Non-Alcoholic Fatty Liver Disease in Cuba.

INTRODUCTION: With a global adult prevalence of 24%, non-alcoholic fatty liver disease is a global health problem that parallels the worldwide increase of obesity. Its frequency, clinical characteristics and related diseases in Cuba remain unknown. OBJECTIVE: Describe the clinical characteristics, comorbidities and personal habits of patients with non-alcoholic fatty liver disease who are being treated in secondary and tertiary health facilities in seven Cuban provinces. METHODS: A cross-sectional, multicenter study was carried out in 6601 adults seen at gastroenterology outpatient clinics of nine hospitals in seven Cuban provinces from September 2018 through May 2019. Non-alcoholic fatty liver disease was diagnosed by abdominal ultrasound. The study included 1070 patients who met the diagnostic and study criteria and agreed to participate. Their personal habits and anthropometric and clinical characteristics, comorbidities and other aspects of their medical histories were recorded. RESULTS: Of the 1070 participants, 60.7% (649) were women. Participants' average age was 54.5 years and average body mass index was 30.5 kg/m2. A total of 397 (37.1%) were overweight and 574 (53.6%) were obese, 945 (88.3%) led a sedentary lifestyle, 564 (52.7%) had high blood pressure, 406 (37.9%) had lipid disorders and 301 (28.1%) were diabetic. While 484 (45.2%) of patients were asymptomatic, the most frequent clinical signs and symptoms were fatigue (262; 24.5%), dyspepsia (209; 19.5%), abdominal pain (306; 28.5%) and hepatomegaly (189; 17.7%). Liver cirrhosis was present in 37 (3.5%) patients at the time of diagnosis. Family history of type 2 diabetes mellitus and obesity were identified in 391 (36.5%) and 279 (26.1%) of participants, respectively. CONCLUSIONS: Prevalence of non-alcoholic fatty liver disease in these Cuban patients coincides with that reported in the Caribbean region, which has high levels of obesity, overweight and sedentary lifestyles. Most were asymptomatic, female or had metabolism-related comorbidities such as high blood pressure, type 2 diabetes mellitus and dyslipidemia.

Pioderma Gangrenoso asociado a colitis ulcerosa en gestante / Pyoderma gangrenosum associated with ulcerative colitis in a pregnant woman

RESUMEN Introducción: El pioderma gangrenoso corresponde a una dermatosis crónica inflamatoria rara, cuya etiología y patogénesis es aún incierta, aunque factores inmunológicos y disfunción neutrofílica parecen desempeñar un papel importante. Se presenta en la mayoría de los casos asociada a enfermedad sistémica no infecciosa, como artritis reumatoide, malignidad hematológica y enfermedad inflamatoria intestinal. Presentación de caso: Paciente femenina de la raza blanca de 26 años de edad con antecedentes de colitis ulcerosa y ahora con ocho semanas de gestación, que se presenta a consulta de gastroenterología del Hospital General Docente "Abel Santamaría Cuadrado", remitido de su área de salud, por presentar diarreas con flemas y sangre, además de lesiones nodulares, pápulas y vesículas múltiples con bordes irregulares, en miembros inferiores, superiores y región posterior del tronco, muy dolorosas. Conclusiones: La evolución de la colitis ulcerosa y la gestación se correlacionan con la actividad de la enfermedad en el momento de la concepción, de forma que la existencia de brote de actividad en este momento se ha asociado a un mayor riesgo de aborto y a una peor respuesta al tratamiento médico.

ABSTRACT Introduction: pyoderma gangrenosum is a rare chronic inflammatory dermatosis, which etiology and pathogenesis is still uncertain, although immunological factors and neutrophilic dysfunction seem to play an important role. In most cases, it occurs associated with non-infectious systemic disease, such as rheumatoid arthritis, hematological malignancy and inflammatory bowel disease. Case report: a 26 year-old white female patient with a history of ulcerative colitis and eight weeks pregnant, who presented herself to the gastroenterology office at Abel Santamaria Cuadrado General Teaching Hospital, she was referred from her health area, presenting diarrhea with phlegm and blood, in addition to nodular lesions, papules and multiple vesicles with irregular edges in lower limbs, upper limbs and posterior region of the trunk, very painful. Conclusions: the evolution of ulcerative colitis and pregnancy are correlated with the activity of the disease at the time of conception, so that the existence of an outbreak at this time has been associated with a higher risk of abortion and a worse response to medical treatment.

Absceso hepático amebiano, presentación atípica / An atypical presentation of amoebic hepatic abscess

Introducción: el absceso hepático amebiano es la manifestación extraintestinal más frecuente de la infección por entoameba histolytica, se calcula que el 10% de la población mundial esta infestada por el parasito, siendo más frecuente en países tropicales, donde hay situaciones de hacinamiento y malas condiciones sanitarias. África, Latinoamérica, el Sudeste Asiático y la India tienen problemas de salud considerables a raíz de esta enfermedad, en Cuba se ha comprobado que la amebiasis no constituye uno de los parasitismos más frecuentes. Presentación de caso: paciente masculino de 48 años de edad y de nacionalidad India, que presenta (hallazgos clínicos) demostrándose lesión única en lóbulo hepático derecho, diagnosticado por ecografía y resonancia magnética nuclear, confirmándose la presencia de anticuerpos séricopara entoameba histolytica. El tratamiento con metronidazol produce mejora clínica y radiológica. Conclusiones: la presentación clínica atípica constituye un elemento destacable y que amerita ser considerada en la práctica clínica diaria.

Introduction: amoebic hepatic abscess is the extraintestinal manifestation of an infection by entamoeba histolytica. Estimations are made that 10% of the world population has been infected by the parasite, being more frequent in tropical regions, where overcrowding and bad sanitary conditions occur. Africa, Latin America, Southeast Asian and India have considerable health problems, resulting from this disease. In Cuba amebiasis has been proved not to be one of the most frequent parasitism cases. Case presentation: male patient of age 48 years and of Indian nationality, presenting clinical findings, which proves a unique lesion in the right liver lobule, diagnosed by ultrasound scan and nuclear magnetic resonance. The presence is confirmed of serum antibodies against entamoeba histolytica. Treatment with metronidazole produced clinical and radiological improvement. Conclusions: atypical clinical presentation constitutes a remarkable element worthy considered in daily clinical practice.

Infección por Helicobacter pylori en pacientes atendidos en consulta de gastroenterología / Helicobacter pylori infection in patients who attended the gastroenterology office

Introducción: la infección por Helicobacter pylori constituye la infección crónica más extensamente difundida en la especie humana. Objetivo: determinar las características clínico epidemiológicas de infección por Helicobacter pylori en pacientes atendidos en consulta de Gastroenterología. Material y Método: se realizó unestudio observacional descriptivo conformado por un universo de 240 pacientes con determinaci ón de Helicobacter pylori por coloración de fucsina básica de Ziehl Neelsen y la muestra la integraron 204 pacientes positivos a dicho examen. Las variables a considerar fueron: la edad, el sexo, diagnóstico histológico, síntomas clínicos y la evolución clínica posterior al tratamiento específico para Helicobacter pylori. Se utilizó la técnica estadística de análisis de distribución de frecuencias. Resultados: la infección por Helicobacter pylori en el 85 % de los casos estudiados con predominio del sexo masculino, siendo la gastritis crónica con 63,7% la alteración gástrica que más se asoció a la infección, la epigastralgia fue el síntoma más frecuente y el 44,6 % de los casos evolucionaron de forma no satisfactoria. Conclusiones: Se obtuvo un alto por ciento de infección por Helicobacter pylori.

Introduction: helicobacter pylori infection constitutes the chronic infection most widely spread amongst the human race. Objective: to determine the clinical-epidemiological characteristics of Helicobacter pylori infection in patients who attended the Gastroenterology office. Method: a descriptive observational study was performed with a universe of 240 patients with Helicobacter pylori determined by Ziehl Neelsen basic fuchsine staining, while the sample was confirmed by 204 patients tested positive to that test. The considered variables were age, sex, histological diagnosis, clinical symptoms, and clinical history following the specific treatment of Helicobacter pylori. Frequencies distribution was used as a statistical analysis technique. Results: Helicobacter pylori infection, in the 85 % of the studies cases, with a predominance of the male sex, being chronic gastritis with 63,7% the gastric disorder more associated with the infection, while epigastric pain was the most frequent symptom and 44,6 % of the cases had a unsatisfactory evolution. Conclusions: a high percentage of Helicobacter pylori infection was obtained.