Colangiopancreatografía retrógrada endoscópica y antígeno carbohidrato 19-9 en el diagnóstico diferencial de las estenosis biliares / Endoscopic retrograde cholangiopancreatography and carbohydrate antigen 19-9 in the differential diagnosis of biliary strictures

Introducción: las estenosis de vías biliares incluyen un amplio espectro de enfermedades benignas y malignas.Objetivo: determinar la utilidad de la colangiopancreatografía retrógrada endoscópica (CPRE) y del antígeno carbohidrato 19-9 (CA 19-9) en el diagnóstico diferencial de las estenosis biliares.Método: estudio observacional, prospectivo y transversal de 75 pacientes con estenosis biliar diagnosticada por CPRE entre octubre de 2018 y enero de 2020; las variables fueron: tipo de estenosis biliar por CPRE, citología biliar y CA 19-9. Para el análisis estadístico se utilizaron medidas descriptivas de resumen de acuerdo con el tipo de variable. La relación entre ellas se realizó mediante los test estadísticos del chi cuadrado de Pearson y la probabilidad exacta de Fisher, denotando las diferencias como significativas cuando p < 0,05. Se calculó el punto de corte del CA 19-9 mediante la curva ROC yel índice kappa de Cohen para medir la concordancia entre los métodos diagnósticos.Resultados: la citología fue positiva en 51 (68 %) pacientes con estenosis biliar. La edad media fue de 63 años. La colangitis aguda predominó en las estenosis malignas (93,7 %). Existió concordancia entre la citología y el valor de corte calculado para el CA 19-9 de 85,4 U/ml, con índice de concordancia kappa = 0,332 (p = 0,004), así como entre la CPRE y la citología, con índice de concordancia kappa = 0,701 (p < 0,001).Conclusiones: un valor sérico de CA 19-9 superior a 85,4 U/ml está altamente relacionado con la estenosis biliar neoplásica. (AU)

Endoscopic retrograde cholangiopancreatography and carbohydrate antigen 19-9 in the differential diagnosis of biliary strictures.

INTRODUCTION: bile-duct strictures include a wide spectrum of benign and malignant diseases. OBJECTIVE: to determine the usefulness of endoscopic retrograde cholangio-pancreatography (ERCP) and circulating carbohydrate antigen 19-9 (CA 19-9) for the differential diagnosis of biliary strictures. METHOD: an observational, prospective, cross-sectional study was performed in 75 patients with biliary stricture diagnosed by ERCP between October 2018 and January 2020. The variables included type of biliary stricture as diagnosed by ERCP, biliary cytology, and CA 19-9 levels. For the statistical analysis, descriptive statistics were used according to type of variable. The relationships between them was analyzed using Pearson's chi-square and Fisher's exact probability tests, assuming differences were significant when p < 0.05. The cut-off point for CA 19-9 was calculated using the ROC curve, and Cohen's kappa index was used to measure concordance between diagnostic methods. RESULTS: cytology was positive in 51 (68 %) patients with biliary stenosis. Mean age was 63 years. Acute cholangitis predominated in malignant strictures (93.7 %). There was agreement between cytology and the cut-off value calculated for CA 19-9 of 85.4 U/mL, with a kappa agreement index of 0.332 (p = 0.004), and between ERCP and cytology, with a kappa concordance index of 0.701 (p < 0.001). CONCLUSIONS: a serum CA 19-9 value higher than 85.4 U/mL is highly related to neoplastic biliary stenosis.

Effect of symbiotic fermented milk together with conventional therapy in the eradication treatment of Helicobacter pylori.

Helicobacter pylori (H. pylori) infection is associated with various gastrointestinal diseases and is the dominant microorganism in gastric microbiota. There are multiple therapeutic combinations used with uneven results for eradication. Studies have been carried out with some strains of Lactobacillus (L) that support its preponderant role in the treatment of infection and reduction of inflammation.

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.

Manifestaciones cardiovasculares de la cirrosis hepática según su gravedad evaluada por la clasificación de Child-Pugh / Cardiovascular manifestations of liver cirrhosis according to its severity evaluated through the Child-Pugh score

RESUMEN Introducción: La miocardiopatía cirrótica es una disfunción cardíaca que está presente en pacientes con cirrosis hepática, en ausencia de otra enfermedad cardíaca. Objetivos: Describir los hallazgos electrocardiográficos, ecocardiográficos y el estado de la oxigenación arterial en pacientes con cirrosis hepática. Método: Se realizó un estudio observacional, descriptivo, transversal, con 95 pacientes en protocolo de trasplante hepático en el CIMEQ, en el período establecido, para lo cual se tuvo en cuenta la clasificación de gravedad de Child-Pugh. Resultados: Se investigaron 95 pacientes (53 mujeres [55,7%]), a los cuales se les realizó electrocardiograma, ecocardiograma, determinación de la presión arterial de oxígeno y su saturación por oximetría. Se usó el SPSS (20), con medidas de resumen para variables cualitativas (razones y porcentajes) y cuantitativas (media y desviación estándar). Los resultados muestran mayor compromiso de las variables estudiadas en relación con la mayor gravedad de la cirrosis hepática, evaluada por Child-Pugh, en relación con la onda S' (p=0,03), onda A (p=0,03), presión sistólica del tronco de la arteria pulmonar (p=0,004) y presión parcial de oxígeno arterial (p=0,004). Conclusiones: Al tener en cuenta dicha clasificación, se evidenció acercamiento progresivo a valores anormales de las variables ecocardiográficas para el análisis de la función diastólica, presiones pulmonares y del estado de la oxigenación arterial expresado por la PaO2, en los estadios más avanzados de la cirrosis hepática.

ABSTRACT Introduction: Cirrhotic cardiomyopathy is a cardiac dysfunction that is present in patients with liver cirrhosis, in the absence of other heart disease. Objectives: To ascertain electrocardiographic and echocardiographic findings and arterial oxygenation state in patients with liver cirrhosis. Methods: An observational, descriptive, cross-sectional study was conducted with 95 liver transplant recipients at the CIMEQ over the established period. The Child-Pug severity classification was applied for this purpose. Results: We screened 95 patients (53 women [55.7%]) who underwent electrocardiography, echocardiography, and determination of blood oxygen pressure and oxygen saturation by oximetry. The SPSS (20), with summary measures for qualitative (ratios and percentages) and quantitative (mean and standard deviation) variables was used. Our results reveal greater compromise of the variables studied in correlation with a greater severity of liver cirrhosis, as assessed by Child-Pugh, in relation to S' wave (p=0.03), A wave (p=0.03), pulmonary artery trunk systolic pressure (p=0.004) and arterial oxygen partial pressure (p=0.004). Conclusions: Taking into account the Child-Pugh score, study showed a progressive approach to pathological values of echocardiographic variables for the analysis of diastolic function and pulmonary pressures, as well as oxygen content of arterial blood (PaO2), in the most advanced stages of liver cirrhosis.