Risk factors associated with the development of hyperamylasemia and post-ERCP pancreatitis in the Cuban National Institute.

CONTEXT: Acute pancreatitis is the most common complication in ERCP, and some risk factors were associated with the development of hyperamylasemia and post-ERCP pancreatitis. OBJECTIVES: identifying new factors associated with the development of hyperamylasemia or post-ERCP pancreatitis in patients attended at our center. MATERIAL AND METHODS: A (retrospective) cohort study was carried out in 170 patients on which a diagnostic-therapeutic ERCP was done due to biliopancreatic disease. 67 patients developed hyperamylasemia (39.4%) and 6 post-ERCP pancreatitis (3.5%). The following diagnostic criteria were applied: Hyperamylasemia: increase in the serum amylase level above the normal value (90 I/U). Acute post-ERCP pancreatitis: clinical: continuous abdominal pain for over 24 hours and biochemical: elevation of amylase3 times above normal value (90 U/I). RESULTS: The number of cannulations more than 4 (19 patients), (p=0.006; RR= 3.00) was associated significantly with the development of hyperamylasemia and the placing of biliary stent (14 patients), (p=0.00; RR= 0.39) was a protective factor. The factors associated with the development of post-ERCP pancreatitis were related with the patient (peridiverticular location of the papilla (p=0.00; RR= 2.00) and the sphincter of Oddi dysfunction (p=0.000; RR=1.20). CONCLUSION: Technical factors were associated with the development of hyperamylasemia, however, the factors associated with the development of post-ERCP pancreatitis in our universe of study were related mainly with the patient.

Risk factors associated with the development of hyperamylasemia and post-ERCP pancreatitis in the Cuban National Institute / Factores de riesgo con el desarrollo de la hiperamilasemia y pancreatitis post PCRE en el Cuban National Institute

Contexto: La pancreatitis aguda es la complicación más frecuente de la PCRE y algunos factores de riesgo son asociados con el desarrollo de hiperamilasemia y pancreatitis post PCRE. Objetivos: Identificar factores nuevos asociados con hiperamilasemia y pancreatitis post PCRE en pacientes que acudieron a nuestro centro. Material y métodos: Un estudio retrospectivo de cohorte se llevó a cabo en 170 pacientes en quienes se realizó una CPRE diagnóstico-terapéutica por enfermedad biliopancreática. 67 pacientes desarrollaron hiperamilasemia (39,4%) y 6 pancreatitis post PCRE (3,5%). Se aplicaron los siguientes criterios diagnósticos: Hiperamilasemia: elevación de la amilasa sérica por encima del valor normal (90IU).Pancreatitis aguda post PCRE: dolor abdominal continuo por más de 24 horas y elevación de la amilasa tres veces por encima del valor normal. Resultados: El número de canulaciones, más de 4 (19 pacientes), (p=0,006; RR= 3,00) se asoció significativamente con el desarrollo de la hiperamilasemia y la puesta de stents biliares (14 pacientes) se asoció como un factor protector (p=0,00; RR= 0,39). Los factores asociados con el desarrollo de la pancreatitis post PCRE se relacionaron con el paciente (localización peridiverticular de la papila (p=0,00; RR= 2,00) y disfunción del Esfinter de Oddi (p=0,000; RR=1,20). Conclusiones: Factores técnicos fueron asociados con el desarrollo de la hiperamilasemia, sin embargo, los relacionados con el desarrollo de la pancreatitis post PCRE fueron mayoritariamente relacionados al paciente.

Context: Acute pancreatitis is the most common complication in ERCP, and some risk factors were associated with the development of hyperamylasemia and post-ERCP pancreatitis. Objectives: identifying new factors associated with the development of hyperamylasemia or post-ERCP pancreatitis in patients attended at our center. Material and methods: A (retrospective) cohort study was carried out in 170 patients on which a diagnostic-therapeutic ERCP was done due to biliopancreatic disease. 67 patients developed hyperamylasemia (39.4%) and 6 post-ERCP pancreatitis (3.5%). The following diagnostic criteria were applied: Hyperamylasemia: increase in the serum amylase level above the normal value (90I/U). Acute post-ERCP pancreatitis: clinical: continuous abdominal pain for over 24 hours and biochemical: elevation of amylase 3 times above normal value (90U/I). Results: The number of cannulations more than 4 (19 patients), (p=0.006; RR= 3.00) was associated significantly with the development of hyperamylasemia and the placing of biliary stent (14 patients), (p=0.00; RR= 0.39) was a protective factor. The factors associated with the development of post-ERCP pancreatitis were related with the patient (peridiverticular location of the papilla (p=0.00; RR= 2.00) and the sphincter of Oddi dysfunction (p=0.000; RR=1.20). Conclusion: Technical factors were associated with the development of hyperamylasemia, however, the factors associated with the development of post-ERCP pancreatitis in our universe of study were related mainly with the patient.

Un análisis de largo plazo del comportamiento de la cirugía conservadora del cáncer de mama / A long-term analysis of the conservative surgery behavior in breast cancer

Introducción: en los últimos años la cirugía conservadora se ha consolidado como un procedimiento válido en el tratamiento de un determinado grupo de pacientes con cáncer de mama, pues permite conseguir un control local satisfactorio con una menor mutilación, sin modificar la supervivencia ni el índice de metástasis a distancia. Objetivo: determinar los resultados de la cirugía conservadora del cáncer de mama según variables seleccionadas en el período 1991-2009. Métodos: se realizó un estudio retropestivo longitudinal a mujeres diagnosticadas y tratadas de cáncer de mama a las que se les realizo cirugía conservadora (n=77), que cumplieron con los criterios de inclusión y exclusión establecidos. El análisis descriptivo de los datos se realizó mediante distribuciones de frecuencias absolutas y relativas. La estimación de las curvas de supervivencia global y libre de recidivas se realizó mediante el método de Kaplan-Meier. Resultados: el grupo de edad 40 a 59 años fue el predominante para 67,6 por ciento. Solo el 10,4 por ciento de las pacientes tuvieron antecedentes de primera línea positivos de cáncer de mama. La etapa clínica IIA predominó con un 54,5 por ciento, y el tipo histológico más frecuente, el carcinoma ductal infiltrante para un 84,4 por ciento. La supervivencia global para nuestras pacientes fue de un 95 por ciento a los 5 años, el intervalo libre de recidiva fue de un 87,5 por ciento. Conclusiones: nuestros resultados no difieren de los encontrados en los estudios a nivel mundial

Introduction: In past years the conservative surgery became consolidated as a valid procedure in treatment of a determined group of breast cancer patients, thus allows to achieve a satisfactory local control with a lesser level of mutilation, neither modifying the survival nor distant metastasis index from a distance. Objective: To determine the results of conservative surgery of breast cancer according to the variables selected during 1991-2009. Methods: a longitudinal and retrospective study was conducted in women diagnosed and treated due to breast cancer who underwent conservative surgery (n=77), fulfilling the established inclusion and exclusion criteria. Data descriptive analysis was performed by absolute and relative frequency distribution. The estimation of global survival curves and free of relapse was performed by Kaplan-Meier method. Results: The 40 to 59 age group was the predominant one for a 67.6 percent. Only the 10.4 percent of patients had first line positive backgrounds of breast cancer. The IIA clinical stage predominates with a 54.5 percent and the more frequent histological type, the infiltrating ductal carcinoma for a 84,4 percent. The 5-years global survival for our patients was of 95 percent and the interval free relapse was of 87.5 percent. Conclusions: Our results not differ from those found in studies at world level

Un análisis de largo plazo del comportamiento de la cirugía conservadora del cáncer de mama / A long-term analysis of the conservative surgery behavior in breast cancer

Introducción: en los últimos años la cirugía conservadora se ha consolidado como un procedimiento válido en el tratamiento de un determinado grupo de pacientes con cáncer de mama, pues permite conseguir un control local satisfactorio con una menor mutilación, sin modificar la supervivencia ni el índice de metástasis a distancia. Objetivo: determinar los resultados de la cirugía conservadora del cáncer de mama según variables seleccionadas en el período 1991-2009. Métodos: se realizó un estudio retropestivo longitudinal a mujeres diagnosticadas y tratadas de cáncer de mama a las que se les realizo cirugía conservadora (n=77), que cumplieron con los criterios de inclusión y exclusión establecidos. El análisis descriptivo de los datos se realizó mediante distribuciones de frecuencias absolutas y relativas. La estimación de las curvas de supervivencia global y libre de recidivas se realizó mediante el método de Kaplan-Meier. Resultados: el grupo de edad 40 a 59 años fue el predominante para 67,6 por ciento. Solo el 10,4 por ciento de las pacientes tuvieron antecedentes de primera línea positivos de cáncer de mama. La etapa clínica IIA predominó con un 54,5 por ciento, y el tipo histológico más frecuente, el carcinoma ductal infiltrante para un 84,4 por ciento. La supervivencia global para nuestras pacientes fue de un 95 por ciento a los 5 años, el intervalo libre de recidiva fue de un 87,5 por ciento. Conclusiones: nuestros resultados no difieren de los encontrados en los estudios a nivel mundial(AU)

Introduction: In past years the conservative surgery became consolidated as a valid procedure in treatment of a determined group of breast cancer patients, thus allows to achieve a satisfactory local control with a lesser level of mutilation, neither modifying the survival nor distant metastasis index from a distance. Objective: To determine the results of conservative surgery of breast cancer according to the variables selected during 1991-2009. Methods: a longitudinal and retrospective study was conducted in women diagnosed and treated due to breast cancer who underwent conservative surgery (n=77), fulfilling the established inclusion and exclusion criteria. Data descriptive analysis was performed by absolute and relative frequency distribution. The estimation of global survival curves and free of relapse was performed by Kaplan-Meier method. Results: The 40 to 59 age group was the predominant one for a 67.6 percent. Only the 10.4 percent of patients had first line positive backgrounds of breast cancer. The IIA clinical stage predominates with a 54.5 percent and the more frequent histological type, the infiltrating ductal carcinoma for a 84,4 percent. The 5-years global survival for our patients was of 95 percent and the interval free relapse was of 87.5 percent. Conclusions: Our results not differ from those found in studies at world level(AU)

Viusid, a nutritional supplement, increases survival and reduces disease progression in HCV-related decompensated cirrhosis: a randomised and controlled trial.

OBJECTIVES: Viusid is a nutritional supplement with recognised antioxidant and immunomodulatory properties which could have beneficial effects on cirrhosis-related clinical outcomes such as survival, disease progression and development of hepatocellular carcinoma (HCC). This study evaluated the efficacy and safety of viusid in patients with HCV-related decompensated cirrhosis. DESIGN: A randomised double-blind and placebo-controlled study was conducted in a tertiary care academic centre (National Institute of Gastroenterology, Havana, Cuba). The authors randomly assigned 100 patients with HCV-related decompensated cirrhosis to receive viusid (three oral sachets daily, n=50) or placebo (n=50) during 96 weeks. The primary outcome of the study was overall survival at 96 weeks, and the secondary outcomes included time to disease progression, time to HCC diagnosis, time to worsening of the prognostic scoring systems Child-Pugh and Model for End-Stage Liver Disease, and time to a new occurrence or relapse for each one of the main clinical complications secondary to portal hypertension at 96 weeks. RESULTS: Viusid led to a significant improvement in overall survival (90%) versus placebo (74%) (HR 0.27, 95% CI 0.08 to 0.92; p=0.036). A similar improvement in disease progression was seen in viusid-treated patients (28%), compared with placebo-treated patients (48%) (HR 0.47, 95% CI 0.22 to 0.89; p=0.044). However, the beneficial effects of viusid were wholly observed among patients with Child-Pugh classes B or C, but not among patients with Child-Pugh class A. The cumulative incidence of HCC was significantly reduced in patients treated with viusid (2%) as compared with placebo (12%) (HR 0.15, 95% CI 0.019 to 0.90; p=0.046). Viusid was well tolerated. CONCLUSIONS: The results indicate that treatment with viusid leads to a notable improvement in overall clinical outcomes such as survival, disease progression and development of HCC in patients with HCV-related decompensated cirrhosis. Trial registration number http://ClinicalTrials.gov (NCT00502086).

Perfil manométrico anorrectal en pacientes con constipación crónica asociada a ciego móvil / Anorectal manometric profile in patients presenting with chronic constipation associated with a mobile cecum

Introducción: La constipación constituye un serio problema de salud que afecta a millones de personas en el mundo. La manometría anorrectal realiza una valoración objetiva de la dinámica del segmento anorrectal para el diagnóstico de la constipación, la incontinencia anal, etc. Desde 1989, quedó demostrado que el ciego móvil causa alteraciones orgánicas del colon que conducen a la constipación crónica. Objetivo: Determinar, mediante manometría, la existencia de un patrón común, reproducible, que puede favorecer el diagnóstico de constipación crónica asociada a ciego móvil. Métodos: Se realizó una investigación descriptiva en 90 pacientes, 40 niños y 50 adultos, entre los años 2006 y 2009, en el Instituto de Gastroenterología, todos con diagnóstico de constipación crónica rebelde a tratamiento convencional, a los cuales se les efectuó estudio radiológico específico de colon por ingestión de bario, como Patrón Oro para diagnosticar ciego móvil. Se les realizó manometría anorrectal con un PC Polygraf HR, mediante un sistema de catéteres de perfusión continua y los registros fueron evaluados en una computadora con programa de análisis. Se encontró que la presión de reposo del esfínter anal interno fue X= 79,6 mmHg para el grupo niños con 65,8 por ciento de relajación para el reflejo recto-anal inhibitorio. En los pacientes adultos, la presión del esfínter anal interno fue de X= 80,9 mmHg y 68,2 por ciento de relajación del esfínter anal interno. La presión de contracción del esfínter anal externo, la longitud del canal anal y la sensibilidad rectal fueron normales en ambos grupos. Se demostró un patrón común y reproducible con hipertonía del esfínter anal interno y un déficit de relajación dado por un reflejo recto-anal inhibitorio incompleto en 94 por ciento de los casos. Conclusión: Se estableció relación entre estos hallazgos y la posible disminución en la transportación de los neurotransmisores inhibitorios...

Introduction: Constipation is a serious health problem affecting to millions of persons at world level. The anorectal manometry makes an objective assessment of the rectoanal segment dynamics for constipation diagnosis, the anal incontinence, etc. From 1989, it was demonstrated that the mobile cecum provoke organic alterations of colon leading to chronic constipation. Objective: To determine by manometry, the existence of a common and reproducible pattern favoring the diagnosis of mobile cecum-associated chronic constipation. Methods: A descriptive research was conducted in 90 patients (40 children, 50 adults) between 2006 and 2009 in the Institute of Gastroenterology all of them diagnosed with chronic constipation refractory to conventional m treatment, as well as a barium-meal specific radiologic colon study as Gold Standard to diagnose presence of mobile cecum. A anorectal manometry was carried out using a PC Polygraf HR, by a catheter system of continuous perfusion and registries were assessed in a computer with analysis program. It was found that the rest pressure of internal anal sphincter was of X = 79,6 mm Hg for the group of children with a 65,8 percent of relaxation for the inhibitory rectoanal reflex. In adult patients, the pressure of internal anal sphincter was of X= 80,9 mm Hg and a 68,2 percent of relaxation of internal anal sphincter. The pressure of contraction of external anal sphincter, the anal canal length and the rectal sensitivity were normal in both groups. There was a common and reproducible pattern with hypertonicity of internal anal sphincter and a relaxation deficit due to an incomplete inhibitory rectoanal reflex in the 94 percent of cases. Conclusion: There was a relation among these findings and the potential decrease in transportation of the inhibitory neurotransmitters produced as consequence of the mobile cecum leading to a chronic constipation

Perfil manométrico anorrectal en pacientes con constipación crónica asociada a ciego móvil / Anorectal manometric profile in patients presenting with chronic constipation associated with a mobile cecum

Introducción: La constipación constituye un serio problema de salud que afecta a millones de personas en el mundo. La manometría anorrectal realiza una valoración objetiva de la dinámica del segmento anorrectal para el diagnóstico de la constipación, la incontinencia anal, etc. Desde 1989, quedó demostrado que el ciego móvil causa alteraciones orgánicas del colon que conducen a la constipación crónica. Objetivo: Determinar, mediante manometría, la existencia de un patrón común, reproducible, que puede favorecer el diagnóstico de constipación crónica asociada a ciego móvil. Métodos: Se realizó una investigación descriptiva en 90 pacientes, 40 niños y 50 adultos, entre los años 2006 y 2009, en el Instituto de Gastroenterología, todos con diagnóstico de constipación crónica rebelde a tratamiento convencional, a los cuales se les efectuó estudio radiológico específico de colon por ingestión de bario, como Patrón Oro para diagnosticar ciego móvil. Se les realizó manometría anorrectal con un PC Polygraf HR, mediante un sistema de catéteres de perfusión continua y los registros fueron evaluados en una computadora con programa de análisis. Se encontró que la presión de reposo del esfínter anal interno fue X= 79,6 mmHg para el grupo ni±os con 65,8 por ciento de relajación para el reflejo recto-anal inhibitorio. En los pacientes adultos, la presión del esfínter anal interno fue de X= 80,9 mmHg y 68,2 por ciento de relajación del esfínter anal interno. La presión de contracción del esfínter anal externo, la longitud del canal anal y la sensibilidad rectal fueron normales en ambos grupos. Se demostró un patrón común y reproducible con hipertonía del esfínter anal interno y un déficit de relajación dado por un reflejo recto-anal inhibitorio incompleto en 94 por ciento de los casos...(AU)

Introduction: Constipation is a serious health problem affecting to millions of persons at world level. The anorectal manometry makes an objective assessment of the rectoanal segment dynamics for constipation diagnosis, the anal incontinence, etc. From 1989, it was demonstrated that the mobile cecum provoke organic alterations of colon leading to chronic constipation. Objective: To determine by manometry, the existence of a common and reproducible pattern favoring the diagnosis of mobile cecum-associated chronic constipation. Methods: A descriptive research was conducted in 90 patients (40 children, 50 adults) between 2006 and 2009 in the Institute of Gastroenterology all of them diagnosed with chronic constipation refractory to conventional m treatment, as well as a barium-meal specific radiologic colon study as Gold Standard to diagnose presence of mobile cecum. A anorectal manometry was carried out using a PC Polygraf HR, by a catheter system of continuous perfusion and registries were assessed in a computer with analysis program. It was found that the rest pressure of internal anal sphincter was of X = 79,6 mm Hg for the group of children with a 65,8 percent of relaxation for the inhibitory rectoanal reflex. In adult patients, the pressure of internal anal sphincter was of X= 80,9 mm Hg and a 68,2 percent of relaxation of internal anal sphincter. The pressure of contraction of external anal sphincter, the anal canal length and the rectal sensitivity were normal in both groups. There was a common and reproducible pattern with hypertonicity of internal anal sphincter and a relaxation deficit due to an incomplete inhibitory rectoanal reflex in the 94 percent of cases. Conclusion: There was a relation among these findings and the potential decrease in transportation of the inhibitory neurotransmitters produced as consequence of the mobile cecum leading to a chronic constipation(AU)

Factores de riesgo para el cáncer colorrectal / Risk factors for colorectal cancer

El cáncer colorrectal (CCR) es una de las neoplasias más frecuentes en nuestro medio, en los últimos años hemos asistido a un avance muy significativo en el conocimiento de los mecanismos que participan en su desarrollo y progresión. Ese avance abarca desde la identificación de diversos factores genéticos o moleculares implicados en la fisiopatología de esta neoplasia, hasta la caracterización de múltiples aspectos epidemiológicos involucrados en su génesis. Se realizó un estudio de casos y controles sobre factores de riesgo del CCR, en pacientes adultos (92 casos y 184 controles), diagnosticados en el Instituto de Gastroenterología. Se aplicó una encuesta para recoger estos posibles factores y determinar su relación con el CCR. El análisis de estos resultados demostró que los factores de riesgo de más sólida causalidad son: hábito de fumar, índice cintura-cadera, consumo de vegetales, inactividad física y antecedentes patológicos personales de pólipos y de otros tumores malignos. Predominó la localización hacia colon izquierdo (descendente, sigmoide y recto) en ambos sexos. Se observó predominio del tipo ulcerado, en ambos sexos y el tipo histológico más frecuente fue el adenocarcinoma

The colorectal carcinoma (CLC) is one of the more frequent neoplasia in our practice, in past years there was a significant advance in the knowledge of mechanisms implicated in its development and progression. Such advance embraces from the identification of different genetic factors or molecular involved in its genesis. A case-control study was conducted on the CLC risk factors in adult patients (92 cases and 184 controls), diagnosed in the Institute of Gastroenterology. A survey was applied to collect these possible factors and to determine its relation to CLC. Analysis of these results showed that the risk factors with a great solid causality are: smoking, hip-waist index, vegetable consumption, physical inactivity and personal pathologic backgrounds of polyps and of other malignant tumors. There was predominance to left colon (descending, sigmoid and rectum) in both sexes. There was also predominance of the ulcerated type in both sexes, and the more frequent histological type was the adenocarcinoma

Factores de riesgo para el cáncer colorrectal / Risk factors for colorectal cancer

El cáncer colorrectal (CCR) es una de las neoplasias más frecuentes en nuestro medio, en los últimos años hemos asistido a un avance muy significativo en el conocimiento de los mecanismos que participan en su desarrollo y progresión. Ese avance abarca desde la identificación de diversos factores genéticos o moleculares implicados en la fisiopatología de esta neoplasia, hasta la caracterización de múltiples aspectos epidemiológicos involucrados en su génesis. Se realizó un estudio de casos y controles sobre factores de riesgo del CCR, en pacientes adultos (92 casos y 184 controles), diagnosticados en el Instituto de Gastroenterología. Se aplicó una encuesta para recoger estos posibles factores y determinar su relación con el CCR. El análisis de estos resultados demostró que los factores de riesgo de más sólida causalidad son: hábito de fumar, índice cintura-cadera, consumo de vegetales, inactividad física y antecedentes patológicos personales de pólipos y de otros tumores malignos. Predominó la localización hacia colon izquierdo (descendente, sigmoide y recto) en ambos sexos. Se observó predominio del tipo ulcerado, en ambos sexos y el tipo histológico más frecuente fue el adenocarcinoma(AU)

The colorectal carcinoma (CLC) is one of the more frequent neoplasia in our practice, in past years there was a significant advance in the knowledge of mechanisms implicated in its development and progression. Such advance embraces from the identification of different genetic factors or molecular involved in its genesis. A case-control study was conducted on the CLC risk factors in adult patients (92 cases and 184 controls), diagnosed in the Institute of Gastroenterology. A survey was applied to collect these possible factors and to determine its relation to CLC. Analysis of these results showed that the risk factors with a great solid causality are: smoking, hip-waist index, vegetable consumption, physical inactivity and personal pathologic backgrounds of polyps and of other malignant tumors. There was predominance to left colon (descending, sigmoid and rectum) in both sexes. There was also predominance of the ulcerated type in both sexes, and the more frequent histological type was the adenocarcinoma(AU)

[Propofol versus midazolam and pethidine in the colonoscopy realization]. / Utilidad de propofol versus midazolam más petidina en la realización de la colonoscopía.

INTRODUCTION: Medications to relief pain are more common in the everyday use during the colonoscopy practice, although schemes of medications vary. OBJECTIVE: To evaluate the efficacy and the safety of propofol versus midazolam and petidhine in colonoscopy. METHOD: A randomized and simple-blind controlled clinical trial was carried out. We included 512 patients who underwent a colonoscopy during the period from February 2008 to January 2009. using propofol in one group and midazolam plus petidhine in another. RESULTS: Cecal intubation was achieved in 247 patients (96.5%) with propofol and in 256 patients (100%) with midazolam plus petidhine. There were no significant differences between both methods regarding to the explored colon distance. Fifty-five patients (21.5%) had complications in the group receiving midazolam plus petidhine and 3 (1.2%) in the group receiving propofol. Complications were mild in both groups. Propofol reduced the relative risk of complications in 94.6% and absolute risk in 20.3%. Patients referred the same satisfaction degree with both methods. CONCLUSIONS: The use of propofol and midazolam plus petidhine is equally efficacious in the performance of the colonoscopy, while propofol is safer than midazolam plus propofol as a method of deep sedation.

Application of a biochemical and clinical model to predict individual survival in patients with end-stage liver disease.

AIM: To investigate the capability of a biochemical and clinical model, BioCliM, in predicting the survival of cirrhotic patients. METHODS: We prospectively evaluated the survival of 172 cirrhotic patients. The model was constructed using clinical (ascites, encephalopathy and variceal bleeding) and biochemical (serum creatinine and serum total bilirubin) variables that were selected from a Cox proportional hazards model. It was applied to estimate 12-, 52- and 104-wk survival. The model's calibration using the Hosmer-Lemeshow statistic was computed at 104 wk in a validation dataset. Finally, the model's validity was tested among an independent set of 85 patients who were stratified into 2 risk groups (low risk 8). RESULTS: In the validation cohort, all measures of fit, discrimination and calibration were improved when the biochemical and clinical model was used. The proposed model had better predictive values (c-statistic: 0.90, 0.91, 0.91) than the Model for End-stage Liver Disease (MELD) and Child-Pugh (CP) scores for 12-, 52- and 104-wk mortality, respectively. In addition, the Hosmer-Lemeshow (H-L) statistic revealed that the biochemical and clinical model (H-L, 4.69) is better calibrated than MELD (H-L, 17.06) and CP (H-L, 14.23). There were no significant differences between the observed and expected survival curves in the stratified risk groups (low risk, P = 0.61; high risk, P = 0.77). CONCLUSION: Our data suggest that the proposed model is able to accurately predict survival in cirrhotic patients.

Application of a biochemical and clinical model to predict individual survival in patients with end-stage liver disease

AIM: To investigate the capability of a biochemical and clinical model, BioCliM, in predicting the survival of cirrhotic patients. METHODS: We prospectively evaluated the survival of 172 cirrhotic patients. The model was constructed using clinical (ascites, encephalopathy and variceal bleeding) and biochemical (serum creatinine and serum total bilirubin) variables that were selected from a Cox proportional hazards model. It was applied to estimate 12-, 52- and 104-wk survival. The model¡¯s calibration using the Hosmer-Lemeshow statistic was computed at 104 wk in a validation dataset. Finally, the model¡¯s validity was tested among an independent set of 85 patients who were stratified into 2 risk groups (low risk ¡Ü 8 and high risk > 8). RESULTS: In the validation cohort, all measures of fit, discrimination and calibration were improved when the biochemical and clinical model was used. The proposed model had better predictive values (c-statistic: 0.90, 0.91, 0.91) than the Model for End-stage Liver Disease (MELD) and Child-Pugh (CP) scores for 12-, 52- and 104-wk mortality, respectively. In addition, the Hosmer-Lemeshow (H-L) statistic revealed that the biochemical and clinical model (H-L, 4.69) is better calibrated than MELD (H-L, 17.06) and CP (H-L, 14.23). There were no significant differences between the observed and expected survival curves in the stratified risk groups (low risk, P = 0.61; high risk, P = 0.77). CONCLUSION: Our data suggest that the proposed model is able to accurately predict survival in cirrhotic patients(AU)

Una mirada al envejecimiento de la población / A glance ath the population's aging

El envejecimiento de la población es una realidad que hemos de enfrentar con dignidad. Se expone una panorámica del envejecimiento de la población así como su actualidad en la región de Las Américas enfatizando en el componente socioeconómico. Se presenta una breve caracterización del fenómeno en Cuba, su actualidad y se enuncia la pertinencia de realizar estudios de carga de enfermedad como medida de la contribución de la enfermedad y la discapacidad a la salud de nuestra población(AU)

The population aging is a reality that we have to face with dignity. A review of the population aging, as well as its current situation is exposed in the Americas, making emphasis on the socio-economic component. A brief characterization of this phenomenon is presented in Cuba nowadays and the relevance to carry out studies on burden of the disease is enunciated as a measure of contribution to the disease and the limitation to our public health(AU)