevalence of advanced fibrosis of 24%, of which only 19% had been previously diagnosed with cirrhosis <a class="elsevierStyleCrossRef" href="#bib0045">[45]</a>.</p><p id="para0033" class="elsevierStylePara elsevierViewall">Patients with type 1 diabetes mellitus are also at increased risk of occult cirrhosis. A study that included patients with type 1 diabetes who underwent liver biopsy found that cirrhosis was diagnosed in 24.6% of patients, with an increased risk when comparing patients ≤ 55 years to the general population (OR 1.87; 95% CI 0.93-3.57) <a class="elsevierStyleCrossRef" href="#bib0046">[46]</a>.</p><p id="para0034" class="elsevierStylePara elsevierViewall">Another study estimated the proportion of candidates for bariatric surgery with liver fibrosis evaluated by transient elastography, 23.1% (95% CI 17.8-29.3%) had ≥ 9.5 kPa, body mass index was an independent predictor of elevated liver stiffness (OR 1.14; 95% CI 1.07-1.21; <span class="elsevierStyleItalic">p</span> < 0.01) <a class="elsevierStyleCrossRef" href="#bib0047">[47]</a>.</p><p id="para0035" class="elsevierStylePara elsevierViewall">Patients with NAFLD are at high risk of presenting liver fibrosis and progression to cirrhosis. The estimated global prevalence of NAFLD is 25%, although data from Latin America is scarce; the estimated prevalence in Latin America is estimated to be ∼30.45% (95% CI 22.74-39.4%), one of the highest globally <a class="elsevierStyleCrossRef" href="#bib0048">[48]</a>.</p></span><span id="sec0009" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">9</span><span class="elsevierStyleSectionTitle" id="cesectitle0012">Future perspectives</span><p id="para0036" class="elsevierStylePara elsevierViewall">There is little data on the prevalence of occult cirrhosis and occult liver disease globally. To the best of our knowledge, there is no data on the prevalence of occult cirrhosis in Latin America. Efforts should be made to assess the prevalence since Latin America is a region with one of the highest rates of metabolic diseases and excessive alcohol consumption.</p><p id="para0037" class="elsevierStylePara elsevierViewall">Screening for NAFLD in high-risk subjects and screening for excessive drinking and alcohol use disorders at every level of medical care is relevant. Patients with persistent thrombocytopenia without hematologic disease should be screened for occult liver disease.</p><p id="para0038" class="elsevierStylePara elsevierViewall">Efforts should also focus on the early treatment of occult liver disease to try to reduce liver disease burden and, in the case of occult viral hepatitis infection, prevent further spreading.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0013">Funding</span><p id="para0039" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Fundación Clínica Médica Sur</span> funded this research.</p></span><span id="sec0011" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0014">Author contributions</span><p id="para0040" class="elsevierStylePara elsevierViewall">Paulina Vidal-Cevallos: conceptualization, writing original draft, writing review and editing. Nayeli Flores-García: conceptualization, supervision, writing review and editing. Norberto Chávez-Tapia: Corresponding author, conceptualization, funding acquisition, supervision, writing review and editing. Naga Chalasani: Corresponding author, conceptualization, supervision, writing review and editing.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:15 [ 0 => array:3 [ "identificador" => "xres2136353" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abss0001" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1814144" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xpalclavsec1814145" "titulo" => "Abbreviations" ] 3 => array:2 [ "identificador" => "sec0001" "titulo" => "Introduction" ] 4 => array:2 [ "identificador" => "sec0002" "titulo" => "Epidemiology" ] 5 => array:2 [ "identificador" => "sec0003" "titulo" => "Detection of occult liver disease" ] 6 => array:2 [ "identificador" => "sec0004" "titulo" => "Occult hepatitis B infection" ] 7 => array:2 [ "identificador" => "sec0005" "titulo" => "Occult hepatitis C virus infection" ] 8 => array:2 [ "identificador" => "sec0006" "titulo" => "Liver fibrosis in HIV carriers" ] 9 => array:2 [ "identificador" => "sec0007" "titulo" => "Unsuspected liver fibrosis in alcohol consumers" ] 10 => array:2 [ "identificador" => "sec0008" "titulo" => "Liver fibrosis in patients with metabolic diseases" ] 11 => array:2 [ "identificador" => "sec0009" "titulo" => "Future perspectives" ] 12 => array:2 [ "identificador" => "sec0010" "titulo" => "Funding" ] 13 => array:2 [ "identificador" => "sec0011" "titulo" => "Author contributions" ] 14 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2023-12-18" "fechaAceptado" => "2024-01-04" "PalabrasClave" => array:1 [ "en" => array:2 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1814144" "palabras" => array:6 [ 0 => "Latin America" 1 => "Viral hepatitis" 2 => "Non-alcoholic fatty liver disease" 3 => "Alcoholic liver disease" 4 => "Cirrhosis" 5 => "Epidemiology" ] ] 1 => array:4 [ "clase" => "abr" "titulo" => "Abbreviations" "identificador" => "xpalclavsec1814145" "palabras" => array:8 [ 0 => "chronic hepatitis B virus" 1 => "chronic hepatitis C virus" 2 => "immunodeficiency virus" 3 => "Non-alcoholic fatty liver disease" 4 => "Occult HBV infection" 5 => "Occult HCV infection" 6 => "peripheral blood mononuclear cells" 7 => "transient elastography" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abss0001" class="elsevierStyleSection elsevierViewall"><p id="spara001" class="elsevierStyleSimplePara elsevierViewall">Occult liver disease refers to the presence of unrecognized chronic liver disease and cirrhosis. Liver disease is currently the eleventh cause of death globally, representing 4% of all deaths in the world. Alcohol consumption is the leading cause of cirrhosis globally, accounting for approximately 60% of cases. The estimated global prevalence of non-alcoholic fatty liver disease (NAFLD) is 32.4% and has been steadily increasing over the last years. Viral hepatitis B and C accounted for 1.3 million deaths in 2020.</p><p id="spara002" class="elsevierStyleSimplePara elsevierViewall">Several studies in populations at high risk of chronic liver disease (elevated liver enzymes, type 2 diabetes, excessive alcohol consumption) have found an elevated prevalence of occult liver disease. Attempts should be made to assess the prevalence of occult liver disease in Latin America, a region with one of the highest rates of metabolic diseases and excessive alcohol consumption.</p><p id="spara003" class="elsevierStyleSimplePara elsevierViewall">Screening for NAFLD in high-risk subjects and screening for excessive drinking and alcohol use disorders at every level of medical care is relevant. Efforts should also focus on the early treatment of occult liver disease to try to reduce liver disease burden and, in the case of occult viral hepatitis infection, prevent further spreading.</p></span>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "cebibsec1" "bibliografiaReferencia" => array:48 [ 0 => array:3 [ "identificador" => "bib0001" "etiqueta" => "[1]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Liver cirrhosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "P. Ginès" 1 => "A. Krag" 2 => "J.G. Abraldes" 3 => "E. Solà" 4 => "N. Fabrellas" 5 => "PS. Kamath" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(21)01374-X" "Revista" => array:7 [ "tituloSerie" => "Lancet" "fecha" => "2021" "volumen" => "398" "numero" => "10308" "paginaInicial" => "1359" "paginaFinal" => "1376" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34543610" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0002" "etiqueta" => "[2]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Global burden of liver disease: 2023 update" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "H. Devarbhavi" 1 => "S.K. Asrani" 2 => "J.P. Arab" 3 => "Y.A. Nartey" 4 => "E. Pose" 5 => "PS. Kamath" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jhep.2023.03.017" "Revista" => array:7 [ "tituloSerie" => "J Hepatol" "fecha" => "2023" "volumen" => "79" "numero" => "2" "paginaInicial" => "516" "paginaFinal" => "537" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/36990226" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0003" "etiqueta" => "[3]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "EASL clinical practice guidelines for the management of patients with decompensated cirrhosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Angeli" 1 => "M. Bernardi" 2 => "C. Villanueva" 3 => "C. Francoz" 4 => "R.P. Mookerjee" 5 => "J. Trebicka" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jhep.2018.03.024" "Revista" => array:7 [ "tituloSerie" => "J Hepatol" "fecha" => "2018" "volumen" => "69" "numero" => "2" "paginaInicial" => "406" "paginaFinal" => "460" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29653741" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0004" "etiqueta" => "[4]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.L. James" 1 => "D. Abate" 2 => "K.H. Abate" 3 => "S.M. Abay" 4 => "C. Abbafati" 5 => "N. Abbasi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(18)32279-7" "Revista" => array:7 [ "tituloSerie" => "Lancet" "fecha" => "2018" "volumen" => "392" "numero" => "10159" "paginaInicial" => "1789" "paginaFinal" => "1858" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30496104" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0005" "etiqueta" => "[5]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Burden of liver diseases in the world" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S.K. Asrani" 1 => "H. Devarbhavi" 2 => "J. Eaton" 3 => "PS. Kamath" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jhep.2018.09.014" "Revista" => array:6 [ "tituloSerie" => "J Hepatol" "fecha" => "2019" "volumen" => "70" "numero" => "1" "paginaInicial" => "151" "paginaFinal" => "171" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0006" "etiqueta" => "[6]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The prevalence and incidence of NAFLD worldwide: a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K. Riazi" 1 => "H. Azhari" 2 => "J.H. Charette" 3 => "F.E. Underwood" 4 => "J.A. King" 5 => "E.E. Afshar" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S2468-1253(22)00165-0" "Revista" => array:7 [ "tituloSerie" => "lancet Gastroenterol Hepatol" "fecha" => "2022" "volumen" => "7" "numero" => "9" "paginaInicial" => "851" "paginaFinal" => "861" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35798021" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0007" "etiqueta" => "[7]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Liver diseases in latin America: Current Status, unmet needs, and opportunities for improvement" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "L.A. Díaz" 1 => "G. Ayares" 2 => "J. Arnold" 3 => "F. Idalsoaga" 4 => "O. Corsi" 5 => "M. Arrese" 6 => "JP. Arab" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11938-022-00382-1" "Revista" => array:7 [ "tituloSerie" => "Curr Treat Options Gastroenterol" "fecha" => "2022" "volumen" => "20" "numero" => "3" "paginaInicial" => "261" "paginaFinal" => "278" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35729970" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0008" "etiqueta" => "[8]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impact of public health policies on alcohol-associated liver disease in latin America: an ecological multinational study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L.A. Díaz" 1 => "F. Idalsoaga" 2 => "E. Fuentes-López" 3 => "A. Márquez-Lomas" 4 => "C.A. Ramírez" 5 => "J.P. Roblero" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/hep.32016" "Revista" => array:7 [ "tituloSerie" => "Hepatology" "fecha" => "2021" "volumen" => "74" "numero" => "5" "paginaInicial" => "2478" "paginaFinal" => "2490" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34134172" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0009" "etiqueta" => "[9]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The clinical significance of slightly to moderately increased liver transaminase values in asymptomatic patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "U.L. Mathiesen" 1 => "L.E. Franzén" 2 => "A. Frydén" 3 => "U. Foberg" 4 => "G. Bodemar" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1080/00365529950172880" "Revista" => array:7 [ "tituloSerie" => "Scand J Gastroenterol" "fecha" => "1999" "volumen" => "34" "numero" => "1" "paginaInicial" => "85" "paginaFinal" => "91" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10048738" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0010" "etiqueta" => "[10]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Occult liver disease burden: Analysis from a large general practitioners’ database" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. Martini" 1 => "E. Ceranto" 2 => "A. Gatta" 3 => "P. Angeli" 4 => "P. Pontisso" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/2050640617696402" "Revista" => array:6 [ "tituloSerie" => "United Eur Gastroenterol J" "fecha" => "2017" "volumen" => "5" "numero" => "7" "paginaInicial" => "982" "paginaFinal" => "986" ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0011" "etiqueta" => "[11]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of cirrhosis in patients with thrombocytopenia who receive bone marrow biopsy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.Y. Sheikh" 1 => "R. Raoufi" 2 => "P.R. Atla" 3 => "M. Riaz" 4 => "C. Oberer" 5 => "MJ. Moffett" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4103/1319-3767.98431" "Revista" => array:7 [ "tituloSerie" => "Saudi J Gastroenterol" "fecha" => "2012" "volumen" => "18" "numero" => "4" "paginaInicial" => "257" "paginaFinal" => "262" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22824769" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0012" "etiqueta" => "[12]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Undiagnosed cirrhosis occurs frequently in the elderly and requires periodic follow ups and medical treatments" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "K. Fujimoto" 1 => "M. Sawabe" 2 => "M. Sasaki" 3 => "K. Kino" 4 => "T. Arai" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1447-0594.2008.00470.x" "Revista" => array:7 [ "tituloSerie" => "Geriatr Gerontol Int" "fecha" => "2008" "volumen" => "8" "numero" => "3" "paginaInicial" => "198" "paginaFinal" => "203" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18822004" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0013" "etiqueta" => "[13]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Occult cirrhosis diagnosed by transient elastography is a frequent and under-monitored clinical entity" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T. Chen" 1 => "R. Wong" 2 => "P. Wong" 3 => "K.C. Rollet-Kurhajec" 4 => "R. Alshaalan" 5 => "M. Deschenes" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/liv.12802" "Revista" => array:7 [ "tituloSerie" => "Liver Int" "fecha" => "2015" "volumen" => "35" "numero" => "10" "paginaInicial" => "2285" "paginaFinal" => "2293" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25676459" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0014" "etiqueta" => "[14]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Obesity and type 2 diabetes are important risk factors underlying previously undiagnosed cirrhosis in general practice: a cross-sectional study using transient elastography" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D.J. Harman" 1 => "S.D. Ryder" 2 => "M.W. James" 3 => "E.A. Wilkes" 4 => "T.R. Card" 5 => "G.P. Aithal" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/apt.14463" "Revista" => array:7 [ "tituloSerie" => "Aliment Pharmacol Ther" "fecha" => "2018" "volumen" => "47" "numero" => "4" "paginaInicial" => "504" "paginaFinal" => "515" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29210096" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0015" "etiqueta" => "[15]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transient elastography as a screening tool for liver fibrosis and cirrhosis in a community-based population aged over 45 years" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. Roulot" 1 => "J.L. Costes" 2 => "J.F. Buyck" 3 => "U. Warzocha" 4 => "N. Gambier" 5 => "S. Czernichow" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/gut.2010.221382" "Revista" => array:7 [ "tituloSerie" => "Gut" "fecha" => "2011" "volumen" => "60" "numero" => "7" "paginaInicial" => "977" "paginaFinal" => "984" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21068129" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0016" "etiqueta" => "[16]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Occult Hepatitis C Virus Infection: A Review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Austria" 1 => "GY. Wu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.14218/JCTH.2017.00053" "Revista" => array:6 [ "tituloSerie" => "J Clin Transl Hepatol" "fecha" => "2018" "volumen" => "6" "numero" => "2" "paginaInicial" => "155" "paginaFinal" => "160" ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0017" "etiqueta" => "[17]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Occult hepatitis B infection and hepatocellular carcinoma: Epidemiology, virology, hepatocarcinogenesis and clinical significance" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "L.-Y. Mak" 1 => "D.K.-H. Wong" 2 => "T. Pollicino" 3 => "G. Raimondo" 4 => "F.B. Hollinger" 5 => "M-F. Yuen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jhep.2020.05.042" "Revista" => array:7 [ "tituloSerie" => "J Hepatol" "fecha" => "2020" "volumen" => "73" "numero" => "4" "paginaInicial" => "952" "paginaFinal" => "964" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32504662" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0018" "etiqueta" => "[18]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Update of the statements on biology and clinical impact of occult hepatitis B virus infection" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Raimondo" 1 => "S. Locarnini" 2 => "T. Pollicino" 3 => "M. Levrero" 4 => "F. Zoulim" 5 => "A.S. Lok" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jhep.2019.03.034" "Revista" => array:7 [ "tituloSerie" => "J Hepatol" "fecha" => "2019" "volumen" => "71" "numero" => "2" "paginaInicial" => "397" "paginaFinal" => "408" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31004683" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0019" "etiqueta" => "[19]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hepatitis B virus infection in Latin America: A genomic medicine approach" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "S. Roman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3748/wjg.v20.i23.7181" "Revista" => array:6 [ "tituloSerie" => "World J Gastroenterol" "fecha" => "2014" "volumen" => "20" "numero" => "23" "paginaInicial" => "7181" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24966588" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0020" "etiqueta" => "[20]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of occult hepatitis B virus infection in adults: a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Y.R. Im" 1 => "R. Jagdish" 2 => "D. Leith" 3 => "J.U. Kim" 4 => "K. Yoshida" 5 => "A. Majid" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S2468-1253(22)00201-1" "Revista" => array:6 [ "tituloSerie" => "lancet Gastroenterol Hepatol" "fecha" => "2022" "volumen" => "7" "numero" => "10" "paginaInicial" => "932" "paginaFinal" => "942" ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0021" "etiqueta" => "[21]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Molecular and serological characterization of occult hepatitis B infection in blood donors from Mexico" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "B.M. García-Montalvo" 1 => "LP. Ventura-Zapata" ] ] ] ] ] "host" => array:2 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Hepatol" "fecha" => "2011" "volumen" => "10" "numero" => "2" "paginaInicial" => "133" "paginaFinal" => "141" ] ] 1 => array:1 [ "WWW" => array:1 [ "link" => "http://www.ncbi.nlm.nih.gov/pubmed/21502674" ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0022" "etiqueta" => "[22]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Occult hepatitis B infection and transfusion-transmission risk" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D. Candotti" 1 => "L. Boizeau" 2 => "S. Laperche" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.tracli.2017.06.014" "Revista" => array:7 [ "tituloSerie" => "Transfus Clin Biol" "fecha" => "2017" "volumen" => "24" "numero" => "3" "paginaInicial" => "189" "paginaFinal" => "195" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28673499" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0023" "etiqueta" => "[23]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Occult hepatitis B in Mexican patients with HIV, an analysis using nested polymerase chain reaction" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Torres-Baranda" 1 => "B.E. Bastidas-Ramírez" 2 => "M. Maldonado-González" 3 => "L.V. Sánchez-Orozco" 4 => "E. Vázquez-Vals" 5 => "E. Rodríguez-Noriega" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S1665-2681(19)32037-X" "Revista" => array:7 [ "tituloSerie" => "Ann Hepatol" "fecha" => "2006" "volumen" => "5" "numero" => "1" "paginaInicial" => "34" "paginaFinal" => "40" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16531963" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0024" "etiqueta" => "[24]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Identification of mutations in the S gene of hepatitis B virus in HIV positive Mexican patients with occult hepatitis B virus infection" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K. Enriquez-Navarro" 1 => "A. Maldonado-Rodriguez" 2 => "O. Rojas-Montes" 3 => "R. Torres-Ibarra" 4 => "L. Bucio-Ortiz" 5 => "M.A. De la Cruz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.aohep.2020.06.002" "Revista" => array:7 [ "tituloSerie" => "Ann Hepatol" "fecha" => "2020" "volumen" => "19" "numero" => "5" "paginaInicial" => "507" "paginaFinal" => "515" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32592870" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0025" "etiqueta" => "[25]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of occult hepatitis B among HIV-positive individuals in Africa: A systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "V.D. Kajogoo" 1 => "S.S. Swai" 2 => "S. Gurung" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/20503121211072748" "Revista" => array:3 [ "tituloSerie" => "SAGE open Med" "fecha" => "2022" "volumen" => "10" ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0026" "etiqueta" => "[26]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Occult HBV infection in patients with autoimmune hepatitis: A virological and clinical study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "X.X. Chen" 1 => "K.H. Xiang" 2 => "H.P. Zhang" 3 => "X.S. Kong" 4 => "C.Y. Huang" 5 => "Y.M. Liu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jmii.2019.04.009" "Revista" => array:6 [ "tituloSerie" => "J Microbiol Immunol Infect" "fecha" => "2020" "volumen" => "53" "numero" => "6" "paginaInicial" => "946" "paginaFinal" => "954" ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0027" "etiqueta" => "[27]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Association between occult hepatitis B infection and the risk of hepatocellular carcinoma: a meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "Y. Shi" 1 => "Y.H. Wu" 2 => "W. Wu" 3 => "W.J. Zhang" 4 => "J. Yang" 5 => "Z. Chen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1478-3231.2011.02481.x" "Revista" => array:7 [ "tituloSerie" => "Liver Int" "fecha" => "2012" "volumen" => "32" "numero" => "2" "paginaInicial" => "231" "paginaFinal" => "240" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21745272" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0028" "etiqueta" => "[28]" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Muto J, Sugiyama M, Shirabe K, Mukaide M, Kirikae-Muto I, Ikegami T, et al. Frequency and Characteristics of Occult Hepatitis B Infection Among Hepatocellular Carcinoma Patients in Japan. <span class="elsevierStyleItalic">Ann Hepatol</span>. 17(4):596-603.<a target="_blank" href="http://doi.org/10.5604/01.3001.0012.0927">10.5604/01.3001.0012.0927</a>" ] ] ] 28 => array:3 [ "identificador" => "bib0029" "etiqueta" => "[29]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Seronegative occult hepatitis C virus infection: clinical implications" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "V. Carreño" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jcv.2014.09.007" "Revista" => array:7 [ "tituloSerie" => "J Clin Virol" "fecha" => "2014" "volumen" => "61" "numero" => "3" "paginaInicial" => "315" "paginaFinal" => "320" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25304062" "web" => "Medline" ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0030" "etiqueta" => "[30]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of occult hepatitis c virus infection among blood donors in Jiangsu, China" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H. Lin" 1 => "X. Chen" 2 => "S. Zhu" 3 => "P. Mao" 4 => "S. Zhu" 5 => "Y. Liu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000455854" "Revista" => array:7 [ "tituloSerie" => "Intervirology" "fecha" => "2016" "volumen" => "59" "numero" => "4" "paginaInicial" => "204" "paginaFinal" => "210" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28208127" "web" => "Medline" ] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0031" "etiqueta" => "[31]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence and risk factors of Occult Hepatitis C infections in blood donors from Mexico City" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.L. Martínez-Rodríguez" 1 => "L.A. Uribe-Noguez" 2 => "C.I. Arroyo-Anduiza" 3 => "J.A. Mata-Marin" 4 => "G. Benitez-Arvizu" 5 => "M.L. Portillo-López" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1371/journal.pone.0205659" "Revista" => array:4 [ "tituloSerie" => "PLoS One" "fecha" => "2018" "volumen" => "13" "numero" => "10" ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0032" "etiqueta" => "[32]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Occult hepatitis c infection among hemodialysis patients: a prevalence study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Naghdi" 1 => "M. Ranjbar" 2 => "F. Bokharaei-Salim" 3 => "H. Keyvani" 4 => "S. Savaj" 5 => "S. Ossareh" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5604/01.3001.0010.0277" "Revista" => array:7 [ "tituloSerie" => "Ann Hepatol" "fecha" => "2017" "volumen" => "16" "numero" => "4" "paginaInicial" => "510" "paginaFinal" => "513" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28611267" "web" => "Medline" ] ] ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0033" "etiqueta" => "[33]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Occurrence of occult HCV infection among Hiv infected patients in Georgia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "L. Gatserelia" 1 => "L. Sharvadze" 2 => "M. Karchava" 3 => "E. Dolmazashvili" 4 => "T. Tsertsvadze" ] ] ] ] ] "host" => array:2 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Georgian Med News" "fecha" => "2014" "numero" => "226" "paginaInicial" => "37" "paginaFinal" => "41" ] ] 1 => array:1 [ "WWW" => array:1 [ "link" => "http://www.ncbi.nlm.nih.gov/pubmed/24523330" ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0034" "etiqueta" => "[34]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hepatitis C virus infection in the family setting of patients with occult hepatitis C" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "I. Castillo" 1 => "J. Bartolomé" 2 => "J.A. Quiroga" 3 => "G. Barril" 4 => "V. Carreño" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/jmv.21483" "Revista" => array:7 [ "tituloSerie" => "J Med Virol" "fecha" => "2009" "volumen" => "81" "numero" => "7" "paginaInicial" => "1198" "paginaFinal" => "1203" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19475603" "web" => "Medline" ] ] ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib0035" "etiqueta" => "[35]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Occult HCV infection: an unexpected finding in a population unselected for hepatic disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. De Marco" 1 => "A. Gillio-Tos" 2 => "V. Fiano" 3 => "G. Ronco" 4 => "V. Krogh" 5 => "D. Palli" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1371/journal.pone.0008128" "Revista" => array:6 [ "tituloSerie" => "PLoS One" "fecha" => "2009" "volumen" => "4" "numero" => "12" "paginaInicial" => "e8128" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19956542" "web" => "Medline" ] ] ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib0036" "etiqueta" => "[36]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Occult hepatitis C virus infection in the middle east and eastern mediterranean countries: A systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.R. Hedayati-Moghaddam" 1 => "H. Soltanian" 2 => "S. Ahmadi-Ghezeldasht" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4254/wjh.v13.i2.242" "Revista" => array:7 [ "tituloSerie" => "World J Hepatol" "fecha" => "2021" "volumen" => "13" "numero" => "2" "paginaInicial" => "242" "paginaFinal" => "260" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33708353" "web" => "Medline" ] ] ] ] ] ] ] ] 36 => array:3 [ "identificador" => "bib0037" "etiqueta" => "[37]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Global prevalence of occult hepatitis C virus: A systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D.S. Mbaga" 1 => "S. Kenmoe" 2 => "J.N. Bikoï" 3 => "G.R. Takuissu" 4 => "M. Amougou-Atsama" 5 => "E.A. Okobalemba" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5662/wjm.v12.i3.179" "Revista" => array:7 [ "tituloSerie" => "World J Methodol" "fecha" => "2022" "volumen" => "12" "numero" => "3" "paginaInicial" => "179" "paginaFinal" => "190" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35721241" "web" => "Medline" ] ] ] ] ] ] ] ] 37 => array:3 [ "identificador" => "bib0038" "etiqueta" => "[38]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in patients with HIV" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "EC. Verna" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S2468-1253(16)30120-0" "Revista" => array:6 [ "tituloSerie" => "Lancet Gastroenterol Hepatol" "fecha" => "2017" "volumen" => "2" "numero" => "3" "paginaInicial" => "211" "paginaFinal" => "223" ] ] ] ] ] ] 38 => array:3 [ "identificador" => "bib0039" "etiqueta" => "[39]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Liver-related events in human immunodeficiency virus-infected persons with occult cirrhosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Benmassaoud" 1 => "R. Nitulescu" 2 => "T. Pembroke" 3 => "A.S. Halme" 4 => "P. Ghali" 5 => "M. Deschenes" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/cid/ciy1082" "Revista" => array:6 [ "tituloSerie" => "Clin Infect Dis" "fecha" => "2019" "volumen" => "69" "numero" => "8" "paginaInicial" => "1422" "paginaFinal" => "1430" ] ] ] ] ] ] 39 => array:3 [ "identificador" => "bib0040" "etiqueta" => "[40]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Global alcohol exposure between 1990 and 2017 and forecasts until 2030: a modelling study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J. Manthey" 1 => "K.D. Shield" 2 => "M. Rylett" 3 => "O.S.M. Hasan" 4 => "C. Probst" 5 => "J. Rehm" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(18)32744-2" "Revista" => array:7 [ "tituloSerie" => "Lancet" "fecha" => "2019" "volumen" => "393" "numero" => "10190" "paginaInicial" => "2493" "paginaFinal" => "2502" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31076174" "web" => "Medline" ] ] ] ] ] ] ] ] 40 => array:3 [ "identificador" => "bib0041" "etiqueta" => "[41]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Alcohol-related liver disease: Clinical practice guidelines by the Latin American association for the study of the liver (ALEH)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.P. Arab" 1 => "J.P. Roblero" 2 => "J. Altamirano" 3 => "F. Bessone" 4 => "R. Chaves Araujo" 5 => "F. Higuera-De la Tijera" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.aohep.2019.04.005" "Revista" => array:7 [ "tituloSerie" => "Ann Hepatol" "fecha" => "2019" "volumen" => "18" "numero" => "3" "paginaInicial" => "518" "paginaFinal" => "535" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31053546" "web" => "Medline" ] ] ] ] ] ] ] ] 41 => array:3 [ "identificador" => "bib0042" "etiqueta" => "[42]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Uncovering unsuspected advanced liver fibrosis in patients referred to alcohol nurse specialists using the ELF test" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Rhodes" 1 => "S. Cococcia" 2 => "J. Panovska-Griffiths" 3 => "S. Tanwar" 4 => "R.H. Westbrook" 5 => "A. Rodger" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s12876-021-01728-2" "Revista" => array:6 [ "tituloSerie" => "BMC Gastroenterol" "fecha" => "2021" "volumen" => "21" "numero" => "1" "paginaInicial" => "143" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33789586" "web" => "Medline" ] ] ] ] ] ] ] ] 42 => array:3 [ "identificador" => "bib0043" "etiqueta" => "[43]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "titulo" => "GBD 2021 diabetes collaborators. Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the global burden of disease study 2021" ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(23)01301-6" "Revista" => array:7 [ "tituloSerie" => "Lancet (London, England)" "fecha" => "2023" "volumen" => "402" "numero" => "10397" "paginaInicial" => "203" "paginaFinal" => "234" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/37356446" "web" => "Medline" ] ] ] ] ] ] ] ] 43 => array:3 [ "identificador" => "bib0044" "etiqueta" => "[44]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Ng" 1 => "T. Fleming" 2 => "M. Robinson" 3 => "B. Thomson" 4 => "N. Graetz" 5 => "C. Margono" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(14)60460-8" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2014" "volumen" => "384" "numero" => "9945" "paginaInicial" => "766" "paginaFinal" => "781" ] ] ] ] ] ] 44 => array:3 [ "identificador" => "bib0045" "etiqueta" => "[45]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hepatic fibrosis of any origin in a large population of type 2 diabetes patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C.B. Giorda" 1 => "R. Picariello" 2 => "B. Tartaglino" 3 => "E. Nada" 4 => "C. Linzalata" 5 => "F. Romeo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.numecd.2021.06.020" "Revista" => array:7 [ "tituloSerie" => "Nutr Metab Cardiovasc Dis" "fecha" => "2021" "volumen" => "31" "numero" => "10" "paginaInicial" => "2887" "paginaFinal" => "2894" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34364773" "web" => "Medline" ] ] ] ] ] ] ] ] 45 => array:3 [ "identificador" => "bib0046" "etiqueta" => "[46]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence and natural history of histologically proven chronic liver disease in a longitudinal cohort of patients with type 1 diabetes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "D.J. Harman" 1 => "P.V. Kaye" 2 => "R. Harris" 3 => "A. Suzuki" 4 => "A. Gazis" 5 => "GP. Aithal" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/hep.27098" "Revista" => array:7 [ "tituloSerie" => "Hepatology" "fecha" => "2014" "volumen" => "60" "numero" => "1" "paginaInicial" => "158" "paginaFinal" => "168" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24585431" "web" => "Medline" ] ] ] ] ] ] ] ] 46 => array:3 [ "identificador" => "bib0047" "etiqueta" => "[47]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of elevated liver stiffness among potential candidates for bariatric surgery in the united states" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S. Ciardullo" 1 => "M. Pizzi" 2 => "P. Pizzi" 3 => "A. Oltolini" 4 => "E. Muraca" 5 => "G. Perseghin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11695-021-05885-x" "Revista" => array:7 [ "tituloSerie" => "Obes Surg" "fecha" => "2022" "volumen" => "32" "numero" => "3" "paginaInicial" => "712" "paginaFinal" => "719" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34988895" "web" => "Medline" ] ] ] ] ] ] ] ] 47 => array:3 [ "identificador" => "bib0048" "etiqueta" => "[48]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Global epidemiology of nonalcoholic fatty liver disease—Meta-analytic assessment of prevalence, incidence, and outcomes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "Z.M. Younossi" 1 => "A.B. Koenig" 2 => "D. Abdelatif" 3 => "Y. Fazel" 4 => "L. Henry" 5 => "M. Wymer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/hep.28431" "Revista" => array:7 [ "tituloSerie" => "Hepatology" "fecha" => "2016" "volumen" => "64" "numero" => "1" "paginaInicial" => "73" "paginaFinal" => "84" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26707365" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/16652681/0000002900000003/v1_202404281202/S1665268124002746/v1_202404281202/en/main.assets" "Apartado" => array:4 [ "identificador" => "97350" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "HOT TOPICS IN HEPATOLOGY: A MULTINATIONAL PERSPECTIVE" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/16652681/0000002900000003/v1_202404281202/S1665268124002746/v1_202404281202/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665268124002746?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 3 | 8 |
| 2024 October | 85 | 16 | 101 |
| 2024 September | 47 | 26 | 73 |
| 2024 August | 46 | 27 | 73 |
| 2024 July | 63 | 11 | 74 |
| 2024 June | 74 | 14 | 88 |
| 2024 May | 65 | 20 | 85 |
| 2024 April | 90 | 27 | 117 |
| 2024 March | 99 | 19 | 118 |
| 2024 February | 55 | 22 | 77 |
