Abnormal Liver Tests during Hospitalization Predict Mortality in Patients with COVID-19: A Multicenter Study from South America.

Background: The role of liver function tests (LFT) as prognostic factors in patients admitted with COVID-19 has not been fully investigated, particularly outside resource-rich countries. We aimed at evaluating the prognostic value of abnormal LFT on admission and during hospitalization of patients with COVID-19. Methods: We performed a retrospective study that included 298 adult patients hospitalized for COVID-19, between 05/2020 and 02/2021, in 6 hospitals from 5 countries in South America. We analyzed demographic and comorbid variables and laboratory tests on admission and during hospitalization. LFT over twice the upper limit of normal (ALEx2) were also evaluated in relation to a variety of factors on admission and during hospitalization. De novo-ALEx2 was defined as the presence of ALEx2 at one week of hospitalization in patients without ALEx2 on admission. Patients were followed until hospital discharge or death. Multivariable analysis was used to evaluate the association between ALEx2 on admission and during hospitalization and mortality. Results: Of the total of 298 patients, 60% were male, with a mean age of 60 years, and 74% of patients had at least one comorbidity. Of those, 137 (46%) patients were transferred to the intensive care unit and 66 (22.1%) patients died during hospitalization. ALEx2 on admission was present in 87 (29.2%) patients and was found to be independently associated with 1-week mortality (odds ratio (OR) = 3.55; 95% confidence interval (95%CI) 1.05-12.05). Moreover, 84 (39.8%) out of 211 patients without ALEx2 at admission developed de novo-ALEx2, which was independently associated with mortality during second week of hospitalization (OR = 6.09; 95%CI 1.28-29) and overall mortality (OR = 2.93, 95%CI 1.05-8.19). Conclusions: A moderate elevation of LFT during admission was associated with a poor short-term prognosis in patients hospitalized with COVID-19. In addition, moderate elevation of LFT at one week of hospitalization was an independent risk factor for overall mortality in these patients.

Enfisema subcutáneo generalizado más neumotórax a tensión posterior a CPRE / Generalized subcutaneous emphysema plus pneumothorax to tension after CPRE

La colangiografía retrograda endoscópica (CPRE) es una técnica invasiva que permite diagnosticar y tratar patologías de vía biliar. La tasa de complicaciones es baja volviendo al procedimiento seguro, no exento de complicaciones como pancreatitis, sangrados, colangitis e incluso perforación (incidencia menor al 1,5%). Se presenta el caso clínico de un paciente de sexo masculino, con dolor en hipocondrio derecho, vómito y fiebre que presenta dilatación del extremo distal del colédoco por causa litiásica evidenciado por colangioresonancia. Se programa para CPR intentándose la canulación sin papilotomía; durante el procedimiento el paciente presenta enfisema subcutáneo y neumotórax a tensión ameritando tratamiento de emergencia. Se decide manejo quirúrgico a las doce horas de la CPRE por la marcada inestabilidad hemodinámica del paciente; en el intraoperatorio y en una endoscopia ulterior no se evidenció una lesión macroscópica que justifiquen la clínica e imágenes radiológicas que presentó el paciente. Se realiza tratamiento quirúrgico de perforación duodenal que obligó una estancia en terapia intensiva durante 11 días. Se complementa con una revisión bibliográfica de las complicaciones post CPRE. (AU)

Endoscopic retrograde cholangiography (ERCP) is an invasive technique that allows diagnosing and treating pathologies of the bile duct. The rate of complications is low returning to the safe procedure, not free of complications such as pancreatitis, bleeding, cholangitis and even perforation (incidence less than 1.5%). We present the clinical case of a male patient, with pain in the right hypochondrium, vomiting and fever that presents dilatation of the distal end of the common bile duct due to lithiasic cause evidenced by cholangioresonance. It is programmed for CPR, trying cannulation without papillotomy; During the procedure, the patient presents subcutaneous emphysema and tension pneumothorax, requiring emergency treatment. Surgical management was decided twelve hours after ERCP due to the marked hemodynamic instability of the patient; In the intraoperative period and in a subsequent endoscopy, there was no evidence of a macroscopic lesion that justified the clinical and radiological images presented by the patient. Surgical treatment of duodenal perforation wasperformed, which forced a stay in intensive therapyfor11 days. It is complemented by a bibliographic review of post-ERCP complications. (AU)

Pancreatitis aguda como manifestación atípica de chikungunya. Reporte de un caso / Acute pancreatitis as an chikungunya atypical manifestation. A case report

La fiebre chikungunya es una enfermedad tropical transmitida a los humanos mediante la picadura del mosquito Aedes aegypti y Aedes albopictus. Se manifiesta por fiebre alta, cefalea, mialgias y artralgias. Generalmente tiene un comportamiento benigno; sin embargo, se han reportado casos con manifestaciones atípicas y mortales. Es una virosis emergente del siglo XXI que en el Ecuador se convirtió en una epidemia en el año 2014. Reportamos un caso de una paciente de sexo femenino, 52 años de edad, residente en Quito (Ecuador) que presenta dolor abdominal, dolor torácico, artralgias, mialgias y alza térmica. Fue tratada por pancreatitis aguda de origen a determinar; no obstante, por los antecedentes epidemiológicos y el cuadro sintomático sugerente, se solicitó IgM (inmunoglobulina M) para chikungunya que fue positiva. Se la trató mediante hidratación y analgésicos; tuvo una adecuada respuesta sintomática.

Chikungunya fever is a tropical disease transmitted to humans by the mosquito bite Aedes aegypti and Aedes albopictus. It is characterized clinically by causing high fever, headache, myalgias and arthralgias; usually has a benign behavior, but cases with atypical manifestations that produce mortality are reported. It is an emerging virus in the 21st century. We report a case of a 52-year-old female patient living in Quito, Ecuador, with abdominal pain, chest pain, arthralgia, myalgias and fever. It was treated by acute pancreatitis of origin to determine, however by epidemiological antecedents and suggestive clinical, we decided to request IgM for chikungunya which was positive. The patient received treatment with hydration and analgesia, with adequate clinical response

Utilidad de los predictores clásicos de severidad en pancreatitis aguda / Usefulness of the classic predictors of severity in acute pancreatitis

Objetivo. Evaluar la utilidad de las escalas tradicionales de Ranson, Glasgow, Apache II y Balthazar en la predicción de la severidad de la pancreatitis aguda. Métodos. De forma prospectiva en el servicio de Gastroenterología del HCAM analizamos una serie de casos, entre julio del 2005 y julio del 2006. Se incluyeron 135 de 138 pacientes con pancreatitis aguda, que cumplieron con los criterios de inclusión. Se obtuvo datos clínicos, estudios de laboratorio e imagen para establecer los valores de las escalas de Ranson, Glasgow, Apache 11 y Balthazar. Calculamos sensibilidad, especificidad, valor predictivo positivo (YPP), valor predictivo negativo (VPN) y Likelihood ratio (LR) de cada escala. Resultados. De los 135 pacientes, 101 (74.8%) presentaron PA leve y 34 (25.2%) PA grave. El valor promedio (OS) de las escalas evaluadas en los pacientes con PA leve versus grave fue: Ranson 2,64 (1,41) vs 4,6 (1 ,6); Glasgow 1,81 (1,17) vs 3,32 (1,42); Apache TI 6,84 (3,63) vs 11,82 (5,05); ISTC 1,63 (1,14) vs 7,47 (1,97). La sensibilidad, especificidad, YPP y VPN para cada escala fue: Ranson 76,5%, 72,2%, 48,1%, y 90,1%; Glasgow 70,6%, 72,3%, 46,2% y 87, 9%; Apache 11 82,3%, 57,4%, 39,4% y 90.6%; ISTC 79,4%, 100%, 100% y 93.5% respectivamente, Conclusión. Oe acuerdo a nuestros resultados en esta serie, el ISTC es la mejor escala para predecir la severidad de la PA. Tiene el inconveniente de la temporalidad, ya que se requiere esperar más de 48 horas, para la valoración real.

Leiomiosarcoma: reporte de un caso clínico / Leiomyosarcomas: a case report

Los leiomiosarcomas son tumores del músculo liso que se presentan con escasa frecuencia en el tracto gastrointestinal. Se derivan del tejido mesenquimal y generalmente metastatizan a hígado o pulmones. Su malignidad depende de factores celulares, de la localización y el tamaño tumoral. Presentamos el caso de un paciente de 82 años de edad con antecedente de un leiomioma gástrico, que acude con sangrado digestivo alto e ictericia progresiva, hepatomegalia y perdida de peso considerable. Los estudios finales concluyen en un leiomiosarcoma con metástasis hepáticas.

Leiomyosarcomas are rare tumors of the gastrointestinal tract, and drift to the mesenchymal tissue. Rarely invade adyacent organs and metastasize to liver and lungs. The malignant features depend on cell changes, place and size of tumor. The case report is a 82 year old male with history of gastric leiomyoma which he has had for the last 3 years ago. He was admitted for upper gastrointestinal bleeding, jaundice, hepatomegaly and weight loose. The final investigation reveals a leiomyosarcoma with liver metastasis.