Prevalence of metabolic associated fatty liver disease (MAFLD) in patients with gallstone disease. Study on a cohort of cases in South-Southeastern Mexico.

INTRODUCTION: Metabolic (dysfunction) associated fatty liver disease (MAFLD) and gallstone disease are entities that share similar risk factors. Numerous publications confirm their elevated frequency, but few studies have considered their prevalence and possible association. AIMS: To determine the prevalence of MAFLD in patients with gallstone disease and the usefulness of liver biopsy for diagnosing the liver disease. MATERIALS AND METHODS: A prospective study was conducted on patients that underwent laparoscopic cholecystectomy, in whom liver biopsy was performed. VARIABLES ANALYZED: Anthropometric characteristics, biochemical profile, conventional ultrasound, risk factors, and histopathologic study of the liver biopsy. STATISTICAL ANALYSIS: Descriptive statistics were carried out for the quantitative variables and the Student's t test and multivariate analysis through binary logistic regression were employed for the continuous variables, utilizing IBM-SPSS, 25.0 (Windows) software. RESULTS: A total of 136 patients were classified into 2 groups: 40 (29.41%) with normal liver and 96 (70.59%) with MAFLD. Of the 136 patients, 71 patients (52.21%) corresponded to hepatic steatosis, 21 (15.44%) to steatohepatitis, and 4 (2.94%) to cirrhosis. Perisinusoidal inflammation was found in 39 cases (28.68%) and fibrosis was found in 10 (7.35%). The risk factors for both groups were age, diabetes, high blood pressure, and obesity. Glucose, triglyceride, and aminotransferase levels were significantly higher in the MAFLD group and conventional ultrasound demonstrated moderate concordance for its detection. DISCUSSION AND CONCLUSIONS: The results confirmed the elevated frequency of MAFLD associated with gallstone disease, justifying liver biopsy during cholecystectomy for diagnosing MAFLD.

Knowledge acquired from Clinical Guidelines on the Diagnosis and Treatment of Acute Pancreatitis by attending physicians and residents in hospitals in Veracruz. / Conocimiento de las Guías Clínicas de Diagnóstico y Tratamiento de la Pancreatitis Aguda en médicos adscritos y residentes de los hospitales de Veracruz.

INTRODUCTION: Clinical practice guidelines on the diagnosis and treatment of acute pancreatitis (CPGDTAP) have been designed in an effort to reduce the morbidity and mortality of that severe disease. AIM: To identify the knowledge acquired from CPGDTAP in hospitals in Veracruz. MATERIALS AND METHODS: A descriptive, observational, multicenter study was conducted at four hospitals in Veracruz, through the application of a survey to evaluate the knowledge of attending physicians and residents that treat patients with acute pancreatitis. Descriptive statistics were employed to analyze the results. RESULTS: A total of 74 physicians were surveyed: 55.41% of whom were attending physicians and 44.59% of whom were resident physicians. The majority of physicians (67.57%) were familiar with CPGDTAP from the Asociación Mexicana de Gastroenterología (AMG), followed by those of the General Health Council of the Mexican Department of Health (CENETEC, the Spanish acronym) (54.05%) and the American College of Gastroenterology (ACG) (48.65%). A total of 97.30% of the physicians routinely use a nasogastric tube, 79.73% considered early enteral nutrition to be very important, as did 98.65% regarding generous fluid replacement, 85.14% did not routinely use antimicrobials, 63.51% ordered a CAT scan at 72h or later, and 87.84% answered that infected necrosis was the indication for surgery, preferably after the third week. DISCUSSION AND CONCLUSIONS: In our hospital environment, the CPGDTAP issued by the AMG and CENETEC were the most well-known, but their recommended measures were given importance by under 85% of the physicians surveyed. Therefore, the diffusion of the knowledge they contain is advisable to guarantee optimal results in acute pancreatitis management.

Influence of socioeconomic and cultural factors in the etiology of cirrhosis of the liver. / Influencia los factores socioeconómicos y culturales en la etiología de la cirrosis hepática.

INTRODUCTION: Cirrhosis of the liver is a serious public health problem worldwide, with regional variations determined by cultural factors and economic development. AIM: To know the characteristics of the social, cultural, and economic factors of the patients with cirrhosis of the liver in Veracruz. MATERIALS AND METHODS: A multicenter, retrolective, relational research study was conducted on patients with cirrhosis of the liver at five healthcare institutions in Veracruz. The variables analyzed were etiology, age, sex, civil status, educational level, occupation, and income. Descriptive and inferential statistics were utilized, and statistical significance was set at a P<.05. The Windows IBM-SPSS version 25.0 program was employed. RESULTS: A total of 182 case records of patients with cirrhosis of the liver were included. The etiologic factors were chronic alcohol consumption (47.8%), viral disease (28.5%), nonalcoholic fatty liver disease (NAFLD) (8.79%), autoimmune liver disease (4.4%), cholestasis (1.64%), and cryptogenic liver disease (8.8%). Mean patient age was 66.14±13.91, with a predominance of men (58.79%). In comparing the socioeconomic and cultural factors related to etiology, secondary and tertiary education and singleness were statistically significant in male alcoholics (P<.05), viral diseases and NAFLD were significantly associated with women with no income (P<.05), cryptogenic liver disease was significantly associated with women (P<.05), and cholestasis and autoimmune liver disease were not significantly associated with any of the factors. CONCLUSIONS: The study results revealed the influence of socioeconomic and cultural factors related to the different causes of cirrhosis of the liver in our environment.

Cancer of the digestive system in Veracruz. The magnitude of the problem by 2025. / Cáncer del aparato digestivo en Veracruz. La magnitud del problema al año 2025.

INTRODUCTION: Malignant tumors of the digestive system are a public health problem with epidemiologic variations attributed to factors resulting from the aging of the population and lifestyle changes. Therefore, estimating the future magnitude of the problem is prudent. AIM: To determine the epidemiologic projection up to 2025 of malignant tumors of the digestive system in Veracruz. MATERIALS AND METHODS: A predictive, analytic, observational study was conducted on patients belonging to the Public health sector of Veracruz that presented with digestive system cancer, within the time frame of 2000-2016, carrying out a disease projection up to 2025. The IBM SPSS 22.0 program was utilized for the statistical analysis, employing simple linear regression. A comparative analysis of the data was carried out and results are shown in scatter graphs. RESULTS: A total of 2,540 cases were included in the study. Mean patient age was 63.25±13.43, with a predominance of men at 56.65%. The most frequent tumor locations were in the colon and rectum (25.04%), liver (23.66%), and stomach (21.93%). Less frequent sites were the esophagus (4.88%) and small bowel (5.08%). A general 7.63% increase in the disease was predicted for 2025, with increases to 11.51% for esophageal cancer, 7.22% for gastric cancer, 9.09% for colorectal cancer, 5.98% for liver cancer, 7.88% for pancreatic cancer, and 6.86% for cancer of the gallbladder and bile ducts. Only cancer of the small bowel showed a predicted decrease to 3.33%. DISCUSSION AND CONCLUSIONS: The results of the present study predict that digestive system cancers in Veracruz will increase importantly by 2025, with colorectal cancer, hepatocellular carcinoma, and gastric cancer as the most frequent tumors, in descending order. The other cancers are estimated to maintain a discrete line of growth. In addition to predicting the behavior of those cancers, the results of the present study are useful for estimating the resources that will be needed for their care by 2025.

Safety of laparoscopic subtotal cholecystectomy in acute cholecystitis. Experience in Southeast Mexico. / Seguridad de la colecistectomía subtotal laparoscópica en colecistitis aguda. Experiencia en el sureste de México.

INTRODUCTION: Subtotal cholecystectomy has been employed in cases of tecnically difficult cholecystectomy to prevent common bile duct injury. Given that there are few reports in Mexico on the theme, we consider it important to present the 18-year experience of a surgical group in the South-Southeast of Mexico. AIM: To determine the safety of laparoscopic subtotal cholecystectomy in patients with acute cholecystitis. MATERIALS AND METHODS: A retrospective, observational, and comparative study was conducted on patients with gallstones that underwent laparoscopic cholecystectomy. The variables analyzed were: anthropometric characteristics, comorbidities, conversion rate, surgery duration, hospital stay, and morbidity and mortality. STATISTICAL ANALYSIS: Descriptive statistics were applied through measures of central tendency and dispersion and standard deviation, utilizing the SPSS v22 program. RESULTS: A total of 1,101 medical records of patients with gallstones were reviewed. Of those patients, 223 presented with acute cholecystitis (20.25%) and they were divided into 2 groups: A) total cholecystectomy (82.95%) and B) subtotal cholecystectomy (17.05%). The anthropometric characteristics, risk factors, conversion rate, and hospital stay were similar in both groups. Only surgery duration was longer in the subtotal cholecystectomy group. Complications were more frequent, there was 1 death, and there was no bile duct injury in the subtotal cholecystectomy group. Those results were not statistically significant between the two groups. CONCLUSIONS: Subtotal cholecystectomy is a valuable resource in patients with acute cholecystitis. In our case series, it was a safe and reliable procedure for preventing bile duct injury. A larger number of cases are needed to corroborate those results.

Frequency of human papillomavirus infection in patients with gastrointestinal cancer. / Frecuencia de infección por virus del papiloma humano en pacientes con cáncer del aparato digestivo.

INTRODUCTION AND AIM: Cancer is the result of the interaction of genetic and environmental factors. It has recently been related to viral infections, one of which is human papillomavirus. The aim of the present study was to describe the frequency of human papillomavirus infection in patients with digestive system cancers. MATERIALS AND METHODS: A prospective, multicenter, observational study was conducted on patients with gastrointestinal cancer at 2public healthcare institutes in Veracruz. Two tumor samples were taken, one for histologic study and the other for DNA determination of human papillomavirus and its genotypes. Anthropometric variables, risk factors, sexual habits, tumor location, and histologic type of the cancer were analyzed. Absolute and relative frequencies were determined using the SPSS version 24.0 program. RESULTS: Fifty-three patients were studied. They had gastrointestinal cancer located in: the colon (62.26%), stomach (18.87%), esophagus (7.55%), rectum (7.55%), and small bowel (3.77%). Human papillomavirus was identified in 11.32% of the patients, 66.7% of which corresponded to squamous cell carcinoma and 33.3% to adenocarcinoma. Only genotype 18 was identified. Mean patient age was 61.8±15.2 years, 56.60% of the patients were men, and 43.40% were women. A total of 15.8% of the patients had a family history of cancer and 31.6% had a personal history of the disease, 38.6% were tobacco smokers, and 61.4% consumed alcohol. Regarding sex, 5.3% of the patients said they were homosexual, 3.5% were bisexual, 29.8% engaged in oral sex, and 24.6% in anal sex. CONCLUSIONS: Our study showed that human papillomavirus infection was a risk factor for the development of gastrointestinal cancer, especially of squamous cell origin.

[Spontaneous rupture of the esophagogastric junction. Report of a case]. / Ruptura espontánea de la unión cardio-esofágica Presentación de un caso.

It is presented a case of spontaneous rupture of the union cardioesophageal consecutive on ingestion of bicarbonate in an old patient with strangulated hiatal hernia. It is analyzed the phisiopathological factors of such complication and the surgical treatment employed.