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Introducción: La enfermedad por hígado graso no alcohólico es una de las principales causas de afección hepática. La citoqueratina 18 surge como marcador no invasivo para la valoración de fibrosis hepática. El objetivo del trabajo fue validar el uso de la citoqueratina 18 en sangre periférica en el diagnóstico y evolución de los pacientes con enfermedad por hígado graso no alcohólico. Metodología: Para validar la citoqueratina 18 en el diagnóstico se realizó un estudio de tipo caso-control. El grupo caso fueron los pacientes mayores de 18 años, de ambos sexos, con diagnóstico de enfermedad por hígado graso no alcohólico vinculado al síndrome metabólico, captados entre 2/2/2019 al 2/2/2020. El grupo control fueron personas donantes de sangre. Se parearon 1-1 por edad y sexo. Se cuantificó la citoqueratina 18 en sangre periférica de ambos grupos. Para validar la citoqueratina 18 en la evolución de los pacientes con enfermedad de hígado graso no alcohólico se realizó un trabajo prospectivo, longitudinal. El grupo de pacientes captados fueron seguidos durante un año bajo tratamiento estándar, finalizando el mismo se realizó la cuantificación de citoqueratina 18 en sangre periférica. Las variables continuas se expresan con la media y desvío estándar. Se analizó con test de t Student, error α < 5% Resultados: 13 pacientes integran el grupo caso (12 mujeres), de 53 ± 11 años, con IMC 35.01 ± 8.9 kg/m2. El valor de citoqueratina 18 pre-tratamiento fue de 1410 ± 120 UI, y el valor post-tratamiento fue de 117 ± 56, p < 0,005.El grupo control fueron 13 personas (12 mujeres), de 43,4 ± 8,1 años e IMC 28,10 ± 5,4 kg/m2 El valor de citoqueratina 18 fue de 193 ± 7.2 UI, p < 0.005 vs grupo caso pretratamiento. Conclusiones: La citoqueratina 18 es más elevada en los pacientes con enfermedad hígado graso no alcohólico, siendo estadísticamente significativa y disminuye con el tratamiento con significación estadística, pudiendo constituirse en un marcador útil en este grupo de pacientes.
Introduction: Nonalcoholic fatty liver disease is one of the main causes of liver disease. Cytokeratin 18 emerges as a non-invasive marker for the assessment of liver fibrosis. The objective of the work was to validate the use of cytokeratin 18 in peripheral blood in the diagnosis and evolution of patients with non-alcoholic fatty liver disease. Methodology: To validate cytokeratin 18 in the diagnosis, a case-control study was carried out. The case group was patients over 18 years of age, of both sexes, with a diagnosis of non-alcoholic fatty liver disease linked to metabolic syndrome, recruited between 2/2/2019 to 2/2/2020. The control group were blood donors. They were matched 1-1 for age and sex. Cytokeratin 18 was quantified in peripheral blood of both groups. To validate cytokeratin 18 in the evolution of patients with non-alcoholic fatty liver disease, a prospective, longitudinal study was carried out. The group of patients recruited were followed for one year under standard treatment, at the end of which cytokeratin 18 was quantified in peripheral blood. Continuous variables are expressed with the mean and standard deviation. It was analyzed with Student's t test, α error < 5%. Results: 13 patients make up the case group (12 women), 53 ± 11 years old, with BMI 35.01 ± 8.9 kg/m2. The pre-treatment cytokeratin 18 value was 1410 ± 120 IU, and the post-treatment value was 117 ± 56, p < 0.005. The control group was 13 people (12 women), 43.4 ± 8.1 years and BMI 28.10 ± 5.4 kg/m2 The cytokeratin 18 value was 193 ± 7.2 IU, p < 0.005 vs. pretreatment case group. Conclusions: Cytokeratin 18 is higher in patients with non-alcoholic fatty liver disease, being statistically significant, and decreases with treatment with statistical significance, and may become a useful marker in this group of patients.
Introdução: A doença hepática gordurosa não alcoólica é uma das principais causas de doença hepática. A citoqueratina 18 surge como um marcador não invasivo para avaliação de fibrose hepática. O objetivo do trabalho foi validar o uso da citoqueratina 18 no sangue periférico no diagnóstico e evolução de pacientes com doença hepática gordurosa não alcoólica. Metodologia: Para validar a citoqueratina 18 no diagnóstico, foi realizado um estudo caso-controle. O grupo caso foi composto por pacientes maiores de 18 anos, de ambos os sexos, com diagnóstico de doença hepática gordurosa não alcoólica ligada à síndrome metabólica, recrutados entre 02/02/2019 a 02/02/2020. O grupo controle eram doadores de sangue. Eles foram comparados em 1 a 1 por idade e sexo. A citoqueratina 18 foi quantificada no sangue periférico de ambos os grupos. Para validar a citoqueratina 18 na evolução de pacientes com doença hepática gordurosa não alcoólica, foi realizado um estudo prospectivo e longitudinal. O grupo de pacientes recrutados foi acompanhado durante um ano sob tratamento padrão, ao final do qual a citoqueratina 18 foi quantificada no sangue periférico. As variáveis ââcontínuas são expressas com média e desvio padrão. Foi analisado com teste t de Student, erro α < 5%. Resultados: Compõem o grupo caso 13 pacientes (12 mulheres), 53 ± 11 anos, com IMC 35,01 ± 8,9 kg/m2. O valor de citoqueratina 18 pré-tratamento foi de 1410 ± 120 UI e o valor pós-tratamento foi de 117 ± 56, p < 0,005. O grupo controle foi de 13 pessoas (12 mulheres), 43,4 ± 8,1 anos e IMC 28,10 ± 5,4 kg/m2 O valor da citoqueratina 18 foi de 193 ± 7,2 UI, p < 0,005 vs. grupo de casos pré-tratamento. Conclusões: A citoqueratina 18 é maior em pacientes com doença hepática gordurosa não alcoólica, sendo estatisticamente significativa, e diminui com o tratamento com significância estatística, podendo se tornar um marcador útil neste grupo de pacientes.
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INTRODUCTION AND AIM: Liver fibrosis is a complication of metabolic dysfunction-associated steatotic liver disease (MASLD). Given the limitations and risks of liver biopsy, examining noninvasive scoring systems that are affordable for the population is necessary. Our aim was to evaluate and compare the diagnostic yield of the APRI, FIB-4, NAFLD score, and Hepamet fibrosis score instruments for detecting liver fibrosis in Mexican subjects with MASLD. MATERIAL AND METHODS: A retrospective study was conducted on a sample of subjects with MASLD. Liver fibrosis was calculated through transient liver elastography. Sociodemographic, epidemiologic, and biochemical variables were evaluated. Scores were calculated utilizing the fibrosis-4 (FIB-4) index, the aspartate aminotransaminase-to-platelet ratio index (APRI), the Hepamet fibrosis score (HFS), and the NAFLD score (NFS), and then compared. ROC curves were constructed, and the optimum cutoff points were determined utilizing the Youden index. Sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratio were calculated. RESULTS: The study included 194 subjects (63% women), of whom 150 (77.3%) were classified with MASLD and 44 (22.7%) as controls with no liver disease. There was a 15.3% prevalence of advanced fibrosis. The cutoff points of 0.57 for APRI, 1.85 for FIB-4, 0.08 for HFS, and -0.058 for NFS showed diagnostic yields with areas under the ROC curves of 0.79, 0.80, 0.70, and 0.68, respectively. CONCLUSION: The APRI, FIB-4, NFS, and HFS scores are useful for evaluating liver fibrosis in Mexican subjects with MASLD. Better diagnostic yield was found with the FIB-4 and APRI scores.
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La trombosis de la vena porta (TVP) en pacientes con o sin cirrosis hepática (CH) se define como una obstrucción de la vena porta debido a la formación de un trombo que puede extenderse a las venas mesentéricas superiores y esplénica. Esta es una complicación común de la enfermedad hepática avanzada. Se creía que la TVP se producía predominantemente debido al potencial protrombótico del paciente con CH, ya que se observaba una mayor incidencia de TVP en CH con una puntuación MELD y Child-Pugh más altas, con una prevalencia informada del 10 % al 25%.
Portal vein thrombosis (PVT) in patients with or without hepatic cirrhosis (CH) is defined as an obstruction of the portal vein due to the formation of a thrombus that may extend to the superior mesenteric and splenic veins. This is a common complication of advanced liver disease. It was believed that PVT predominantly occurred due to the prothrombotic potential of the patient with CH, as a higher incidence of PVT was observed in CH with higher MELD and Child-Pugh scores, with a reported prevalence of 10% to 25%.
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Resumen Introducción : El carcinoma hepatocelular (HCC) es el cáncer primario más común del hígado y la tercera causa principal de muerte por cáncer en todo el mun do. La resección hepática es el tratamiento de elección para pacientes no cirróticos, mientras que, en cirróticos, la elección depende del estadio tumoral y la función hepática. Métodos : En este estudio retrospectivo realizado en el Hospital El Cruce entre 2015 y 2022, se evaluaron pa cientes con HCC sometidos a resección hepática, tanto cirróticos como no cirróticos. Se analizó la morbimorta lidad, la tasa de recurrencia y la sobrevida. Resultados : Se realizaron 262 hepatectomías, 44 fue ron para tratamiento del HCC, de las cuales 35 fueron hepatectomías menores, y 9 hepatectomías mayores (no cirróticos). La mayoría eran hombres (77%) con una edad promedio de 58.5 años. Hubo 29 pacientes con cirrosis, siendo la hepatitis C (HCV) la causa principal en un 48%, HCV con alcohol como cofactor (21%) y alcohol (17%). La morbilidad fue del 47.7%, con complicaciones menores predominantes. La recurrencia de enfermedad ocurrió en el 59% de los pacientes, y los factores asociados incluyeron tamaño tumoral y niveles elevados de Alfa-fetoproteína. La supervivencia fue mejor en pacientes cirróticos en comparación con no cirróticos. Conclusión : La resección hepática es una opción efectiva para el tratamiento del HCC en pacientes bien seleccionados cirróticos y no cirróticos, con resultados alentadores en términos de supervivencia y control de la enfermedad. Además, se sugiere una vigilancia cercana para detectar recurrencias tempranas y proporcionar tratamientos oportunos.
Abstract Introduction : Hepatocellular carcinoma (HCC) is the most common primary liver cancer and the third lead ing cause of cancer-related deaths worldwide. Hepatic resection is the treatment of choice for non-cirrhotic patients, while in cirrhotic individuals, the choice de pends on tumor stage and liver function. Methods : In this retrospective study conducted at Hospital El Cruce between 2015 and 2022, patients with HCC undergoing hepatic resection, both cirrhotic and non-cirrhotic, were evaluated. Morbidity, mortality, re currence rate, and survival were analyzed. Results : A total of 262 hepatectomies were performed, with 44 for HCC treatment. Among them, 35 were minor hepatectomies, and 9 were major hepatectomies (non-cirrhotic patients). The majority were males (77%) with an average age of 58.5 years. Twenty-nine patients had cirrhosis, with hepatitis C (HCV) being the main cause in 48%, HCV with alcohol as a cofactor (21%), and alcohol alone (17%). Morbidity was 47.7%, with predominance of minor complications. Disease recurrence occurred in 59% of patients, and associated factors included tumor size and elevated AFP levels. Survival was better in cir rhotic patients compared to non-cirrhotic ones. Discussion : Results tion 5837Hepatic resection is an effective option for treating HCC in well-selected cirrho tic and non-cirrhotic patients, with encouraging results in terms of survival and disease control. Additionally, close surveillance for early recurrence detection and timely interventions is suggested.
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RESUMEN Antecedentes: En las últimas décadas ha habido un cambio considerable hacia un enfoque más conservador en el tratamiento del traumatismocerrado de abdomen, con énfasis en la preservación de la función de órganos; actualmente, el tratamiento no operatorio (TNO) se ha convertido en la técnica de manejo estándar en pacientes hemodinámicamente estables con lesiones de órgano sólido. Objetivo: Describir las variables clínicas asociadas a la tasa de éxito en una serie de pacientes con TNO de trauma abdominal cerrado con lesión de órganos sólidos. Material y métodos: Estudio retrospectivo, observacional, longitudinal, analítico entre enero de 2017 y diciembre de 2022, sobre pacientes admitidos con diagnóstico de traumatismo abdominal cerrado. Las variables evaluadas fueron: edad, sexo, estadía hospitalaria, complicaciones, requerimiento de transfusiones, tasa de éxito y mortalidad. Resultados: De 2590 pacientes ingresados por Guardia de Cirugía General, 24 pacientes se internaron con diagnóstico de traumatismo cerrado de abdomen. Fueron excluidos 15 pacientes por no cumplir con los criterios de inclusión. Los 9 pacientes seleccionados tuvieron un promedio de edad de 39 años (15-80) y 9 fueron varones. En el 36% presentaron lesiones esplénicas grados I-II, 27% presentó lesión renal grado II y el 18% restante con lesión hepática grado II. La tasa de éxito del tratamiento fue del 100% en nuestra serie sin evidenciar fallos en la terapéutica instaurada. Conclusión: Con los criterios empleados en TNO del traumatismo abdominal cerrado con lesión de órganos sólidos fue factible y permitió alcanzar una alta tasa de éxito, sin mortalidad.
ABSTRACT Background: In recent decades, there has been a significant shift toward a more conservative approach to the management of blunt abdominal trauma with an emphasis on preserving organ function; currently, non-operative management (NOM) has become the standard of care for hemodynamically stable patients with solid organ injury. Objective: The aim of this study was to determine the different clinical variables associated with the success rate of NOM of blunt abdominal trauma with involving solid organs. Material and methods: We conducted a retrospective, observational, longitudinal, and analytical study of patients admitted for blunt abdominal trauma between January 1, 2017, and December 1, 2022. The variables evaluated were age, sex, length of hospital stay, complications, transfusion requirements, success rate and mortality. Results: Between January 2017 and December 2022, of 2590 patients seen in the emergency department, 24 were admitted with a diagnosis of blunt abdominal trauma. Fifteen patients did not meet the inclusion criteria. The mean age of the 9 patients included was 39 years (15-80 years) and 6 were men. Thirty-six percent had grade I and II splenic lesions, 27% had grade II renal lesions, and 18% had grade II hepatic lesions. The success rate of our series was 100% and there were no failures. Conclusion: The variables analyzed allowed us to affirm that NOM of blunt abdominal trauma with solid organ injury was feasible and allowed us to achieve a high success rate, without deaths.
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Fasciolosis, a globally re-emerging zoonotic disease, is mostly caused by the parasitic infection with Fasciola hepatica, often known as the liver fluke. This disease has a considerable impact on livestock productivity. This study aimed to evaluate the fluke burdens and faecal egg counts in goats that were administered phage clones of cathepsin L mimotopes and then infected with F. hepatica metacercariae. Additionally, the impact of vaccination on the histology of the reproductive system, specifically related to egg generation in adult parasites, was examined. A total of twenty-four goats, which were raised in sheds, were divided into four groups consisting of six animals each. These groups were randomly assigned. The goats were then subjected to two rounds of vaccination. Each vaccination involved the administration of 1 × 1013 phage particles containing specific mimotopes for cathepsin L2 (group 1: PPIRNGK), cathepsin L1 (group 2: DPWWLKQ), and cathepsin L1 (group 3: SGTFLFS). The immunisations were carried out on weeks 0 and 4, and the Quil A adjuvant was used in combination with the mimotopes. The control group was administered phosphate-buffered saline (PBS) (group 4). At week 6, all groups were orally infected with 200 metacercariae of F. hepatica. At week 22 following the initial immunisation, the subjects were euthanised, and adult F. hepatica specimens were retrieved from the bile ducts and liver tissue, and subsequently quantified. The specimens underwent whole-mount histology for the examination of the reproductive system, including the testis, ovary, vitellaria, Mehlis' gland, and uterus. The mean fluke burdens following the challenge were seen to decrease by 50.4%, 62.2%, and 75.3% (p < 0.05) in goats that received vaccinations containing cathepsin L2 PPIRNGK, cathepsin L1 DPWWLKQ, and cathepsin L1 SGTFLFS, respectively. Animals that received vaccination exhibited a significant reduction in the production of parasite eggs. The levels of IgG1 and IgG2 isotypes in vaccinated goats were significantly higher than in the control group, indicating that protection is associated with the induction of a mixed Th1/Th2 immune response. The administration of cathepsin L to goats exhibits a modest level of efficacy in inducing histological impairment in the reproductive organs of liver flukes, resulting in a reduction in egg output.
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Catepsina L , Fasciola hepatica , Fasciolíase , Cabras , Vacinação , Animais , Fasciola hepatica/imunologia , Catepsina L/metabolismo , Fasciolíase/veterinária , Fasciolíase/prevenção & controle , Fasciolíase/imunologia , Fasciolíase/parasitologia , Vacinação/métodos , Feminino , Masculino , Doenças das Cabras/parasitologia , Doenças das Cabras/prevenção & controle , Doenças das Cabras/imunologia , Contagem de Ovos de Parasitas , Bacteriófagos/imunologiaRESUMO
INTRODUCTION: Tyrosinemia type 1 is a rare disease with autosomal recessive inheritance, featuring various clinical manifestations. These may encompass acute neonatal liver failure, neonatal cholestatic syndrome, chronic hepatitis, cirrhosis, hepatocellular carcinoma, and, alternatively, kidney disorders like renal tubular acidosis, Fanconi syndrome, hypophosphatemic rickets, among other alterations. Diagnosis relies on detecting toxic metabolites in the blood and urine, ideally confirmed through molecular testing. METHOD: A consensus was reached with experts in the field of inborn errors of metabolism (EIM), including eight pediatric gastroenterologists, two EIM specialists, two geneticists, three pediatric nutritionists specialized in EIM, and a pediatric surgeon specializing in transplants. Six working groups were tasked with formulating statements and justifications, and 32 statements were anonymously voted on using the Likert scale and the Delphi method. The first virtual vote achieved an 80% consensus, with the remaining 20% determined in person. RESULTS: The statements were categorized into epidemiology, clinical presentation, diagnosis, nutritional and medical treatment, and genetic counseling. CONCLUSIONS: This consensus serves as a valuable tool for primary care physicians, pediatricians, and pediatric gastroenterologists, aiding in the prompt diagnosis and treatment of this disease. Its impact on the morbidity and mortality of patients with tyrosinemia type 1 is substantial.
INTRODUCCIÓN: La tirosinemia tipo 1 es una enfermedad rara, con herencia autosómica recesiva, con múltiples manifestaciones clínicas, que pueden comprender desde falla hepática aguda neonatal, síndrome colestásico neonatal, hepatitis crónica, cirrosis o hepatocarcinoma, hasta alteraciones renales como acidosis tubular renal, síndrome de Fanconi o raquitismo hipofosfatémico, entre otras. El diagnóstico se basa en la presencia de metabolitos tóxicos en la sangre y la orina, idealmente con la confirmación molecular de la enfermedad. MÉTODO: Se realizó un consenso con expertos en el área de los errores innatos del metabolismo (EIM): ocho gastroenterólogos pediatras, dos médicos especialistas en EIM, dos genetistas, tres nutriólogas pediatras especializadas en EIM y un cirujano pediatra especialista en trasplantes. Se formaron seis mesas de trabajo encargadas de desarrollar los enunciados con sus justificaciones y fueron votados anónimamente 32 enunciados en una escala Likert con un método Delphi. La primera votación fue virtual, obteniendo consenso del 80% de los enunciados, y la segunda fue presencial, obteniendo el 20% restante. RESULTADOS: Los enunciados fueron divididos en epidemiología, cuadro clínico, diagnóstico, tratamiento nutricional y médico, y consejo genético. CONCLUSIONES: Este consenso constituye una valiosa herramienta para los médicos de atención primaria, pediatras y gastroenterólogos pediátricos, ya que ayuda a diagnosticar y tratar rápidamente esta enfermedad. Su impacto en la morbilidad y mortalidad de los pacientes con tirosinemia tipo 1 es sustancial.
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Consenso , Tirosinemias , Humanos , Tirosinemias/diagnóstico , Tirosinemias/terapia , México , Recém-Nascido , Técnica Delphi , Aconselhamento GenéticoRESUMO
Acute liver failure is a rare but serious syndrome, with an incidence of approximately 2,000 to 3,000 cases per year in North America. Its pathophysiology and clinical course vary, depending on the cause of the primary liver injury, and can lead to high morbidity and mortality or the need for liver transplantation, despite available therapies. This syndrome involves excessive activation of the immune system, with damage in other organs, contributing to its high mortality rate. The most accepted definition includes liver injury with hepatic encephalopathy and coagulopathy within the past 26 weeks in a patient with no previous liver disease. The main causes are paracetamol poisoning, viral hepatitis, and drug-induced liver injury, among others. Identifying the cause is crucial, given that it influences prognosis and treatment. Survival has improved with supportive measures, intensive therapy, complication prevention, and the use of medications, such as N-acetylcysteine. Liver transplantation is a curative option for nonresponders to medical treatment, but adequate evaluation of transplantation timing is vital for improving results. Factors such as patient age, underlying cause, and severity of organ failure influence the post-transplant outcomes and survival.
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Falência Hepática Aguda , Humanos , Falência Hepática Aguda/terapia , Falência Hepática Aguda/etiologia , Falência Hepática Aguda/diagnóstico , Prognóstico , Transplante de FígadoRESUMO
RESUMEN Antecedentes: la cirugía hepática ha evolucionado con el correr del tiempo. No existe bibliografía publicada sobre experiencia previa de hepatectomía en Corrientes. Nuestro grupo de trabajo se desenvuelve en el ámbito público y privado. Objetivo: describir los resultados iniciales de una serie consecutiva de pacientes con hepatectomías de distinta extensión, por el mismo equipo quirúrgico. Material y métodos: trabajo retrospectivo, observacional, descriptivo, sobre datos de las historias clínicas y libros de quirófano de pacientes con hepatectomías realizadas entre septiembre de 2019 y enero de 2023, en la práctica pública y privada. Resultados: fueron intervenidos 27 pacientes, con media de edad 53 años (25-72); 16 eran mujeres. El abordaje fue convencional en 25 casos y laparoscópico en 2. Se realizaron 4 hepatectomías mayores y 23 menores. Los diagnósticos fueron de patología maligna en 22 oportunidades y benigna en 5. La sobrevida a los 90 días fue de 96,2%. La mortalidad fue de 1 paciente (3,7%). Con respecto a las complicaciones, 2 pacientes (7,4%) presentaron abscesos hepáticos en el posoperatorio, 2 pacientes (7,4%) requirieron reintervención quirúrgica por sangrado, con buena evolución posterior y alta hospitalaria. Conclusión: la morbimortalidad en la serie descripta estuvo en relación con lo comunicado por otros autores.
ABSTRACT Background: Liver surgery has evolved over time. There are no prior publications on the experience of liver surgery in the province of Corrientes. Our work group operates in both the public and private sectors. Objective: The aim of this study was to describe the initial results of a consecutive series of patients undergoing different types of liver resections, performed by the same surgical team. Material and methods: We conducted a retrospective, observational, and descriptive study based on data from the medical records and operating room records of patients undergoing liver resection at public and private institutions from September 2019 to January 2023. Results: A total of 27 patients were operated on; mean age was 53 years (25-72) and 16 were women. We used the conventional approach in 25 cases and laparoscopy in 2. Four procedures were major liver resections and 23 were minor liver resections, The diagnoses were cancer in 22 cases and benign conditions in 5. Survival at 90 days was 96.2% One patient died (3.7%). The complications included postoperative liver abscesses in 2 patients (7.4%) and re-operation due to bleeding in 2 patients (7.4%), who had a subsequent favorable course and were discharged from the hospital. Conclusion: The morbidity and mortality in the described series were similar to those reported by other authors.
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RESUMEN La enfermedad de Caroli es un trastorno congénito causado por malformación de la placa ductal. Se manifiesta con litiasis intrahepática y colangitis recurrente, habitualmente en personas jóvenes. Los hallazgos imagenológicos incluyen dilatación multifocal y segmentaria de los conductos biliares intrahepáticos. El colangiocarcinoma puede aparecer como complicación a largo plazo debido a la inflamación crónica de los conductos, por lo que debe estar siempre presente dentro de los posibles diagnósticos diferenciales. Se describe el caso infrecuente de una mujer de 52 años que presentó un cuadro de obstrucción biliar poscolecistectomía laparoscópica y requirió en su tratamiento quirúrgico la resección de los segmentos hepáticos II y III por enfermedad de Caroli, con buena evolución.
ABSTRACT Caroli's disease is a congenital disorder caused by a defect of the ductal plate. The clinical picture includes intrahepatic duct lithiasis and recurrent cholangitis usually in young people. The imaging tests reveal the presence of multifocal and segmental dilatation of the intrahepatic bile ducts. Cholangiocarcinoma can develop as a long-term complication of chronic bile duct inflammation and should always be considered as a differential diagnosis. We describe a rare case of a 52-year-old woman who presented with bile duct obstruction after laparoscopic cholecystectomy and required resection of liver segments II and III due to Caroli's disease with a favorable outcome.
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Introducción: El aneurisma de la arteria hepática es infrecuente, presentándose principalmente en trauma y en pacientes con aterosclerosis. Su manejo es complejo y desafiante aún en manos expertas, siendo el abordaje endovascular de elección. Caso clínico: Se presenta el caso de una paciente de 66 años con poliarteritis nodosa a la que se le diagnostica, incidentalmente, un aneurisma de la arteria hepática común (AHC). Inicialmente, se intenta manejo conservador, sin embargo se evidencia crecimiento significativo en el seguimiento por lo que se decide resolución quirúrgica endovascular. Se realiza embolización selectiva de todo el segmento aneurismático de la AHC, mantiendo la perfusión del lóbulo hepático derecho, con apoyo de ultrasonografía intraoperatoria. Discusión: El método de tratamiento preferido para esta entidad es la embolización percutánea con coils metálicos. Si bien es el de menor morbimortalidad asociada, no está exento de riesgos.
Introduction: Hepatic artery aneurysm is rare. The most common etiologies are atherosclerosis and trauma. Management is difficult and challenging. An endovascular approach is preferred to open surgery. Case report: 66-year-old patient with polyarteritis nodosa who was incidentally diagnosed with a common hepatic artery (CHA) aneurysm. Initially, conservative management was performed, however, during follow-up significant growth was evidenced. Endovascular treatment was decided over surgery. Selective embolization of the entire aneurysmal segment of CHA was performed, maintaining perfusion of the right hepatic lobe. Discussion: Percutaneous embolization with metal coils is the treatment of choice for this entity. Although it is the one with the lowest morbidity and mortality, it is not without risks.
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La enfermedad hepática relacionada con fibrosis quística se observa en el 10% de las personas portadoras de la enfermedad. La terapia con moduladores ha mejorado la morbimortalidad, pero teniendo en cuenta que presentan efectos secundarios infrecuentes es necesario monitorizar. Se analiza el algoritmo propuesto por Eldredge et al, que sugiere las decisiones a tomar basado en el resultado de perfil hepático y su aplicación en la práctica clínica.
Cystic fibrosis-related liver disease is seen in 10% of people with the disease. Therapy with modulators has improved morbidity and mortality, but taking into account that they present infrequent side effects, monitoring is necessary. The algorithm proposed by Eldredge et al is analyzed, which suggests the decisions to be made based on the liver profile result and its application in clinical practice.
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Humanos , Criança , Regulador de Condutância Transmembrana em Fibrose Cística/efeitos adversos , Fibrose Cística/complicações , Fibrose Cística/tratamento farmacológico , Hepatopatias/etiologia , Hepatopatias/prevenção & controleRESUMO
Abstract Introduction: Esophageal varices represent one of the main complications in patients with liver cirrhosis. The main objective was to determine the diagnostic performance of the new Baveno VII criteria to exclude the presence of esophageal varices in compensated advanced chronic liver disease (cACLD), in an independent Peruvian population. Materials and methods: A cross-sectional study, including patients with cACLD, upper digestive endoscopy, and transient hepatic elastography from January 2017 to December 2019. Results: The mean age was 59.4 (12.9) years, while the mean measurement of liver stiffness was 27.21 (14.6) kPa. The prevalence of esophageal varices was 85.6%; non-alcoholic fatty liver disease (NAFLD) (63.6%) was the most prevalent etiology, followed by viral hepatitis (14.4%). For esophageal varices exclusion, Baveno VII criteria for all etiologies demonstrated adequate sensitivity and negative predictive value (sensitivity: 96.7%; 95% confidence interval [CI]: 92.3%-98.8%; negative predictive value: 76.9%, 95% CI: 56.4% -91%). However, better diagnostic performance was found when applying the Baveno VII criteria without considering NAFLD patients (sensitivity: 98.4%, 95% CI: 79.2% -99.2%; negative predictive value: 90.9%, 95% CI: 79.2% -99.2%). This would prevent 14% of endoscopic studies with a 9% risk of failing to detect esophageal varices. Conclusions: The Baveno VII criteria present good diagnostic performance for the exclusion of esophageal varices, especially in patients with cACLD without NAFLD, in an independent Peruvian population.
Resumen Introducción: Las várices esofágicas representan una de las principales complicaciones en pacientes con cirrosis hepática. El objetivo principal fue determinar el rendimiento diagnóstico de los nuevos criterios de Baveno VII para excluir la presencia de várices esofágicas en la enfermedad hepática crónica compensada (cACLD), en una población peruana independiente. Materiales y métodos: Estudio transversal que incluyó a pacientes con cACLD, endoscopia digestiva alta y elastografía hepática transitoria desde enero de 2017 hasta diciembre de 2019. Resultados: La edad media fue de 59,4 (12,9) años, mientras que la medición media de rigidez hepática fue de 27,21 (14,6) kPa. La prevalencia de várices esofágicas fue del 85,6%; la enfermedad metabólica asociada al hígado graso (MASLD) (63,6%) fue la etiología más prevalente, seguida de la hepatitis viral (14,4%). Para la exclusión de várices esofágicas, los criterios de Baveno VII para todas las etiologías demostraron una sensibilidad y un valor predictivo negativo adecuados (sensibilidad: 96,7%; intervalo de confianza [IC] del 95%: 92,3%-98,8%; valor predictivo negativo: 76,9%, IC 95%: 56,4%-91%). Sin embargo, se encontró un mejor rendimiento diagnóstico al aplicar los criterios de Baveno VII sin considerar a los pacientes con MASLD (sensibilidad: 98,4%, IC 95%: 79,2%-99,2%; valor predictivo negativo: 90,9%, IC 95%: 79,2%-99,2%). Se evitaría el 14% de estudios endoscópicos con un riesgo del 9% de no detectar várices esofágicas. Conclusiones: Los criterios de Baveno VII presentan buen rendimiento diagnóstico para la exclusión de várices esofágicas, especialmente en pacientes con cACLD sin MASLD, en una población peruana independiente.
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The transmission of Fasciola hepatica occurs only where there are -or recently were- aquatic or amphibious snails of the Lymnaeidae family, the intermediate host of this parasite. Direct detection of these snails is time-consuming and imprecise, hindering accurate and detailed mapping of transmission risk. To identify which microenvironmental factors could be used as proxies for the occurrence of the lymnaeid snail Galba viator, a major intermediate host in South America, a total of 183 1-m2 quadrants across diverse water bodies in an endemic area in Andean Patagonia were manually timed-searched for snails and microenvironmental variables were registered. Data was analyzed using a Bayesian hierarchical occupancy model that assessed the effects of the microenvironmental variables on the presence of snails while considering imperfect snail detection. The model estimated that G. viator predominantly inhabits shallow aquatic environments, in the presence of grasses, where snails of the genus Biomphalaria are also detected, and with scarce tree canopy cover. Physical factors affecting occupancy presumably act as proxies for the average water temperature, while the temperature at the time of sampling was found to affect snail detectability. The identified variables are easy, fast, and inexpensive to measure, and can complement management decisions and risk maps based on coarser remote-sensing data, particularly relevant in a context of growing resistance to anthelminthic drugs.
Assuntos
Fasciola hepatica , Caramujos , Temperatura , Água , Animais , Fasciola hepatica/fisiologia , Caramujos/parasitologia , Água/parasitologia , Água/química , Argentina/epidemiologia , Fasciolíase/veterinária , Fasciolíase/epidemiologia , Fasciolíase/parasitologia , Teorema de BayesRESUMO
Fasciola hepatica has a complex lifecycle with multiple intermediate and definitive hosts and influenced by environmental factors. The disease causes significant morbidity in children and its prevalent worldwide. There is lack of data about distribution and burden of the disease in endemic regions, owing to poor efficacy of the different diagnostic methods used. A novel PCR-based test was developed by using a portable mini-PCR® platform to detect Fasciola sp. DNA and interpret the results via a fluorescence viewer and smartphone image analyzer application. Human stool, snail tissue, and water samples were used to extract DNA. Primers targeting the ITS-1 of the 18S rDNA gene of Fasciola sp. were used. The limit of detection of the mini-PCR test was 1 fg/µL for DNA samples diluted in water, 10 fg/µL for Fasciola/snail DNA scramble, and 100 fg/µL for Fasciola/stool DNA scramble. The product detection by agarose gel, direct visualization, and image analyses showed the same sensitivity. The Fh mini-PCR had a sensitivity and specificity equivalent to real-time PCR using the same specimens. Testing was also done on infected human stool and snail tissue successfully. These experiments demonstrated that Fh mini-PCR is as sensitive and specific as real time PCR but without the use of expensive equipment and laboratory facilities. Further testing of multiple specimens with natural infection will provide evidence for feasibility of deployment to resource constrained laboratories.
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Introducción. La enfermedad hepática grasa no alcohólica (EHGNA) es la hepatopatía crónica más común en el mundo, y en aproximadamente el 10 % de los casos progresará a cirrosis o a carcinoma hepatocelular. La presencia de fibrosis hepática es el mejor predictor de esta progresión, pero su diagnóstico mediante biopsia hepática es invasivo y con riesgo de complicaciones (alrededor del 2,5 %). Existen puntajes no invasivos que se han desarrollado y validado para estadificar la fibrosis, pero no conocemos su rendimiento en la población colombiana. El objetivo de este estudio fue evaluar el desempeño de los puntajes fibrosis-4 (FIB-4), la relación AST/ALT y el índice AST/plaquetas (APRI) para la detección de fibrosis avanzada en pacientes colombianos con EHGNA. Metodología. Estudio observacional tipo transversal de pacientes con EHGNA, que entre 2008 y 2022 tuvieran disponible el resultado de una biopsia hepática. Se hizo una descripción demográfica básica y se calculó el FIB-4, la relación AST/ALT y el APRI con los laboratorios más recientes previos al procedimiento. Posteriormente se calcularon valores de sensibilidad, especificidad, valores predictivos, razones de verosimilitud y área bajo la curva-característica operativa del receptor (AUC-ROC) para los puntos de corte evaluados previamente en la literatura. Resultados. Se incluyeron 176 pacientes, de los cuales el 14,3 % tenían fibrosis avanzada. El FIB-4 presentó el mejor rendimiento con un valor AUC-ROC de 0,74 para el punto de corte de 1,30 y 2,67. En segundo lugar, estuvo la relación AST/ALT con un valor AUC-ROC de 0,68 con el punto de corte de 0,8, y finalmente el APRI con valor AUC-ROC 0,62 con el punto de corte de 1. Conclusión. En la población analizada los tres puntajes tienen menor rendimiento diagnóstico comparado a los resultados reportados en Europa y Japón. El FIB-4 es el único que alcanza una AUC-ROC con rendimiento razonable, con la limitación que 27,4 % obtuvieron un resultado indeterminado.
Introduction. Non-alcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease worldwide, with approximately 10% of cases progressing to cirrhosis or hepatocellular carcinoma. Liver fibrosis presence is the best predictor of this progression, yet its diagnosis through liver biopsy is invasive and poses risk of complications. Although non-invasive scoring systems have been developed and validated for fibrosis staging, their performance remains unexplored in the Colombian population. This study aims to assess the efficacy of the fibrosis-4 (FIB-4) score, AST/ALT ratio, and AST to platelet ratio index (APRI) in detecting advanced fibrosis among Colombian NAFLD patients. Methods. This cross-sectional observational study included NAFLD patients with available liver biopsy results from 2008 to 2022. Basic demographic characteristics were described, and FIB-4, APRI, and AST/ALT ratio were calculated using the latest laboratory data before the procedure. Subsequently, sensitivity, specificity, predictive values, likelihood ratios, and the area under the receiver operating characteristic curve (AUC-ROC) were computed for previously assessed cutoff points. Results. A total of 176 patients were included, among whom 14.3% had advanced fibrosis. FIB-4 demonstrated superior performance with an AUC-ROC value of 0.74 for cutoff points of 1.30 and 2.67. Following was the AST/ALT ratio with an AUC-ROC value of 0.68 for cutoff point of 0.8, and finally, APRI with an AUC-ROC of 0.62 for the cutoff point of 1. Conclusion. All three scores have lower diagnostic efficacy compared to results reported in Europe and Japan. FIB-4 is the only one that achieves an acceptable AUC-ROC performance with the limitation that an indeterminate result was obtained in 27,4% of the sample.
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Tanto la lesión hepática inducida por drogas (DILI), así como la lesión hepática inducida por hierbas (HILI), son una preocupación creciente en la atención sanitaria contemporánea que plantea importantes desafíos clínicos debido a sus variadas etiologías, presentaciones clínicas y posibles resultados potencialmente mortales. Presentamos el caso de un paciente masculino de 38 años con antecedentes de cálculos renales que consultó por dolor lumbar y hematuria. Al ingreso presentó ictericia, hepatomegalia, dolor a la palpación en fosa ilíaca derecha y no tenía signos de hepatopatía crónica, con pruebas de función hepática anormales, que mostraron un patrón hepatocelular asociado con hiperbilirrubinemia. Se descartó obstrucción biliar, trombosis portal, hepatitis autoinmune y viral, con panel autoinmune negativo. El paciente refirió haber consumido un remedio herbario para los cálculos renales llamado "vino rompe cálculos (chancapiedra)", que se supone contiene Phyllanthus niruri, cinco días antes del inicio de los síntomas. Una biopsia hepática reveló hepatitis aguda con infiltrado inflamatorio mixto. Debido al empeoramiento de las pruebas de función hepática y la sospecha de DILI idiosincrásico, se inició un ensayo terapéutico con corticosteroides, que resultó en una mejoría clínica y del perfil hepático. La gravedad de este caso nos recuerda la necesidad de incrementar el seguimiento por parte de las autoridades reguladoras de medicamentos, implementar campañas educativas para los pacientes e informar a la comunidad sobre productos con alertas activas.
Both drug-induced liver injury (DILI) and herb-induced liver injury (HILI) are a growing concern in contemporary healthcare that poses significant clinical challenges due to their varied etiology, clinical presentations, and potential life-threatening outcomes. We present the case of a 38-year-old male patient with a history of kidney stones who consulted for low back pain and hematuria. On admission he presented with jaundice, hepatomegaly, pain on palpation in the right iliac fossa and no signs of chronic liver disease, with abnormal liver function tests, which showed a hepatocellular pattern associated with hyperbilirubinemia. Biliary obstruction, portal thrombosis, autoimmune and viral hepatitis were ruled out, with negative autoimmune panel. The patient reported consuming an herbal remedy for kidney stones called "stone-breaking wine (chancapiedra)", presumed to contain Phyllanthus niruri, five days before the onset of symptoms. A liver biopsy revealedacute hepatitis with mixed inflammatory infiltrate. Due to worsening liver function tests and suspicion of idiosyncratic DILI, a therapeutic trial with corticosteroids was initiated, which resulted in clinical and liver profile improvement. The severity of this case reminds us of the need to increase follow-up by drug regulatory authorities, implement educational campaigns for patients, and inform the community about products with active alerts.
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Objetivo: Identificar as estratégias utilizadas para o diagnóstico precoce da cirrose hepática, considerando reflexões sobre a atuação do (a) enfermeiro (a) nesse processo, principalmente, no contexto da Atenção Primária à Saúde. Métodos: Revisão integrativa da literatura. As buscas foram realizadas nas bases de dados indexadas na Biblioteca Virtual de Saúde e no portal PubMed. Incluiu-se artigos originais, textos completos disponíveis gratuitamente, na íntegra, publicados entre janeiro de 2013 e fevereiro de 2024 nos idiomas inglês, português e espanhol. Resultados: Levantou-se 5471, sendo que 1771 foram descartadas por duplicação. Os critérios de elegibilidade resultaram em 65 artigos. Após análise criteriosa, 45 artigos formaram a amostra final. Conclusão: Evidenciou-se que são distintas as estratégias para a detecção da cirrose em sua fase inicial, sendo estas, em sua maioria, aplicáveis ao contexto da Atenção Primária à Saúde e correlacionadas com a atuação de enfermeiros (as). (AU)
Objective: To identify the strategies used for the early diagnosis of liver cirrhosis, considering reflections on the role of nurses in this process, mainly in the context of Primary Health Care. Methods: Integrative literature review. The searches were carried out in databases indexed in the Virtual Health Library and on the PubMed portal. Original articles were included, complete texts available for free, in full, published between January 2013 and February 2024 in English, Portuguese and Spanish. Results: 5471 were collected, 1771 of which were discarded due to duplication. The eligibility criteria resulted in 65 articles. After careful analysis, 45 articles formed the final sample. Conclusion: It was evident that the strategies for detecting cirrhosis in its initial phase are different, most of which are applicable to the context of Primary Health Care and correlated with the work of nurses. (AU)
Objetivo: Objetivo: Identificar las estrategias utilizadas para el diagnóstico precoz de la cirrosis hepática, considerando reflexiones sobre el papel del enfermero en ese proceso, principalmente en el contexto de la Atención Primaria de Salud. Métodos: Revisión integrativa de la literatura. Las búsquedas se realizaron en bases de datos indexadas en la Biblioteca Virtual en Salud y en el portal PubMed. Se incluyeron artículos originales, textos completos disponibles de forma gratuita, íntegros, publicados entre enero de 2013 y febrero de 2024 en inglés, portugués y español. Resultados: Se recolectaron 5471, de los cuales 1771 fueron descartados por duplicación. Los criterios de elegibilidad resultaron en 65 artículos. Después de un análisis cuidadoso, 45 artículos formaron la muestra final. Conclusión: Se evidenció que las estrategias para detectar la cirrosis en su fase inicial son diferentes, la mayoría de las cuales son aplicables al contexto de la Atención Primaria de Salud y correlacionadas con el trabajo del enfermero. (AU)
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Cirrose Hepática , Equipe de Assistência ao Paciente , Diagnóstico Precoce , HepatopatiasRESUMO
This review aims to promote discussion about the situation of fasciolosis in ruminants in Brazil. The disease is still found more frequently in the South and Southeast regions, but reports outside these areas show the spread of the disease, including human cases. Many studies have been published on the diagnosis and control of fasciolosis, but development of field diagnosis methods and drugs that control all stages of the parasite is still a challenge. Studies should be carried out of new distribution areas and alternatives for control in Brazil, which depends on understanding the complex interactions between of the environment, ecosystems and hosts of this trematode.
Esta revisão tem como objetivo levantar uma discussão sobre a situação da fasciolose em ruminantes no Brasil. A enfermidade ainda se encontra mais frequentemente nas regiões Sul e Sudeste do país, entretanto relatos fora dessas regiões evidenciam a expansão da enfermidade, inclusive casos em humanos. Muitos estudos têm sido publicados sobre o diagnóstico e controle da fasciolose, entretanto, o diagnóstico a campo e fármacos que combatam todas as fases evolutivas do parasito ainda são desafios. Novos estudos devem ser realizados sobre novas áreas de distribuição e alternativas de controle em condições brasileiras, o que depende da compreensão das complexas interações entre meio ambiente, ecossistemas e hospedeiros desse trematódeo.
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INTRODUCTION AND AIMS: Hepatocellular carcinoma (HCC) is a primary malignant tumor of liver epithelial cells and is the most frequent primary liver cancer. The broadening of transplantation and resectability criteria has made therapeutic decisions more complex. Our aim was to describe the clinical and survival characteristics of patients with HCC treated through resection or liver transplantation at our hospital and identify the presence of factors that enable outcome prediction and facilitate therapeutic decision-making. MATERIALS AND METHODS: Patients with HCC that underwent surgery with curative intent at the Hospital Universitario Marqués de Valdecilla, within the time frame of 2007 and 2017, were retrospectively identified. Survival, mortality, disease-free interval, and different outcome-related variables were analyzed. RESULTS: Ninety-six patients with a mean follow-up after surgery of 44 months were included. Overall mortality and recurrence were higher in the resection group. Mean survival was 51.4 months in the liver transplantation group and 37.5 months in the resection group, and the disease-free interval was 49.4⯱â¯37.2 and 27.4⯱â¯28.7 months, respectively (pâ¯=â¯0.002). The tumor burden score was statistically significant regarding risk for recurrence and specific mortality. CONCLUSIONS: There appears to be no patient subgroup in whom the results of surgical resection were superior or comparable to those of transplantation. Tumor burden determination could be a useful tool for patient subclassification and help guide therapeutic decision-making.