Endoscopic ultrasound-guided liver biopsy (EUS-LB) has been proposed as a novel technique that could offer some advantages over traditional methods, especially regarding specimen adequacy. A ...systematic review that included 32 studies evaluating the quality of percutaneous hepatic biopsies (PC-LB) demonstrated that the average number of portal tracts with this technique was 7.5 +/-3.4. (1) The objective of our study was to determine if EUS-LBs meet AASLD quality criteria, defined by the presence of more than 11 portal tracts.
A retrospective study was carried out from a prospectively created EUS-LB database. The primary objective was to evaluate the sample quality, using as a parameter the number of portal tracts. The secondary objective was to determine the security profile of the procedure and evaluate the rate of complications.
82 patients were included (average age 55). The main indication for tissue acquisition was elevated transaminases. Steatosis/steatohepatitis was the most common histological diagnosis. The average number of portal tracts was 19.23 +/- 7.2. All the samples had at least 11 portal tracts. The rate of adverse events was 9.75%. The majority were minor complications (post-procedure pain). Only one patient presented a severe complication, bleeding secondary to an arterio-biliary fistula, that required embolization by interventional radiology.
EUS-LBs meet quality criteria established by AASLD, have an excellent security profile, and might be considered the method of choice for liver tissue acquisition in the centers where the resource is available.
Introducción: Costa Rica es un país con un sistema de salud pública que ha permitido detectar oportunamente a los pacientes con hepatitis C, y ofrecer un tratamiento con base en antivirales de acción ...directa (AAD) de última generación. No obstante, no se han publicado estudios que evalúen la respuesta de la población costarricense a estos fármacos.Objetivo: describir la efectividad clínica del tratamiento con AAD en una cohorte tratada en la Caja Costarricense de Seguro Social (CCSS).Materiales y métodos: estudio retrospectivo de los expedientes clínicos de los pacientes tratados con sofosbuvir / ledipasvir, sofosbuvir / velpatasvir y ombitasvir / paritaprevir / ritonavir / dasabuvir, en tres hospitales nacionales para adultos de la CCSS, en 2017 - 2018. Se recolectaron variables epidemiológicas, clínicas y analíticas, y se compararon los resultados pre y postintervención.Resultados: se reclutaron 139 pacientes; 22 fueron excluidos porque no cumplían los criterios. El análisis se realizó con 117 pacientes, de los cuales 101 tenían viremia documentada para determinación de la respuesta virológica sostenida (RVS). La mayoría de los pacientes fue costarricense, nacida en 1945 - 1965, con factores de riesgo para hepatitis C no documentados, sin cirrosis e infectada por el genotipo 1b. La RVS general de la población estudiada fue del 98 %, sin notarse diferencia significativa entre pacientes cirróticos (94 %) y no cirróticos (100 %).Hubo una reducción significativa (p < 0,01) en: el índice de aspartato-aminotransferasa: número de plaquetas (APRI), el puntaje del Modelo para Enfermedad Hepática Terminal (MELD), la alaninoaminotransferase (ALT) y la bilirrubina total, para los pacientes tratados con AAD.
Conclusión: los antivirales de acción directa fueron efectivos en la población tratada en Costa Rica, con respuesta viral sostenida similar a aquella reportada en otros ensayos de vida real.
Se hizo un estudio retrospectivo en el cual se revisaron los expedientes de 1135 pacientes sometidos a endoscopias digestivas diagnósticas y terapéuticas, en el período comprendido entreenero de 2016 ...y marzo de 2017. Los pacientes se organizaron por su: edad, género, clasificación de riesgo de la Sociedad Americana de Anestesiólogos, indicación para la endoscopia, y dosis utilizada de propofol. Se registraron los efectos adversos asociados al uso de Propofol, tales como: episodios de hipoxemia transitoria, complicaciones cardiopulmonares serias y muerte.
Pyogenic liver abscess (PLA) is a rare disease with an estimated incidence that varies widely across the globe, being as high as 115.4/100000 habitants in Taiwan and as low as 1.1-1.2/100000 ...habitants in Europe and Canada. Even though there are multiple microorganisms capable of producing an abscess in the liver, including
, fungi, and viruses, most abscesses are derived from bacterial infections. The epidemiology of PLA in Mexico is currently unknown.
To describe the clinical, demographic and microbiologic characteristics of PLA in Mexico.
This is a retrospective study carried out in two centers, and included patients seen between 2006 and 2018 with the diagnosis of pyogenic abscess. We collected demographic, clinical, and microbiological information, treatment, complications, and outcomes. A logistic regression analysis was used to determine the association between different variables and mortality rates.
A total of 345 patients were included in this study. 233 (67.5%) had confirmed PLA, 133 (30%) patients had no positive culture and negative serology and 9 (2.5%) had mixed abscesses. The mean age was 50 years (ranging from 16-97 years) and 63% were female. 65% of the patients had positive cultures for Extended Spectrum Beta-Lactamases (ESBL)-
and
. Cefotaxime was administered in 60% of cases. The most common sources of infection were ascending cholangitis and cholecystitis in 34 (10%) and 31 (9%), respectively. The median length of hospital stay was 14 d. 165 patients underwent percutaneous catheter drainage. The inpatient mortality rate was 63%. Immunocompromised state OR 3.9, 95%CI: 1.42-10.46, ESBL-
OR 6.7, 95%CI: 2.7-16.2 and
OR 4-8, 95%CI: 1.6-14.4 predicted inpatient mortality by multivariate analysis.
The prevalence of PLA is increasing in Mexico and has a very high mortality rate. ESBL-
and
are the most common microorganisms causing PLA and are independent predictors of inpatient mortality.
La colonoscopia se considera como la prueba de elección para el tamizaje de cáncer colorrectal. Su eficacia dependerá de múltiples factores entre los que se incluyen una preparación adecuada, una ...inspección meticulosa al realizar la exploración, apego a las recomendaciones de seguimiento y una capacitación óptima del colonoscopista. Para asegurar que los endoscopistas a nivel nacional brinden una colonoscopia de calidad, surge la iniciativa de establecer indicadores de calidad locales. A continuación, la Asociación Costarricense de Gastroenterología y Endoscopia Digestiva propone los indicadores de calidad para la realización de colonoscopias seguras y efectivas.
Sinusoidal Obstruction Syndrome (SOS) refers to an obliterative inflammation of terminal hepatic veins characterized by hepatomegaly, right upper quadrant pain, jaundice, and ascites, most often ...occurring in patients after hematopoietic stem cell transplantation (HSCT), although many other etiologies have been described. The diagnosis is suspected based on clinical features, risk factors and confirmed by liver biopsy. Many treatments have been described, mostly studied in SOS after HSCT. Little is known about the treatment of SOS in liver transplant (LT) recipients. Herein we describe an adult male patient with liver cirrhosis secondary to SOS which recurred two years after LT and was treated with systemic anticoagulation and double immunosuppressive scheme with calcineurin inhibitors and mycophenolate mofetil. Our case highlights the possible immunological background in patients presenting with SOS after LT.
Introducción: El déficit de alfa-1 Antitripsina (a1AT) es una de las enfermedades genéticas más prevalentes en el ser humano, lastimosamente como entidad clínica tiende a ser pobremente sospechada. ...Con más de 100 mutaciones conocidas, las que se encuentran asociadas a enfermedad hepática son los homocigotos Z en el alelo del gen a1AT que ocurre en 1 a 2000- 3500 nacimientos. A diferencia de la enfermedad pulmonar donde las secuelas ocurren primordialmente por el déficit propio de la a1AT con destrucción enzimática de la microestructura de la vía aérea, el compromiso hepático ocurre por acúmulo intracelular de la proteína Z mutante, que se desdobla de forma aberrante, en vez de ser secretada. Esta acumulación produce lesión celular, hepatitis, fibrosis, cirrosis y carcinoma hepatocelular (CHC) por desencadenar una serie de eventos que culminan con la apoptosis hepatocitaria, regeneración e injuria crónica. Materiales y métodos: Se presentan 9 casos de pacientes que se han encontrado bajo nuestro cuidado, con edades variadas desde infantes hasta adultos mayores. Resultados: Cada uno con una presentación clínica distinta que va desde la elevación de enzimas hepáticas y otros como cirrosis que se han trasplantado con diagnóstico confirmatorio postquirúrgico. Conclusión: Se comenta acerca del manejo de la hepatopatía y su progresión a lo largo del tiempo que se han mantenido en la clínica de hígado a nuestro cargo.
Alfa 1-antitrypsin deficiency is one of the most prevalent genetic diseases in the human being, sadly it is not a commonly suspected clinical entity. With more than 100 known mutations, those ...associated with hepatic disease are the Z homocygote allele mutations in the gene a1AT which occur in every 2000-3500 births. Opposing to the pulmonary disease, in which de sequelae are caused by the deficit of this protein which in turn fastens the enzymatic destruction of the airway microstructure, the hepatic compromise is secondary to the intracellular accumulation of the aberrant misfolded protein. This accumulation causes cellular damage, hepatitis, fibrosis, cirrhosis and hepatocellular carcinoma through activation of a series of mechanisms which culminate in hepatocitary apoptosis, regeneration and chronic cellular injury.
9 cases of confirmed a1AT deficiency are presented, from different ages ranging from adolescence through elderly patients.
Each of one of them with different clinical presentation going from asymptomatic liver enzyme elevations to transplanted cirrhosis in which the diagnosis was post procedural.
We comment about the management of the chronic liver disease and the evolution of these patients through time in the liver clinic.
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