Browsing by Author "Díaz, Luis Antonio"

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    Comparative effectiveness of different corticosteroid regimens in severe alcohol-associated hepatitis
    (Lippincott Williams and Wilkins, 2024) Islam, Alvi Husni; Díaz, Luis Antonio; Idalsoaga Ferrer, Francisco Javier; Guizzetti, Leonardo; Mortuza, Rokhsana; Dunn, Winston; Singal, Ashwani K.; Simonetto, Douglas; Ramírez Cadiz, Carolina; Zhang, Wei; Qian, Steve; Cabezas, Joaquín; Sarin, Shiv K.; Maiwall, Rakhi; Jalal, Prasun K.; Higuera De La Tijera, Fátima; Skladany, Lubomir; Bystrianska, Natalia; Rincón, Diego; Chacko, Kristina R.; Ventura Cots, Meritxell; García Tsao, Guadalupe; Abraldes, Juan G.; Kamath, Patrick S.; Arrese Jiménez, Marco; Shah, Vijay; Bataller, Ramón; Arab Verdugo, Juan Pablo
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    Disparities in steatosis prevalence in the United States by Race or Ethnicity according to the 2023 criteria
    (2024) Díaz, Luis Antonio; Lazarus, Jeffrey V.; Fuentes López, Eduardo; Idalsoaga Ferrer, Francisco Javier; Ayares Campos, Gustavo Ignacio; Desaleng, Hailemichael; Danpanichkul, Pojsakorn; Cotter, Thomas G.; Dunn, Winston; Barrera Martínez, Francisco; Wijarnpreecha, Karn; Noureddin, Mazen; Alkhouri, Naim; Singal, Ashwani K.; Wong, Robert J.; Younossi, Zobair M.; Rinella, Mary E.; Kamath, Patrick S.; Bataller, Ramon; Loomba, Rohit; Arrese Jiménez, Marco; Arab Verdugo, Juan Pablo
    © The Author(s) 2024.Introduction: The 2023 nomenclature defined criteria for steatotic liver disease (SLD), including metabolic dysfunction-associated SLD (MASLD), alcohol-associated liver disease (ALD), and the overlapping MASLD/ALD (MetALD). We aimed to assess racial and ethnic disparities in the SLD prevalence among United States (US) adults based on this new nomenclature. Methods: We undertook a cross-sectional study employing the 2017–2018 National Health and Nutrition Examination Survey (NHANES) database. We identified SLD according to a controlled attenuation parameter ≥288 dB/m, liver stiffness ≥7.2 kPa, or elevated aminotransferase levels. Alcohol use thresholds were established according to the updated SLD definition. We estimated prevalences using the complex design of the NHANES survey. Multivariable logistic regressions with complex design weights were employed. Results: A total of 5532 individuals are included. The mean age is 45.4 years, and 50.9% are women. The adjusted estimated prevalence of MASLD is 42.4% (95% CI: 41.1–43.8%), MetALD 1.7% (95% CI: 1.3–2.0%), and ALD 0.6% (95% CI: 0.3–0.8%). Hispanics exhibit a higher prevalence of SLD, but there are no significant differences in advanced fibrosis prevalence due to SLD among racial/ethnic groups. In MASLD, men, individuals aged 40–64 and ≥65 years, Hispanics, those with health insurance, higher BMI, diabetes, hypertension, hypertriglyceridemia, and low high-density lipoprotein (HDL) cholesterol or use of lipid-lowering agents are independently associated with a higher risk, while Blacks have the lowest risk. In MetALD, men and higher BMI are independently associated with a higher risk of MetALD in adjusted multivariable analysis. In ALD, the adjusted multivariable analysis shows that only health insurance is independently associated with a lower ALD risk. Conclusions: MASLD prevalence is high in the US, especially in men, older individuals, and Hispanics. MetALD and ALD prevalence was substantial but could be underestimated.
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    Evaluación de docentes clínicos de Postgrado: desarrollo y propiedades psicométricas del instrumento MEDUC-PG14
    (2015) Pizarro Rojas, Margarita Alicia; Solís, Nancy; Rojas, Viviana; Díaz, Luis Antonio; Padilla, Oslando; Letelier Saavedra, Luz María; Aizman, Andrés; Sarfatis Feige, Alberto; Olivos, Trinidad; Soza, Alejandro; Delfino, Alejandro; Latorre, Gonzalo; Ivanovic-Zuvic, Danisa; Hoyl, Trinidad; Bitrán Carreño, Marcela; Arab Verdugo, Juan Pablo; Riquelme Pérez, Arnoldo; Pizarro, Margarita; Solís, Nancy; Rojas, Viviana; Díaz, Luis Antonio; Padilla, Oslando; Letelier Saavedra, Luz María; Aizman, Andrés; Sarfatis Feige, Alberto; Olivos, Trinidad; Soza, Alejandro; Delfino, Alejandro; Latorre, Gonzalo; Ivanovic-Zuvic, Danisa; Hoyl, Trinidad; Bitrán Carreño, Marcela; Arab Verdugo, Juan Pablo; Riquelme Pérez, Arnoldo
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    High inherited risk predicts age-associated increases in fibrosis in patients with MASLD
    (2025) Díaz, Luis Antonio; Alazawi, William; Agrawal, Saaket; Arab, Juan Pablo; Arrese, Marco; Idalsoaga, Francisco; Barreyro, Fernando Javier; Gadano, Adrián; Marciano, Sebastián; Martínez Morales, Jorge; Villela Nogueira, Cristiane; Leite, Nathalie; Alves Couto, Claudia; Theodoro, Rafael; Dias Monteiro, Mísia Joyner de Sousa; Oliveira, Claudia P.; Pessoa, Mario G.; Reis Alvares-da-Silva, Mario; Madamba, Egbert; Bettencourt, Ricki; Richards, Lisa M.; Majithia, Amit R.; Khera, Amit V.; Loomba, Rohit; Ajmera, Veeral
    Background & AimsLimited data have prevented routine genetic testing from being integrated into clinical practice in metabolic dysfunction-associated steatotic liver disease (MASLD). We aimed to quantify the effect of genetic variants on changes in fibrosis severity per decade in MASLD.MethodsThis cross-sectional study included prospectively recruited adults with MASLD aged 18–70 who underwent magnetic resonance elastography (MRE) and genotyping for PNPLA3, TM6SF2, MBOAT7, GCKR, and HSD17B13. A genetic risk score (GRS) was calculated as the sum of established risk alleles in PNPLA3 minus protective variants in HSD17B13 (0=low risk, 1=high risk). We also estimated the polygenic risk score-hepatic fat content (PRS-HFC) and the adjusted version (PRS-5). The primary endpoint was the age-related change in liver stiffness measurement (LSM) on MRE by GRS. Findings were validated using an external cohort from Latin America.ResultsAmong 570 participants, the median age was 57 [49–64] years, 56.8% were women, and 34.2% were Hispanic. Median MRE was 2.4 [2.1–3.0] kPa, and 51% had high GRS. High GRS was independently associated with increased LSM (β=0.28 kPa, 95%CI:0.12–0.44, p=0.001) per 10-year age increase, while the low GRS group showed no significant difference. Similar findings were observed using PRS-HFC and PRS-5. PNPLA3 genotype alone also predicted higher LSM (C/G: β=0.32 kPa, 95%CI:0.02–0.61, p=0.034; G/G: β=0.87 kPa, 95%CI:0.52–1.22, p<0.0001) and G/G genotype was associated with significantly higher LSM by age 44, which was consistent in the validation population.ConclusionGRS, PRS-HFC, PRS-5, and PNPLA3 genotypes alone are associated with greater fibrosis per decade, resulting in divergent disease trajectories starting in midlife. Assessing genetic risk in MASLD will identify high-risk patients who require more frequent monitoring."
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    Identification of Optimal Therapeutic window for steroid use in severe alcohol associated Hepatitis: a worldwide study
    (2021) Arab, Juan Pablo; Díaz, Luis Antonio; Baeza, Natalia; Idalsoaga, Francisco; Fuentes-López, Eduardo; Arnold, Jorge; Ramírez, Carolina A.; Morales-Arraez, Dalia; Ventura-Cots, Meritxell; Alvarado-Tapias, Edilmar; Wei Zhang; Clark, Virginia; Simonetto, Douglas; Ahn, Joseph C.; Buryska, Seth; Mehta, Tej I.; Stefanescu, Horia; Horhat, Adelina; Bumbu, Andreea; Dunn, Winston
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    Identifying aspects related to high-quality internal medicine clinical rotations based on residents’ and teachers’ perceptions : a qualitative study
    (2020) Vergara Riquelme, Claudia Francisca; Díaz, Luis Antonio; Abbott Cáceres, Eduardo Francisco; Sepúlveda Andrade, Paola; Letelier Saavedra, Luz María; Riquelme Pérez, Arnoldo; Aizman, Andrés; Pontificia Universidad Católica de Chile. Facultad de Medicina
    INTRODUCTION: Clinical rotations (CR) are the core of teaching and learning process of Internal Medicine (IM) residency programmes. Feedback about CR identifies which aspects are deficient and need improvement. However, during curricular improvement processes, difficulties prioritising these improvements emerge. AIM: To explore residents’ and clinical teachers’ perceptions about which aspects constitute a high-quality CR in an IM programme. METHODS: Qualitative methodology was used. Data were obtained from two focus groups (residents and clinical teachers, separately) and from open-ended responses collected from CR questionnaire instrument. Data were analysed with ATLAS.ti software using grounded theory methodology. RESULTS: Two focus groups and ninety-eight open-ended questions were analysed. Eight themes and thirty-two categories emerged from residents’ and clinical teachers’ perspectives: ‘Learning & Feedback’, ‘Learning assessment’, ‘Clinical Teachers: Roles & Characteristics’, ‘Scholar: Specialty Knowledge & Skills’, ‘Clinical Teaching rounds’, ‘CR Organisation’, and ‘Learning Environment’ were themes with common ground in both groups. ‘IM Programme Committee’ emerged as a theme exclusively on residents’ perspectives. CONCLUSIONS Residents’ and teachers' perspectives are central to identifying issues that help CR improvement. Both groups agree on most aspects. An IM clinical rotation framework is proposed, based on eight themes that emerged. IM Programme Committee should have an articulating role among CR to assure high-quality teaching.
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    Measuring the educational environment in ambulatory settings
    (2015) Riquelme Pérez, Arnoldo; Padilla Pérez, Oslando; Herrera Riquelme, Cristian Alberto; Olivos, Trinidad; Román, Jpsé Antonio; Sarfatis Feige, Alberto; Solís, Nancy; Pizarro Rojas, Margarita Alicia; Díaz, Luis Antonio; Torres, Patricio; Roff, Sue
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    MetALD: New Perspectives on an Old Overlooked Disease
    (WILEY, 2025) Ayares, Gustavo; Díaz, Luis Antonio; Idalsoaga, Francisco; Alkhouri, Naim; Noureddin, Mazen; Bataller, Ramon; Loomba, Rohit; Arab, Juan Pablo; Arrese, Marco
    Metabolic dysfunction-associated steatotic liver disease (MASLD) and alcohol-associated liver disease (ALD) are the major contributors to the liver disease burden globally. The rise in these conditions is linked to obesity, type 2 diabetes, metabolic syndrome and increased alcohol consumption. MASLD and ALD share risk factors, pathophysiology and histological features but differ in their thresholds for alcohol use, and the ALD definition does not require the presence of metabolic dysfunction. A recent multi-society consensus overhauled the nomenclature of liver steatosis and introduced the term MetALD to describe patients with metabolic dysfunction who drink more than those with MASLD and less than those with ALD. This new terminology aims to enhance the understanding and management of liver disease but poses challenges, such as the need to accurately measure alcohol consumption in research and clinical practice settings. Recent studies show that MetALD has significant implications for patient management, as it is associated with increased mortality risks and more severe liver outcomes compared to MASLD alone. MetALD patients face increased risks of liver disease progression, cancer and cardiovascular disease. The diagnosis of MetALD involves the adequate quantification of alcohol use through standardised questionnaires and/or biomarkers as well as proper assessment of liver disease stage and progression risk using non-invasive tools including serologic markers, imaging, elastography techniques and genetic testing. Effective management requires addressing both metabolic and alcohol-related factors to improve outcomes. This review intends to provide a comprehensive overview of MetALD, covering pathogenesis, potential diagnostic approaches, management strategies and emerging therapies.
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    Phantosmia May Predict Long‐Term Measurable Olfactory Dysfunction After COVID‐19
    (WILEY, 2022) Aliaga Durán, Rodrigo Francisco; Callejas Canepa, Claudio Andrés; Cordano Guajardo Valentina Paz; Díaz, Luis Antonio; Fuentes López, Eduardo; García Huidobro, Francisco Gustavo; García Salum, Tamara; González G, Claudia; Lagos Villaseca, Antonia Elisa; Leung Caballero, Jai-sen Francisco; Medina, Rafael A.; Palmer, James N.
    Objectives Persistent olfactory dysfunction (OD) after 6 months caused by SARS-CoV-2 infection has been reported with a variable prevalence worldwide. This study aimed to determine the prevalence of long-term OD and identify predisposing factors. Methods
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    Prioritization for liver transplantation using the MELD score in Chile : Inequities generated by MELD exceptions. A collaboration between the Chilean Liver Transplant Programs, the Public Health Institute and the National Transplant Coordinator
    (2019) Díaz, Luis Antonio; Norero, B.; Lara, B.; Robles, C.; Elgueta, S.; Humeres, R.; Poniachik, J.; Silva, G.; Wolff, R.; Innocenti, F.; Rojas, J.L.; Zapata, R.; Hunter, B.; Alvarez, S.; Cancino, A.; Ibarra, J.; Rius, M.; González Bombardiere, Sergio; Calabran, L.; Perez, R.M.
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    Viral shedding dynamics reveals sputum as a reliable and cost-saving specimen for SARS-CoV-2 diagnosis within the first 10 days since symptom onset: A prospective cohort study
    (2020) Levican, Jorge; Almonacid, Leonardo I.; Valenzuela, Gonzalo; García-Salum, Tamara; Rojas, Luis; Serrano, Eileen; Pardo-Roa, Catalina; Salinas, Erick; Avendaño, María José; Perazzo, Fabiola; Díaz, Luis Antonio; Valderrama, Sebastián; Ortega, Marcos; Toro, Adriana; Montecinos, Viviana; Riquelme, Arnoldo; Medina, Rafael A.
    Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome virus (SARS-CoV-2) is challenging global public health, due to an increasing demand for testing and the shortage of diagnostic supplies. Nasopharyngeal swab (NPS) is considered the optimal sample for SARS-CoV2 diagnosis and sputum (SPT) has been proposed as an economic alternative. However, the temporal concordance of diagnosis in NPS and SPT has not been addressed. Methods: Through a longitudinal study we compared the shedding dynamics of SARS-CoV-2 RNA evaluated by RT-qPCR in serially collected SPT and NPS obtained from 82 ambulatory and hospitalized patients during acute infection and convalescence. The concordance during the follow-up and cost analysis between both collected specimens was evaluated. Findings: We analyzed 379 samples, 177 NPS and 202 SPT. The highest proportion of positive samples was detected within the first 15 days after the symptoms onset. The median time of positivity was higher for NPS (median= 25 days) than SPT (median= 21 days). There was no significant difference in the median RT-qPCR CT values between both sample types. The temporal categorization of matched-paired samples indicated substantial correlation (r=0·6023) and substantial agreement (87·23%) during the first ten days since symptoms onset (kappa = 0·697). A cost analysis demonstrated a significant saving when the SPT specimen was used. Interpretation: Sputum is a feasible and cost-saving alternative to NPS, providing an equivalent value for the detection and follow-up of SARS-CoV-2 RNA.