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Patients with fatty liver are almost always asymptomatic; aminotransferases are usually elevated two to five times the expected value and are an important cause of initial consultation. All images can show fatty liver, and liver biopsy remains the gold standard for diagnosis. In any patient, non-invasive tests are an excellent alternative to biopsy to determine the degree of liver fibrosis and establish the stage of fibrogenesis. Weight loss and exercise are the fundamental pillars of the indicated treatment for all patients with overweight or obesity; a weight loss between 5% and 10% and a diet with caloric restriction of 500-1000 kcal/day, low in saturated fat and rich in Mediterranean diet products such as fruit, fish, vegetables, nuts, olive oil, among others, are recommended. There are other treatments, such as pharmacological measures and endoscopic and surgical procedures.

Los pacientes con hígado graso son casi siempre asintomáticos, las aminotransferasas usualmente están elevadas dos a cinco veces el valor normal y son una causa importante de consulta inicial. Todas las imágenes pueden evidenciar el hígado graso y la biopsia hepática sigue siendo la prueba de oro para su diagnóstico. En cualquier paciente las pruebas no invasivas son una excelente alternativa a la biopsia para determinar el grado de fibrosis hepática y establecer en qué etapa de la fibrogénesis se encuentra. La pérdida de peso y el ejercicio son los pilares fundamentales del tratamiento indicado para todos los pacientes con sobrepeso u obesidad; se recomienda una pérdida de peso entre 5% y 10% del peso corporal y una dieta con restricción calórica de 500-1000 kcal/día, baja en grasas saturadas y rica en productos de la dieta mediterránea como fruta, pescado, verduras, frutos secos, aceite de oliva, entre otros. Hay otros tratamientos como las medidas farmacológicas y los procedimientos endoscópicos y quirúrgicos.

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OBJECTIVE: To evaluate the performance of the quantitative markers of hepatitis B core-related antigen (HBcrAg) and anti-hepatitis B core antigen antibodies HbcAb versus hepatitis B surface antigen (HBsAg) and hepatitis B virus DNA (HBV DNA) in predicting liver fibrosis levels in chronic hepatitis B patients. METHODS: Two hundred and fifty hepatitis B e antigen (HBeAg)-positive and 245 HBeAg-negative patients were enrolled. With reference to the Scheuer standard, stage 2 or higher and stage 4 liver disease were defined as significant fibrosis and cirrhosis, respectively. A receiver operating characteristic (ROC) curve was used to evaluate the performance of the HBV markers investigated. RESULTS: The areas under the ROC curves (AUCs) of HBcrAg in predicting significant fibrosis and cirrhosis in HBeAg-positive patients (0.577 and 0.700) were both close to those of HBsAg (0.617 and 0.762) (both P> 0.05). In HBeAg-negative patients (0.797 and 0.837), they were both significantly greater than those of HBV DNA (0.723 and 0.738) (P=0.0090 and P=0.0079). The AUCs of HBcAb in predicting significant fibrosis and cirrhosis in HBeAg-positive patients (0.640 and 0.665) were both close to those of HBsAg. In HBeAg-negative patients (0.570 and 0.621), they were both significantly less than those of HBcrAg (P <0.0001 and P=0.0001). Specificity in predicting significant fibrosis and sensitivity in predicting cirrhosis in HBeAg-positive patients, using a single cut-off of HBsAg ≤5,000 IU/ml, were 76.5% and 72.7%, respectively. In HBeAg-negative patients, using a single cut-off of HBcrAg>80kU/ml, they were 85.9% and 81.3%, respectively. CONCLUSIONS: HBsAg has good performance in predicting liver fibrosis levels in HBeAg-positive and HBeAg-negative patients, and HBcrAg has very good performance in predicting liver fibrosis levels in HBeAg-negative patients.

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There has been an increase in the prevalence of nonalcoholic fatty liver disease (NAFLD) throughout the western world and especially in Latin America. This condition is associated with metabolic syndrome, risk of diabetes, cardiovascular risk and extrahepatic cancer. However, in patients with NAFLD, risk of mortality from diseases affecting the liver does not exceed 5 percent in contrast to 60 percent when advanced fibrosis is present. Only 10 to 20 percent of patients with NAFLD have non-alcoholic steatohepatitis (NASH), a condition that can potentially progress to fibrosis and cirrhosis. The non-invasive diagnostic tools for discriminating current patients at risk of progression to advanced fibrosis are sub-optimal. Clinical variables and routine laboratory tests help in detecting NAFLD but do not allow discrimination of NASH patients. New diagnostic tools could allow prediction of NASH such as markers of oxidative stress, inflammatory markers and markers of apoptosis. Regarding liver fibrosis biomarkers, there are indirect markers that are related to the degree of liver function and direct markers that reflect the dynamics of extracellular matrix. Imaging methods such as ultrasound-based elastography, (ARFI) and magnetic resonance elastography have shown a good correlation with the degree of fibrosis. Finally various predictor models that combine clinical and laboratory variables have a very good correlation with the degree of fibrosis. Although there is still some controversy on its clinical utility, liver biopsy still plays a role in NAFLD severity assessment for initiation of drug therapy.

Se ha registrado un aumento en la prevalencia de la enfermedad por hígado graso no alcohólico HGNA (NAFLD, por su sigla en inglés) en todo el mundo occidental y especialmente en Latinoamérica. Esta condición se relaciona con síndrome metabólico, riesgo de diabetes, riesgo cardiovascular y cáncer extrahepático. Sin embargo, en pacientes con HGNA el riesgo de mortalidad por enfermedades que afectan al hígado no supera el 5 por ciento en contraste con 60 por ciento cuando hay fibrosis avanzada. Sólo 10 a 20 por ciento de los pacientes presenta esteatohepatitis no alcohólica EHNA (NASH, por su sigla en inglés), una condición que potencialmente puede progresar a fibrosis y cirrosis. Las herramientas de diagnóstico no invasivo actuales para discriminar pacientes con riesgo de progresión a fibrosis avanzada son subóptimas. Las variables clínicas y exámenes de laboratorio habituales ayudan en la detección de HGNA,pero no permiten discriminar pacientes con EHNA. Nuevas herramientas diagnósticas podrían permitir predecir EHNA como marcadores de estrés oxidativo, marcadores de inflamación y de apoptosis. De los marcadores de fibrosis existen los indirectos que se relacionan con el grado de función hepática, marcadores directos que reflejan la dinámica de la matriz extracelular. Los métodos de imagen como la elastografía por ultrasonido (ARFI), elastografía por resonancia magnética, han demostrado una buena correlación con el grado de fibrosis. Finalmente, diversos índices que combinan variables clínicas y de laboratorio tienen una muy buena correlación con el grado de fibrosis. La biopsia aun cumple un rol a pesar de la controversia en su real necesidad para iniciar tratamiento.

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The most common causes of steatohepatitis are alcohol intake and metabolic disorders. Several methods based on biochemical determinations (carbohydrate deficient transferrin) and questionnaires (AUDIT, CAGE, MALE) are useful for detecting surreptitious alcohol intake. Although new non-invasive methods are under development, based both on lipidomics (Owl-Liver(®)) and on biochemical determinations and anthropometric parameters (NAFLD Fibrosis score) or imaging methods (DeMILI NASH-MRi(®)), none has been proposed as definitive and the gold standard continues to be liver biopsy. The pathogenesis of alcoholic and non-alcoholic steatohepatitis shares some elements such as insulin resistance, cytochrome CYP2E1-mediated oxidative stress, adiponutrin and its PNPLA3 gene, and the microbiota. The first-line treatment consists of lifestyle changes, including giving up alcohol, diet and exercise.

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La trombosis venosa profunda es una enfermedad que requiere de un diagnóstico exacto y rápido que permita aplicar sin pérdida de tiempo la terapia correspondiente a los que la padecen, para evitar las complicaciones futuras que pueden llegar a ser fatales, y a la vez evitar los costos y el peligro potencial de aplicar esta terapia a los que no la padecen. La flebografía ascendente es la prueba diagnóstica de referencia en el diagnóstico de la trombosis venosa profunda pero su uso es limitado ya que es invasiva, costosa, y está contraindicada en ciertos casos. En este artículo se exponen las pruebas no invasivas utilizadas en la actualidad para el diagnóstico de la trombosis venosa profunda (ultrasonido doppler de onda continua, ultrasonido modo B, ecodoppler y ecodoppler-color), la exactitud de cada una de ellas y sus ventajas y desventajas. La prueba no invasiva de elección es la realización seriada del ultrasonido modo B con compresión, dentro de una estrategia diagnóstica que incluya el dímero D y la probabilidad clínica(AU)

Deep venous thrombosis is a pathology requiring an exact and quick diagnosis that allows applying the right the therapy to the patients as soon as possible. This will make possible to avoid future complications that can be fatal, and at the same time, largecosts and the potential danger of applying this therapy to those that do not have this disease. The phlebography is the gold standard in the diagnosis of deep vein thrombosis but it has limited use, since it is invasive, expensive, and contraindicated in certain cases. This article presented the noninvasive tests used at the present time for the diagnosis of the deep venous thrombosis (Continuous wave Doppler ultrasound, B-mode ultrasound, Echodoppler and Echodoppler-color), their respective accuracy and their advantages and disadvantages. The noninvasive test of choice is the serial B-mode Ultrasound with compression as part of a diagnostic strategy that includes the D-dimer and the clinical probability(AU)

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La microscopia confocal de reflectancia (MCR) es una herramienta de imágenes no invasiva que permite la visualización in vivo y en tiempo real de estructuras microscópicas de la epidermis, unión dermo-epidérmica y dermis superficial con una resolución cuasi histológica. Ha sido utilizada en la evaluación de lesiones benignas y malignas, demostrando un gran potencial para aplicaciones en investigación básica y en dermatología clínica. En el presente trabajo se revisan conceptos acerca del desarrollo y principios básicos del funcionamiento de la MCR, así como de sus aplicaciones en la práctica clínica.

Reflectance confocal microscopy (RCM) is a noninvasive imaging tool that allows in-vivo and realtimevisualization of microscopic structures of the epidermis, dermo-epidermal junction and superficialdermis with a quasi-histological resolution. It has been used in the evaluation of benignand malignant lesions, showing a great potential for applications in basic research and clinicaldermatology. This paper reviews concepts about the development and basic principles of the RCMand its applications in clinical practice.

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