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BACKGROUND AND AIMS: Metabolic Dysfunction-associated Steatotic Liver Disease (MASLD) poses a heightened cardiovascular risk. Identifying efficient biomarkers for early MASLD detection in resource-limited Latin American regions is crucial. We aimed to evaluate the diagnostic efficacy of sixteen biomarkers for MASLD in Mexican individuals. METHODS: In this cross-sectional and analytical study, steatosis was assessed using vibration-controlled transient elastography. MASLD was defined according to international standards. Assessed biomarkers included: Visceral Fat (VF), Waist Circumference (WC), Waist-Height Ratio (WHtr), Waist-Hip Ratio (WHr), Visceral Adiposity Index (VAI), Hepatic Steatosis Index (HSI), Body Mass Index (BMI), Homeostatic Model Assessment (HOMA), Weight-Adjusted-Waist Index (WWI), Lipid Accumulation Product (LAP), Uric Acid-Creatinine Ratio (UACR), Triglyceride-Glucose Index (TyG) and its variants TyG-WC, TyG-HDL, TyG-BMI, TyG-WHtr. RESULTS: 161 participants were included, of which 122 met MASLD criteria (56 % women, age 53.9 years [47.5-64]) and 39 were healthy controls (76 % women, age 52 [45-64]). The AUROCs of the biomarkers for MASLD were: TyG-WC (0.84), LAP (0.84), TyG-BMI (0.82), TyG-WHtr (0.80), WC (0.78), TyG (0.77), WHtr (0.75), BMI (0.76), VF (0.75), HSI (0.75), TyG-HDL (0.75), WHr (0.72), VAI (0.73), UA/CR (0.70), HOMA (0.71), and WWI (0.69). Sex-based differences were observed. After adjusting for sociodemographic variables, the TyG-WC index was the best predictor of MASLD. CONCLUSIONS: In conclusion, our results underscore the potential of several noninvasive biomarkers for MASLD assessment in a Mexican population, highlighting variations in diagnostic efficacy and cut-off values between sexes. After adjusting, TyG-WC was the best MASLD predictor.

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BACKGROUND: The definition of metabolic-dysfunction-associated fatty liver disease (MAFLD) allows identification of metabolically complicated patients. Fibrosis risk scores are related to cardiovascular risk (CVR) scores and could be useful for the identification of patients at risk of systemic complications. AIM: To evaluate the relationship between MAFLD and CVR using the Framingham risk score in a group of Mexican patients. METHODS: Cross-sectional, observational and descriptive study carried out in a cohort of 585 volunteers in the state of Veracruz with MAFLD criteria. The risk of liver fibrosis was calculated with aspartate aminotransferase-to-platelet ratio index, nonalcoholic fatty liver disease score and fibrosis-4, as well as with transient hepatic elastography with Fibroscan®. The CVR was determined by the Framingham system. RESULTS: One hundred and twenty-five participants (21.4%) with MAFLD criteria were evaluated, average age 54.4 years, 63.2% were women, body mass index 32.3 kg/m2. The Framingham CVR was high in 43 patients (33.9%). Transient elastography was performed in 55.2% of volunteers; 39.1% with high CVR and predominance in advanced fibrosis (F3-F4). The logistic regression analysis showed that liver fibrosis, diabetes and hypertension independently increased CVR. CONCLUSION: One of every three patients with MAFLD had a high CVR, and in those with high fibrosis risk, the CVR risk was even greater.

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BACKGROUND: Constipation is a heterogeneous symptom so an accurate diagnosis requires an appropriate approach. OBJECTIVE AND METHODS: To establish the clinical guidelines for diagnosis and treatment of chronic constipation in Mexico we have reviewed the diagnostic aspects of constipation according to the availability of resources in our country. In addition, evidence-based recommendations have been provided. RESULTS: The symptoms that best define constipation in our population are infrequent stool, hard stool expulsion, excessive effort and sensation of incomplete evacuation. Digital rectal examination is a useful diagnostic tool to discard organic diseases and pelvic floor dyssynergia. Patients with risk factors such as recent onset of constipation, family history of inflammatory bowel disease or colon cancer and those with alarm signs (unintentional weight loss and significant anemia, blood in stool) should undergo endoscopic diagnostic studies. If they are available, the most useful tests in evaluating patients with functional constipation are colonic transit with radiopaque markers and anorectal manometry with balloon expulsion test. CONCLUSIONS: Patients with symptoms of chronic constipation should undergo advanced colorectal physiological studies to try to establish the cause of constipation.

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BACKGROUND: There are multiple therapeutic options for the management of constipation, from lifestyle modifications to the use of laxatives and in extreme cases surgery. OBJECTIVES AND METHODS: To establish the clinical guidelines for diagnosis and treatment of chronic constipation in Mexico we conducted a review of the literature regarding medical and surgical treatments for chronic constipation and have made recommendations based on evidence. RESULTS: Low water consumption, physical inactivity and low intake of fiber are conditions associated with chronic constipation, but the evidence to prove these associations is scarce. Bolus forming agents are useful in the management of constipation with normal colonic transit and defecation without dissynergia. Evidence supports the use of lactulose (IB) and polyethylene glycol (IA) as the most safe and effective agents in the long term in adults. The use of stimulant laxatives (docusate, picosulfate, senna) is recommended only for short periods. Tegaserod is an agonist of 5-HT4 receptors and there are many clinical trials supporting its effectiveness in the management of functional constipation (IA). However "their cardiovascular safety has been questioned recently. Biofeedback therapy is the gold standard in the management of constipation associated with pelvic floor dyssynergia. Surgical treatment is reserved for extreme cases of colonic inertia. CONCLUSIONS: The treatment of constipation should be based on the underlying pathophysiological mechanisms and the selection of drugs must be made according to the scientific evidence.

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BACKGROUND: Proton pump inhibitor test (PPIt) has been shown adequate diagnostic usefulness and cost-effectiveness in the evaluation of patients with gastroesophageal reflux disease (GERD). However, comparative studies of PPIt with 24 hr esophageal pH-metry (24-pH) in non erosive GERD (NERD) are scarce and the utility of rabeprazole as a PPIt has not been evaluated. OBJECTIVE: To investigate the diagnostic utility of rabeprazole test in patients with NERD. MATERIAL AND METHODS: An open label trial was performed, and NERD patients with heartburn at least 3 times per week were included. Symptomatic evaluation before, during and after rabeprazole 20 mg bid for 7 days was performed. All patients underwent 24-pH before treatment with rabeprazole. Patients were classified in three groups: 1) abnormal pH, 2) normal pH and symptom index (SI) positive, and 3) normal pH and SI negative. A positive rabrepazole test was considered when symptoms improvement was higher than 50% at the end of the test. Sensitivity, specificity, negative predictive value, positive predictive value and positive likelihood ratio were calculated considering the 24-pH as gold standard. RESULTS: Sixty four patients, 47 (72%) female were studied. Forty four percent of the patients had normal pH, 29% with SI positive and 71% with SI negative. Sensitivity, specificity, positive predictive value, negative predictive value and positive likelihood ratio were 82%, 47%, 78%, 52% and 1.406 respectively. No adverse events were reported. CONCLUSION: PPI test with rabeprazole 20 mg bid for 7 days is a simple and useful test in the diagnostic approach of patients with NERD.

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Objetivo: informar un caso clínico de enfermedad de Hirschsprung, (EH) diagnosticada en la edad adulta. Antecedentes: la EH se diagnostica en 80 a 90 por ciento de los casos en el periodo neonatal. Esta enfermedad es rara en la edad adulta y generalmente se presenta como EH de segmento ultracorto. Informe de caso: paciente femenino de 49 años con constipación crónica de inicio en la infancia, sometida de manera repetida a laparotomía exploradora por abdomen agudo secundario a impactación fecal, realizándose colostomía. Se estableció el diagnóstico de EH por imagen radiológica de megacolon y hallazgos manométricos e histopatológicos típicos. Se realizó proctectomía y hemicolectomía izquierda con anastomosis coloanal. Conclusión: el diagnóstico de la EH en el adulto es poco frecuente, pero debe sospecharse cuando exista constipación crónica e intratable de inicio en la infancia, megacolon y hallazgos manométricos e histológicos característicos. La enfermedad de segmento corto y ultracorto es más frecuente en la etapa adulta. El diagnóstico diferencial es con constipación funcional, megarrecto idiopático y pseudoobstrucción colónica.

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Se presenta una niña con un padecimiento raro, la enfermedad de Werdnig-Hoffman, que se manifestó sobre todo por imposibilidad de gatear y de sostenerse en pie; en la radiografía tenía escoliosis toracolumbar derecha, luxación de cadera y una importante oblicuidad pélvica. Se le corrigió la escoliosis de 90 a 30 grados y la cifosis de 55 a 35 grados. La paciente falleció a los ocho meses de oprada, por neumonía bacteriana bilateral.

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