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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.

Introduction. Cirrhosis is one of the ten leading causes of death in the Western hemisphere and entails a significant cost of health care. Objective. To describe the sociodemographic, clinical, and laboratory characteristics of patients older than 18 years who received care for acute decompensation of cirrhosis in the emergency services of three highly complex centers in Medellín, Colombia. Materials and methods. This was an observational retrospective cohort study from clinical records. The results were analyzed by frequency measures and represented in tables and graphics. Results. In total, 576 clinical records met the inclusion criteria; 287 were included for analysis, and 58.9% were men, with an average age of 64 (± 13.5) years. The most frequent causes of cirrhosis were alcohol intake (47.7%), cryptogenic or unspecified etiology (29.6%), and non-alcoholic fatty liver disease (9.1%). The main reasons for visiting the emergency department were the presence of edema and/or ascites (34.1%), suspicion of gastrointestinal bleeding (26.5%), abdominal pain (14.3%) and altered mental status (13.9%). The most frequent clinical manifestations of an acute decompensation of cirrhosis were ascites (45.6%), variceal hemorrhage (25.4%), hepatic encephalopathy (23.0%), and spontaneous bacterial peritonitis (5.2%). During their treatment, 56.1% of the patients received intravenous antibiotics; 24.0%, human albumin; 24.0%, vasoactive support, and 27.5%, blood products; 21.3% required management in an intensive or intermediate care unit, registering 53 deceased patients for a mortality of 18.5%. Conclusion. Patients who consult the emergency services due to acute decompensation of cirrhosis demand a high amount of health resources, frequently present associated complications, and a high percentage requires management in critical care units and shows a high in-hospital mortality rate.

This study examined 37 patients with hepatitis and cirrhosis of the liver and 30 healthy individuals, assessing liver function indicators and renal function under conditions of daily diuresis and after a load of drinking water and a 0.5% sodium chloride solution, at 0.5% of body weight. The study showed that hepatitis and cirrhosis of the liver lead to signs of hepatorenal syndrome development, particularly in patients with cirrhosis, primarily manifested by a reduction in glomerular filtration rate (GFR). The extent of reduction correlated with the severity of liver damage. Simultaneously, it was independent of blood pressure, plasma protein, and renal sodium exchange mechanisms. The primary dysfunction in hepatorenal syndrome was determined to be a reduction in GFR, evidenced by the rise in creatinine concentration, although urea increased only in cirrhosis, requiring further explanation. The results showed that liver diseases, especially cirrhosis, can lead to kidney problems, mainly by reducing the kidney's ability to filter blood, which was shown by higher creatinine levels in the blood.

Resumen: Introducción y objetivo: Las várices esofágicas son una de las complicaciones de la hipertensión portal en pacientes cirróticos, lo cual lleva a una alta morbimortalidad. Nuestro objetivo fue evaluar el nivel de calprotectina fecal (CF) en pacientes cirróticos egipcios como marcador no invasivo de la presencia de várices esofágicas. Materiales y métodos: El presente estudio incluyó a 250 participantes en el período de junio de 2019 a noviembre de 2020, divididos en 3 grupos: grupo 1: 100 pacientes cirróticos por VHC con várices esofágicas, posteriormente subdivididos según la clasificación de Paquet; grupo 2: 100 pacientes cirróticos por VHC sin várices esofágicas; grupo 3: 50 sujetos sanos emparejados por edad y sexo como grupo de control. Se excluyó a pacientes con otras causas de calprotectina anormal. Resultados: La comparación entre los 3 grupos estudiados en cuanto a CF reveló una diferencia estadísticamente significativa. Los niveles de CF fueron mayores en los grupos 1 y 2, con medias de 66.4 ± 10.41 y 48.4 ± 10.92, respectivamente. Existió una diferencia significativa en los niveles de CF entre los subgrupos, subdivididos según la clasificación de Paquet (p = 0.001). Los niveles de CF fueron más altos en los subgrupos de grado iii y iv. La CF en el diagnóstico de pacientes cirróticos por VHC con várices esofágicas mostró el mejor desempeño cuando el punto de corte fue > 55; el área bajo la curva fue 0.918, con 92% de sensibilidad, 95% de especificidad y 93% de precisión. Conclusión: Los niveles de CF sirven como herramienta de tamizaje para várices esofágicas. La CF fue mayor en pacientes cirróticos con várices esofágicas, especialmente en los subgrupos de grado iii y iv, según la clasificación de Paquet. Abstract: Introduction and aim: Esophageal varices are one of the complications of portal hypertension in cirrhotic patients that lead to high morbidity and mortality. Our aim was to assess the fecal calprotectin (FC) level in Egyptian cirrhotic patients as a non-invasive marker for the presence of esophageal varices. Materials and methods: The current study included 250 participants in the period from June 2019 to November 2020, divided into 3 groups: group 1: 100 HCV cirrhotic patients with esophageal varices that would then be subdivided, according to the Paquet classification; group 2: 100 HCV cirrhotic patients without esophageal varices; group 3: 50 normal age and sex-matched healthy subjects as the control group. Patients with other causes of abnormal calprotectin results were excluded. Results: The comparison of FC in the 3 study groups revealed a statistically significant difference, with FC levels higher in groups 1 and 2 (mean 66.4 ± 10.41 and 48.4 ± 10.92, respectively). There was a significant difference in FC levels between the subgroups, subdivided according to the Paquet classification (P = .001). FC levels were higher in the grade III and IV subgroups. FC in the diagnosis of HCV cirrhotic patients with esophageal varices showed the best performance when the cut-off value was > 55; AUC was 0.918, with 92% sensitivity, 95% specificity, and 93% accuracy. Conclusion: FC levels serve as a screening tool for esophageal varices. FC was higher in cirrhotic patients with esophageal varices, especially in the grade III and IV subgroups, according to the Paquet classification.

Chronic liver disease and related complications, cirrhosis and hepatocellular carcinoma, are associated with high mortality. Curative treatments, partial hepatectomy or liver transplantation, have limited applicability in patients with cirrhosis due to the poor liver regenerative capacity. Thus, we need to find new diagnostic and therapeutic alternatives, to block the disease progression and to improve the survival of patients. In this context, preclinical studies have demonstrated the key role of the protein kinase B (Akt) in liver dysfunction, but the status of Akt and its targets in patients with chronic hepatopathy remains unknown. Aims: To determine the activation status of the Akt pathway and their association with liver functionality in cirrhotic patients.

Introduction: Liver cirrhosis is a disease whose development is influenced by many factors, including those related to lifestyle. The disease causes disturbances in the functioning of not only the liver but also many other organs and systems. During the course of the disease, there are a number of complications that affect the patient's functioning in all areas. Patients with liver cirrhosis require constant and systematic treatment and comprehensive care, including care provided by nursing staff. Purpose of research: Analysis of problems occurring in the care of patients with liver cirrhosis Material and methods: The study included 103 patients with liver cirrhosis, hospitalized from October 10, 2022 to April 10, 2023. in the Observation and Infection Ward for Adults of the SPZOZ in Puławy. The method used in the work was a diagnostic survey, the technique was a survey, and the research tool was an original survey questionnaire developed for the needs of the research. Results: Patients with liver cirrhosis have many problems of a physical nature and related to non-compliance with medical recommendations, which may affect the inhibition of the progression of the disease, the prevention of complications and the improvement of the general condition. Conclusions: • Patients with liver cirrhosis have a number of physical problems, the knowledge of which may affect the organization of work of nursing staff, facilitate the identification of problems, help determine the goal of care and plan nursing interventions. • Not all respondents followed the specialist's recommendations, including: in the field of pharmacotherapy, dietary recommendations, performing check-ups, reporting for follow-up visits and physical activity. • An important element in the care of a patient with liver cirrhosis is patient education and motivation to follow recommendations that are important in stopping the progression of the disease, preventing complications and improving the general condition.

Purpose - correlation analysis of the postmortem ammonia level and numbers of Alzheimer type 2 astrocytes in different parts of the brain with intravital laboratory blood parameters of deceased patients with liver cirrhosis of varying severity. Material and methods. Autopsied brains of 90 patients with non-alcoholic liver cirrhosis (LC) of class A, B and C according to Child-Pugh formed 3 groups: «A» (n = 30), «B» (n = 30) and «C» (n = 30). Control group - 30 patients deceased from cardiovascular failure. Cortex, white matter, hippocampus, thalamus, striatum and cerebellum were histochemically (HC) studied with Nessler's reagent for ammonia level. Correlation analysis of ammonia expression, Alzheimer type 2 astrocytes (AA2) numbers and 14 intravital laboratory blood parameters was performed. Results. HC method reveals region-dependent ammonia expression in the brain neuropil. The most significant correlations are observed in thalamus, striatum, cerebellum, and cortex between ammonia expression (ACUOD), AA2-astrocytosis, and lifetime values of total bilirubin (for Bil/ACUOD & /AA2 r = 0.31-0.97), AST (for AST/ACUOD & /AA2 r = 0.30-0.81), ALT (for ALT/ACUOD & /AA2 r = 0.30-0.78), leukocyte index of intoxication (for LII/ACUOD & /AA2 r = 0.34-0.76), albumin (for Alb/ACUOD & /AA2 r = -0.34 to -0.78), leukocytes (for Wbc/ACUOD & /AA2 r = 0.31-0.68), prothrombin index (for PI/ACUOD & /AA2 r = -0.31 to -0.45) and potassium (for K+/ACUOD & /AA2 r = -0.32 to -0.45), p

Hepatic transplantation (HT) is the standard of care of end-stage liver disease with Cirrhotic Cardiomyopathy (CCM), but medical treatment with combination of diuretics and non-selective beta blockers are important before and after that. Owing to its particular pathophysiology unlike another etiologies of heart failure, in CCM angiotensin-converting enzyme inhibitors (ACEI), angiotensin II type I receptor blockers (ARB), and angiotensin receptor neprilysin inhibitor (ARNI) are not recommended. Transjugular intrahepatic porto-systemic shunt (TIPS) has indications in CMM but its potential benefits and risks must be considered and more researh is necessary. HT is a demanding therapy but the most effective one, and showed improvement in QTc, diastolic and systolic dysfunction; in recent decades, in spite of more severe ill patients (more severe MELD score), survival has improved significantly due to better surgical techniques, intensive care, immunosupresive drugs, and images., (Universidad Nacional de Córdoba)

Nonalcoholic fatty liver disease is characterized by fat accumulation in the liver exceeding 5% of its weight. The spectrum of the disease includes fatty liver, steatohepatitis and progressive fibrosis leading to cirrhosis. It is also possible to develop hepatocellular carcinoma even without cirrhosis. Its physiopathology highlights the metabolic component of the disease, being acknowledged as a hepatic expression of a multisystemic metabolic disorder. Fat accumulation causes apoptosis, inflammation and fibrosis. In the view of the rising research on the subject, a new terminology is being proposed, consis-ting in metabolic associated fatty liver disease, now perceived as a standalone condition not needing the exclusion of other entities to make a diagnosis. The diagnosis includes the identification of liver steatosis and fibrosis, as a prognosis marker, using imaging studies and scoring models with biochemical markers. Treatment consists primarily in weight reduction and improving the metabolic baseline condition. New studies seeking pharmacologic interventions targeting hepatic inflammation are being conducted. Therapy also includes appropriate management of other medical comorbidities and cardiovascular risk control.

Hepatic encephalopathy is a neuropsychiatric syndrome associated with abnormal liver function and portosystemic venous shunting. According to the West-Haven classification, depending on the degree of neurological disorders, there are minimal, I - IV stages of HE, which are characterized by a gradual progression of the disease. To date, the pathogenesis of HE is controversial.

La aspergilosis pulmonar invasiva es una enfermedad presente principalmente en pacientes inmunocomprometidos con alta carga de mortalidad. La neumonía por Pneumocystis jirovecii es una infección oportunista potencialmente mortal que afecta a pacientes inmunocomprometidos por diversas etiologías. La coinfección por estos patógenos en pacientes inmunocompetentes es inusual. Reportamos un caso de un paciente sin las causas tradicionales de inmunocompromiso en el desarrollo de una neumonía en coinfección por Aspergillus fumigatus y Pneumocystis jirovecii.

The diagnosis of Cirrhotic Cardiomyopathy is based on severe hepatic cirrosis with deterioration of cardiac function without previous cardiopathy, but this is subclinical during a long time. In this second part we review the non-invasive diagnostic methods and their prognostic value in patients with or without hepatic transplant, from ECG to cardiac images of magnetic resonance., (Universidad Nacional de Córdoba)

Introduction: Patients with liver cirrhosis who are candidates for liver transplantation must be evaluated both clinically and socially in order to obtain the optimal outcomes and avoid futile therapeutic measures. For the evaluation of the social aspects in these patients, no validated scale in Spanish is available. The SIPAT (Stanford Integrated Psychosocial Assessment for Transplantation) scale is an instrument that measures the social, family and psychological aspects in candidates for solid organ transplantation. The objective of this study is to adapt and validate an abbreviated version of the SIPAT scale in Spanish for patients with liver cirrhosis., Material and Methods: Prospective observational study carried out in the Hepatology Unit of the La Fe Unversity Hospital in Valencia, by questionnaire validation methodology. To analyze the reliability of the questionnaire, the internal consistency of all variables was calculated, for variability an exploratory factor analysis, and for stability the test-retest test was carried out., Results: 96 patients who were admitted for decompensated cirrhosis to the Hepatology Unit of the La Fe Hospital in Valencia between November 1, 2017 and January 31, 2017 were selected. 84% were men, the mean age was 60.01 (SD 10.12) years. In 73.2% of those admitted, the etiology of cirrhosis was alcoholic. 14.4% had a Child's stage A, 57.7% B and 27.8% C. The internal consistency of all variables reached a Cronbach's Alpha of 0.766. In the exploratory factor analysis, 6 dimensions of the questionnaire were identified that explain 84.27% of the total variability. To see the stability of the instrument, the measurement was repeated at 2 and 6 months of follow-up, obtaining in the test-retest a kappa agreement of 0.612 and 0.565 respectively., Conclusion: The SIPAT-11 questionnaire has good psychometric characteristics in cirrhotic patients who are candidates for liver transplantation. It is easy to complete and can be administered by professionals who are not specialists in the area of Mental Health., (Copyright © 2024 Elsevier España, S.L.U. All rights reserved.)

Background and Aim of the Study: There are still patients with hepatitisC in Spain who have yet to be diagnosed, but their clinical profile is unclear. In 2021, 21.93% of patients diagnosed had cirrhosis and were mostly treatment-naïve., Methods: This sub-analysis describes the clinical profile of the 60Spanish treatment-naïve patients with compensated cirrhosis who were included in the CREST study., Major Results: Sixty percent of patients were male, median age 56years, and 33% had a history of drug use. Almost three-quarters (71.3%) had more than one comorbidity and 78.3% took concomitant medication. At treatment initiation, median platelet count was 139×10 3 /μL and FibroScan® 17kPa. No virological failure was observed and no patient discontinued treatment due to adverse events. No clinically significant changes were noted during or after treatment in the median platelet, albumin, bilirubin, and transaminase levels., Conclusions: Treatment with glecaprevir/pibrentasvir for 8weeks in this cohort of treatment-naïve patients with compensated cirrhosis in Spain was safe and effective. This information reinforces the use of this short antiviral regimen even when there is compensated cirrhosis, simplifying the approach to hepatitisC among those patients still to be diagnosed and treated in Spain., (Copyright © 2024 Elsevier España, S.L.U. All rights reserved.)

The search for pathogenetic methods for treating cirrhosis of the liver continues. One of the promising areas of regenerative medicine is the use of platelet-rich plasma (PRP). Due to numerous publications on the efficacy of PRP in conditions of abnormal liver damage in the experiment, the work is devoted to the study of the possibility of manufacturing PRP from the blood of patients with liver cirrhosis (LC) for the purpose of proposals for further clinical use. The study included 12 men suffering from CP-class B-C (average grade by Child-Pugh classification - 8.8) at the age of 45 ± 2.2 years. The comparison group consisted of 5 healthy men at the age of 44 ± 1.8 years. All men measured blood platelets in accordance with the usual method. The manufacture of PRP was carried out according to the scheme, which includes the collection of blood from the elbow vein in a 9 ml syringe-flask, which contains an anticoagulant. The collected blood in the same test tube is centrifuged in two stages: on the first - within 12` at a speed of 4000 rpm. Then the formed plasma, namely, from the supernatant layer, is recruited into another tube without an anticoagulant and treated in a centrifuge for 15` at a speed of 3600 rpm. After the removal of poor plasma platelets, the final product - a PRP aggregate in the volume of 0.3 ml - is obtained, which is used for the next determination of platelet count using an automated hemo-analyzer. In patients with LC, both thrombocytopenia and thrombocytosis were observed. In the PRP, the increase in the total platelet count was 2.2-2.4 times, both in baseline thrombocytopenia and in baseline thrombocytosis, due to the absence of the mean platelet count and the platelet distribution width. In the control group male, the average increase in the number of platelets was 3.37 times, in the absence of significant changes in the mean platelet count and platelet distribution width. The fact is that the use of autologous PRP in patients with LC is likely to be ineffective. In the presence of initial thrombocytopenia - there is no possibility to reach a "critical" quantity of 1 million G/L, which is necessary for the implementation of regenerative potential of PRP. Concomitant presence of morpho-functional defects of these platelets practically makes it impossible for such a method of protection/regeneration of liver parenchyma in patients with lC. In patients with LC there is a moderate increase in the concentration of platelets in the manufacture of PRP by standard method; therefore, it is necessary to find new methods for obtaining PRP for autologous use.

Introduction: The platelet count/spleen diameter (PC/SD) ratio is a noninvasive method for the diagnosis of esophageal varices (EV) used as an alternative to endoscopy in patients with cirrhosis. Objective: To evaluate the diagnostic performance of the PC/SD ratio (cut-off point

Severe cirrhosis affecting myocardial function provokes a syndrome called Cirrhotic Cardiomyopathy, defined as cardiac disfunction associated with hepatic cirrhosis in the absence of other known cardiac disease. The prevalence is variable according different groups of investigation owing to the latent or subclinical course until a stressful situation unmask it such as surgery, hemorrhage, infection, hepatic transplant or transjugular intrahepatic porto-systemic shunt. We aimed to review the definition, pathology, pathophysiology, clinical manifestations, diagnostic criteria, images, clinical relevance, pharmacological treatment and hepatic transplantation., (Universidad Nacional de Córdoba)

Background: Hepatic fibrosis (HF) is a common result of the repair process of various chronic liver diseases. Hepatic stellate cells (HSCs) activation is the central link in the occurrence of HF., Methods: ELISA and histological analysis were performed to detect the pathological changes of liver tissues. In vitro, HSCs were treated with TGF-β1 as HF cell model. Combination of GATA-binding protein 3 (GATA3) and miR-370 gene promoter was ensured by ChIP and luciferase reporter assay. Autophagy was monitored by observing the GFP-LC3 puncta formation. The interaction between miR-370 and high mobility group box 1 protein (HMGB1) was verified by luciferase reporter assay., Results: CCl 4 -induced HF mice exhibited an increase of ALT and AST, and severe damage and fibrosis of liver tissues. GATA3 and HMGB1 were up-regulated, and miR-370 was down-regulated in CCl 4 -induced HF mice and activated HSCs. GATA3 enhanced expression of the autophagy-related proteins and activation markers in the activated HSCs. Inhibition of autophagy partly reversed GATA3-induced activation of HSCs and the promotion of GATA3 to hepatic fibrosis. Moreover, GATA3 suppressed miR-370 expression via binding with its promotor, and enhanced HMGB1 expression in HSCs. Increasing of miR-370 inhibited HMGB1 expression by directly targeting its mRNA 3'-UTR. The promotion of GATA3 to TGF-β1-induced HSCs autophagy and activation was abrogated by miR-370 up-regulation or HMGB1 knockdown., Conclusions: This work demonstrates that GATA3 promotes autophagy and activation of HSCs by regulating miR-370/HMGB1 signaling pathway, which contributes to accelerate HF. Thus, this work suggests that GATA3 may be a potential target for prevention and treatment of HF., (Copyright © 2023 Elsevier España, S.L.U. All rights reserved.)

ABSTRACT Introduction: nonalcoholic fatty liver disease presents a broad spectrum of histopathological alterations, from steatosis to liver cirrhosis. Patients with diabetes mellitus (DM) present increased incidence and severity of NAFLD. Objective: determine the prevalence and severity of NAFLD in diabetic and non-diabetic obese patients undergoing bariatric surgery. Method: the evaluation of liver biopsies was carried out through NAFLD activity score (NAS) in order to evaluate degree of hepatic steatosis, presence of ballooning, inflammatory activity and degree of fibrosis. Results: a total of 154 patients who have undergone bariatric surgery with intraoperative biopsy were observed and divided into two BMI ranges: from 35 to 44.9 and from 45 to 54.9. 32 (20.8%) from 154 patients were diabetic and 122 (79.2%) were non-diabetic. Patients with DM were significantly older than patients without the disease, presenting 41.29 ± 9.40 years vs 36.71 ± 10.13 years in the group with BMI of 35 to 44.9 (p=0.049); and 45.13 ± 7.10 years vs 37.00 ± 9.24 years in the group with BMI of 45 to 54.9 (p=0.024). In the histological evaluation, patients with DM from the BMI group of 35 to 44.9 had a strong association with higher prevalence and severity of steatosis, balloning, inflammation, fibrosis and steatohepatitis. Conclusion: the present study confirms the high prevalence of NAFLD in patients with Morbid Obesity. Prevalence and severity increase proportionally to BMI and who have DM as comorbidity.

Liver cirrhosis is one of the acute problems of modern hepatology that develops in case of long-term chronic hepatitis. It is known that cytokines play an important role in controlling an adaptive response to chronic toxic damage. After the morphological examination of the hepatic tissue and of the proinflammatory cytokine system in case of experimental cirrhosis it was established the prominent immune response to acute inflammation at early stage as well as pro-inflammatory interleukins level significant increase. The further pathomorphological examination showed a minor involution of the pathological process, the immune response was also slightly inhibited in comparison to the previous period.

Introduction. Reynolds syndrome (RS) is an autoimmune disorder characterized by overlapping primary biliary cirrhosis (PBC) and limited cutaneous systemic sclerosis (lcSSc). Some published cases do not report pulmonary arterial hypertension (PAH), and diagnoses are usually based on clinical, immunological and histological findings, mainly focused on dermatologic features, on those associated with Sjögren's syndrome, or on an interesting presentation of malignant thymoma; only one case of reported PAH was found, but it was an image report. Case Presentation. This paper reports the case of a 75-year-old woman who presented with some of the features mentioned above, severe PAH, dyspnea for one month and two weeks of purulent expectoration, as well as generalized pruritus, nasal telangiectasias, Raynaud phenomenon, sclerodactyly, and high levels of alkaline phosphatase and transaminases. Pulmonary arterial hypertension was documented through a transthoracic echocardiogram, and inmunoflorecence reported mitochondrial and centromere patterns of antinuclear-antibodies. Consequently, RS was diagnosed and phosphodiesterase type-5 inhibitors were started for PAH treatment resulting in the improvement of dyspnea. Conclusion. Dyspnea could be caused by many conditions, but in the presence of clinical and physical findings, it suggests an autoimmune disorder. Scleroderma should be considered and, additionally, PAH should be investigated since it is present in up to 10% of patients, conferring a worse prognosis. Internists should keep in mind that these disorders may be associated with other autoimmune diseases.

Fundamento: la elastografía de transición (Fibroscan) es una técnica no invasiva, que permite detectar el grado de fibrosis hepática, siendo una importante alternativa a la biopsia del hígado.Objetivo: correlacionar las características ultrasonográficas y los resultados de la elastografía en pacientes diabéticos tipo 2 con hígado graso no alcohólico, atendidos en el Hospital Clínico Quirúrgico “Hermanos Ameijeiras”, de La Habana, entre enero de 2016 y mayo de 2018.Métodos: se realizó un estudio descriptivo y transversal en 33 pacientes, con las características, en la institución y periodo de tiempo referidos en el objetivo. Se utilizó ultrasonido abdominal para evaluar la severidad de la esteatosis hepática y elastografía de transición para determinar el grado de fibrosis. Se hicieron pruebas bioquímicas.Resultados: en 39,4 % de los casos se encontró un grado leve de fibrosis y en 27,3 % se detectó fibrosis hepática severa. Se observó una ecogenicidad moderadamente aumentada en 45,5 %. El 100 % de los pacientes, con hiperecogenicidad leve por ultrasonido, presentaron fibrosis hepática leve con el Fibroscan. Los patrones humorales más alterados fueron los triglicéridos (75,8 %), el colesterol total (66,7 %) y la glicemia (87,9 %).Conclusiones: los patrones ecográficos en los pacientes diabéticos tipo 2, con aumento leve de la ecogenicidad hepática, tienen coincidencia diagnóstica con los resultados de la elastografía de transición, para fibrosis mínima (F0-F1).

Evaluation and staging of liver disease is essential in the clinical decision-making process of liver tumors. The severity of portal hypertension (PH) is the main prognostic factor in advanced liver disease. Performing an accurate hepatic venous pressure gradient (HVPG) measurement is not always possible, especially when veno-venous communications are present. In those complex cases, a refinement in HVPG measurement with a thorough evaluation of each of the components of PH is mandatory. We aimed at describing how some technical modifications and complementary procedures may contribute to an accurate and complete clinical evaluation to improve therapeutic decisions., (Copyright © 2023 Elsevier España, S.L.U. All rights reserved.)

Objective: The lack of consensus and specific guidelines, and the introduction of new treatments in thrombocytopenia management in liver cirrhosis patients, required a series of recommendations by experts to improve knowledge on this disease. This study's aim was to improve the knowledge around thrombocytopenia in liver cirrhosis patients, in order to contribute to the generation of future evidence to improve the management of this disease., Patients and Methods: A modified version of the RAND/UCLA appropriateness method was used. The scientific committee, a multidisciplinary team of 7 experts in managing thrombocytopenia in liver cirrhosis patients, identified the expert panel, and participated in elaborating the questionnaire. Thirty experts from different Spanish institutions were invited to answer a 48-item questionnaire covering 6 areas on a nine-point Likert scale. Two rounds were voted. The consensus was obtained if >77.7% of panelists reached agreement or disagreement., Results: A total of 48 statements were developed by the scientific committee and then voted by the experts, resulting in 28 defined as appropriate and completely necessary, relating to evidence generation (10), care circuit, (8), hemorrhagic risk assessment, decision-making and diagnostic tests (14), professionals' role and multidisciplinary coordination (9) and patient education (7)., Conclusions: This is the first consensus in Spain on the management of thrombocytopenia in liver cirrhosis patients. Experts indicated several recommendations to be carried out in different areas that could help physicians make better decisions in their clinical practice., (Copyright © 2023. Publicado por Elsevier España, S.L.U.)

Introduction: Cirrhosis is one of the ten leading causes of death in the Western hemisphere and entails a significant cost of health care., Objective: To describe the sociodemographic, clinical, and laboratory characteristics of patients older than 18 years who received care for acute decompensation of cirrhosis in the emergency services of three highly complex centers in Medellín, Colombia., Materials and Methods: This was an observational retrospective cohort study from clinical records. The results were analyzed by frequency measures and represented in tables and graphics., Results: In total, 576 clinical records met the inclusion criteria; 287 were included for analysis, and 58.9% were men, with an average age of 64 (± 13.5) years. The most frequent causes of cirrhosis were alcohol intake (47.7%), cryptogenic or unspecified etiology (29.6%), and non-alcoholic fatty liver disease (9.1%). The main reasons for visiting the emergency department were the presence of edema and/or ascites (34.1%), suspicion of gastrointestinal bleeding (26.5%), abdominal pain (14.3%) and altered mental status (13.9%). The most frequent clinical manifestations of an acute decompensation of cirrhosis were ascites (45.6%), variceal hemorrhage (25.4%), hepatic encephalopathy (23.0%), and spontaneous bacterial peritonitis (5.2%). During their treatment, 56.1% of the patients received intravenous antibiotics; 24.0%, human albumin; 24.0%, vasoactive support, and 27.5%, blood products; 21.3% required management in an intensive or intermediate care unit, registering 53 deceased patients for a mortality of 18.5%., Conclusion: Patients who consult the emergency services due to acute decompensation of cirrhosis demand a high amount of health resources, frequently present associated complications, and a high percentage requires management in critical care units and shows a high in-hospital mortality rate.

Background: Chronic hepatitis E virus (HEV) in persons with immune impairment has a progressive course leading to a rapid progression to liver cirrhosis. However, prospective data on chronic HEV is scarce. The aim of this study was to determine the prevalence and risk factors for chronic HEV infection in subjects with immune dysfunction and elevated liver enzymes., Patients and Methods: CHES is a multicenter prospective study that included adults with elevated transaminases values for at least 6 months and any of these conditions: transplant recipients, HIV infection, haemodialysis, liver cirrhosis, and immunosuppressant therapy. Anti-HEV IgG/IgM (Wantai ELISA) and HEV-RNA by an automated highly sensitive assay (Roche diagnostics) were performed in all subjects. In addition, all participants answered an epidemiological survey., Results: Three hundred and eighty-one patients were included: 131 transplant recipients, 115 cirrhosis, 51 HIV-infected subjects, 87 on immunosuppressants, 4 hemodialysis. Overall, 210 subjects were on immunosuppressants. Anti-HEV IgG was found in 94 (25.6%) subjects with similar rates regardless of the cause for immune impairment. HEV-RNA was positive in 6 (1.6%), all of them transplant recipients, yielding a rate of chronic HEV of 5.8% among solid-organ recipients. In the transplant population, only therapy with mTOR inhibitors was independently associated with risk of chronic HEV, whereas also ALT values impacted in the general model., Conclusions: Despite previous abnormal transaminases values, chronic HEV was only observed among solid-organ recipients. In this population, the rate of chronic HEV was 5.8% and only therapy with mTOR inhibitors was independently associated with chronic hepatitis E., (Copyright © 2023. Publicado por Elsevier España, S.L.U.)

Introducción. Las infecciones bacterianas representan una complicación grave de la cirrosis. En los últimos años se han observado cambios en el espectro microbiológico de estas infecciones, fundamentalmente, el aumento de infecciones por gérmenes multirresistentes. Objetivo. Establecer la proporción de infecciones por microorganismos multirresistentes en pacientes cirróticos ingresados en un centro de atención de Madrid, y analizar su epidemiología, factores de riesgo e impacto clínico. Materiales y métodos. Se hizo un estudio retrospectivo en el cual se evaluaron 294 pacientes hospitalizados por infección bacteriana en el Hospital General Universitario Gregorio Marañón de Madrid, entre junio de 2011 y junio de 2013. Resultados. Se aislaron 310 microorganismos de 223 pacientes; 109 (35,2 %) eran Gram positivos, 167 (53,9 %), Gram negativos, y 34 (11 %), hongos. El agente etiológico más frecuente fue Escherichia coli (98 aislamientos). Las infecciones se habían adquirido en la comunidad en 22,9 % de los casos, se asociaron con la atención de salud en 38,1 % y se adquirieron durante la estancia hospitalaria en 39 %. Los pacientes con aislamientos multirresistentes desarrollaron con más frecuencia choque séptico (p=0,05), y presentaron peor función hepática y alta mortalidad durante la estancia hospitalaria (p=0,017). El ingreso previo, el uso de antibióticos en los 60 días anteriores, la adquisición de la infección en el hospital o asociada a un ingreso reciente y el aislamiento de bacterias en los cultivos de control, se determinaron como posibles factores de riesgo para el desarrollo de la infección multirresistente. Discusión. Los resultados del estudio confirmaron que el espectro microbiológico de las infecciones bacterianas en pacientes con cirrosis ha sufrido importantes cambios. Las infecciones por gérmenes multirresistentes causan infecciones con gran morbimortalidad y el fracaso del tratamiento antibiótico habitual. Para controlarlas de forma eficaz, es imprescindible detectar precozmente a aquellos pacientes con factores de riesgo.

Usually there are collaterals between the portal venous system and the systemic circulation. In normal circumstances the blood circulation is directed from collaterals to the portal vein; however, in the presence of portal hypertension, this is reversed resulting in the appearance of esophageal and gastric varices. The standard diagnostic is practiced with digestive system endoscopy and every patient with cirrhosis should be checked with this procedure within the twelve months following the diagnosis in a period not exceeding three months if presents a decompensated cirrhosis. The varices can be classified like small (< 5 mm) or big (< 5 mm) based on their size, likewise must report the presence of red spots in the wall because this information, also the Child Pugh Turcotte test, are essential for risk stratification and defining the need for the use of prophylaxis in the variceal bleeding. The nonselective beta blockers and endoscopic elastic band ligation are the two treatments currently accepted to prevent the variceal hemorrhage. The choice of method depends on each patient characteristics and the available resources. During the acute hemorrhage the treatment has as a goal to restore the volemia, prevent the complications and the use of splanchnic vasoconstrictors to diminish the portosystemic collaterals circulation. In case of refractory bleeding, the intrahepatic portosystemic derivation and surgical portosystemic shunt can be used, but they use is limited because these treatments are only available in advanced hospitals. Rev.cienc.biomed. 2015;6(2):381-389. KEYWORDS Esophageal varices; Liver cirrhosis; Bleeding; Screening.

Edema-ascitic syndrome is one of the clinical manifestations of decompensation of liver cirrhosis (LC) in the development of which an essential role belongs to renal dysfunction with disturbance of water-electrolyte metabolism. The purpose of our study was to study the function of the kidneys in conditions of spontaneous diuresis and during the salt load in this category of patients. 21 patients with a low-active decompensated LC of toxic etiology at the age of 32 to 68 years and 18 practically healthy people were examined. The functional state of the kidneys was assessed by the clearance method under conditions of a 12-hour spontaneous night and 2-hour induced diuresis (using 0.5% sodium chloride solution at a rate of 5 ml / kg body weight). Impaired renal function in spontaneous diuresis was manifested by a slight increase in the concentration of blood creatinine (p

The case of a patient whose imaging tests indicated liver cirrhosis is presented. The detailed diagnostic reveals advanced hepatocellular carcinoma (HCC). Alpha-fetoprotein and a blind liver biopsy was necessary. The authors conclude that in oncological surveillance of patients with cirrhosis, not only ultrasound but also AFP should be included.

Introduction Autoimmune hepatitis (AIH) is a disease of unknown etiology. In pregnancy, it may have mild clinical course as well as can lead to liver failure, or exacerbation of clinical symptoms. In pregnant women the severity of symptoms is often observed between the second and third trimester, and in the puerperium. The disease is marked by enhanced activity of Th lymphocytes, which hepatocytes recognize as foreign antigens. This results in interleukin production activating B lymphocytes, and the production of specific antibodies attacking and destroying the hepatocytes. Case report A 35-year old patient, CII PII, 7 Hbd, with autoimmune hepatitis reported for a check-up. Her first pregnancy was 18 years ago, without history of underlying disease, carried to term without complications. The woman gave birth to a baby-son weighing 3,280g, 10 points Apgar. The delivery was spontaneous and uneventful. The patient got pregnant after an 18-year break. When she twice-tested positively for pregnancy, the treatment with azathioprine was switched to prednisolone. Over the pregnancy the patient was hospitalized 4 times, in 25, 29, 35, and 37 week of gestation due to a threat of preterm delivery, and pregnancy-related cholestasis associated with AIH. In 37 week of gestation, delivery was induced, and she gave birth to a healthy male, weighing 2,650 g, body height of 49 cm, 10 points Apgar scale. The liver function improved and stabilized after the delivery. Treatment with prednisolone has been continued, and the patient’s condition is still controlled. Pregnant patients with autoimmune hepatitis often experience exacerbation of the disease, especially in the third trimester, and in the postpartum period. This case shows that with proper care it is possible to continue and terminate pregnancy safely for the mother and her newly born baby.

The clinical manifestation of liver cirrhosis (LC) in patients is often complicated, for example, by the cirrhotic syndrome, which is accompanied by free fluid accumulation in the abdominal cavity. One of the likely ways to improve the clinical condition of such patients is the purified ascetic fluid (AF) reinfusion. The efficacy of 48 patients with LC complicated by ascites treatment was retrospectively analyzed. These patients were undergone laparocentesis, their AF was purified using the original device and reinfused. The expressed efficacy of purified AF reinfusion in patients with LC complicated by ascites was shown. One should take into consideration only additional method of treatment of the named contingent of patients using purified AF reinfusion, since in this case we only gain time before performing the surgery. According to majority of treated patients clinical condition improvement after AF reinfusion the author argues that complex follow-up treatment of the underlying disease may include single-step surgical interventions and minimally invasive surgical interventions. Conclusion was made about the purified AF reinfusion reasonability with the therapeutic purposes in patients with LC complicated by ascites. It is well tolerated in most cases and contributes to the improvement of the patients with LC clinical manifestation.

The ascites is one of the typical complications of the decompensated liver cirrhosis. The paracentesis is important for the diagnosis and treatment. The serum-ascites albumin gradient must be estimated because it has sensibility of 97% for the diagnosis of ascites secondary to portal hypertension. The initial treatment consists in to provide sodiumrestricted diet and diuretics. The combination of 400 mg/day of spironolactone and 160 mg/day of furosemide are the maximum accepted doses. The refractory ascites is presented in 10% of the patients with liver cirrhosis and it is defined as the lack of an answer to the indicated measures or as recurrent ascites after the paracentesis. The lack of answer to the diuretics is identified by the absence of loss of weight together with the inadequate excretion of sodium, or by the presence of brain diseases, renal failure or hyperkalemia. In these cases, the patients must be treated with periodic paracentesis, for which the albumin replacement from 6-8 gr per each 1 liter of ascitic fluid extracted is recommended. When the volume exceeds the 5 liters, the leucocytes count with differential in the ascitic fluid must be done to reject spontaneous bacterial peritonitis. The periodic paracentesis are not recommended in patients who respond adequately to diuretics neither when increase in the risk of infections exist. The ascites indicates the beginning of a more aggressive period of the diseases and the liver transplantation must be considered as important, if there are not contraindications. Rev.cienc.biomed. 2014;5(2):361-368. KEYWORDS Liver Cirrhosis, Ascites, Hepatic Insufficiency, Ascitic Fluid.

Este artículo revisa los principales aspectos de la hepatitis C crónica (epidemiológicos y genómicos, relacionados con un mejor conocimiento molecular del ciclo vital del virus de la hepatitis C, VHC) y de modo notable la terapia estándar con interferón α pegilado y ribavirina. El énfasis se ha puesto especialmente en los aspectos biológicos de la respuesta inmunológica del hígado frente al VHC y en la valoración del grado de fibrosis hepática mediante la elastografía de transición.This article reviews the main aspects of chronic hepatitis C (epidemiological, genomic related to enhanced molecular understanding of the life cycle of the hepatitis C virus, HCV) especially standard therapy with pegilated interferon α and ribavirin. Emphasis is also placed on the immune response of the liver to HCV and the assessment of liver fibrosis via transient elastography.

Introducción: algunos investigadores consideran que la malnutrición proteico energética es la complicación más frecuente en el paciente cirrótico y que constituye un elemento predictor independiente de supervivencia. Objetivos: determinar el estado nutricional y su relación con la causa, el tiempo de evolución y la ingesta calórica en pacientes con cirrosis hepática compensada. Métodos: se realizó un estudio observacional descriptivo de todos los pacientes gaboneses de ambos sexos, entre 15 y 60 años, con este diagnóstico. Se halló predominio de las mujeres y del grupo entre 45 y 54 años, con una edad media de 45 años (± 7,6). Prevalecieron la causa mixta y el grupo A de la clasificación de Child-Pugh-Turcotte. Todos tenían menos de 1 año desde el diagnóstico de la enfermedad y según el índice de masa corporal, la malnutrición proteico-energética se observó en 75 % de los casos, predominó la delgadez moderada. La circunferencia del brazo se afectó con menor frecuencia e intensidad que el índice de masa corporal. En la medida que disminuyó el número de comidas al día aumentó el porcentaje de pacientes con malnutrición proteico-energética. Conclusiones: la frecuencia de malnutrición de la población cirrótica compensada fue elevada, con mayor índice de malnutrición en los casos de causa mixta, además, se comprobó que el estado nutricional del paciente cirrótico no puede ser valorado al margen de factores dietéticos.Introduction: some researchers believe that protein energy malnutrition is the most common complication in cirrhotic patients and it is an independent predictor of survival element. Objectives: to determine the nutritional status and its relationship to the cause, time of evolution and caloric intake in patients with compensated liver cirrhosis. Methods: a descriptive study of all Gabonese patients of both sexes, between the ages 15 and 60 years, with this diagnosis. Women and the group between 45 and 54 years was found predominant (mean age 45 years (± 7.6)). Additionally, mixed cause and group A in Child-Pugh-Turcotte widely existed. All patients had diagnosis of this disease for less than a year and according to their body mass index, protein-energy malnutrition was observed in 75% of cases; moderate thinness predominated. The arm circumference was less frequently and intensively affected than the body mass index. To the extent that the number of meals reduced per day, the percentage of patients with protein-energy malnutrition increased. Conclusions: the frequency of malnutrition of compensated cirrhotic population was high, with the highest rate of malnutrition in cases of mixed causes; it also was proved that the nutritional status of cirrhotic patient cannot be valued regardless of dietary factors.