Browsing by Author "Gonzalez Dominguez, Esteban Horacio"

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Cardiomyopathy in patients with liver cirrhosis: review article
(2022) Gonzalez Dominguez, Esteban Horacio; Cordova Reyes, Diego Andres; Abad Polo, Paula Gabriela; González, Juan Eduardo; Gonzalez Dominguez, Camila Maria; Cordero Cedillo, Juan Jose
Cirrhotic cardiomyopathy is a complication in cirrhotic patients, with a prevalence of more than 40%. During the resting state, it is a subclinical entity, which triggers symptoms upon exercise or circulatory Cirrhotic cardiomyopathy is a complication in cirrhotic patients, with a prevalence of more than 40%. During the resting state, it is a subclinical entity, which triggers symptoms upon exercise or circulatory
Evaluación del valor diagnóstico de la calprotectina fecal en pacientes con dispepsia
(2022) Gonzalez Dominguez, Camila Maria; Vasquez Moscoso, Ana Isabel; Cordova Reyes, Diego Andres; Abad Polo, Paula Gabriela; González, Juan Eduardo; Lopez Dominguez, Guillermo Estuardo; Cordero Asanza, Juan Jose; Gonzalez Dominguez, Esteban Horacio
The diagnosis of patients with dyspepsia represents a challenge since in most cases complex and costly endoscopic observations are required. In this study, we evaluated the diagnostic role of fecal calprotectin in patients with dyspepsia. To this end, an observational study was performed in 2019 on 149 patients with dyspepsia registered in the private Gastroenterology Specialists Center in Cuenca, Ecuador. The available data encompassed age, sex, alarm signs, fecal calprotectin (FC) values, and endoscopic findings. Patients in the age group >65 years were most represented, 56.4% of the population were female, 48.57% were FC positive of whom 86.8% possessed significant values of FC. FC+ was significantly associated with findings by EDA/colonoscopy (p<0.001). The most diagnostic pathologies in patients with FC+ were congestive gastropathy, intestinal metaplasia, giardiasis, and polyposis. FC correlated positively with the presence of pathological findings in the invasive diagnostic tests (r=0.298) and is a useful, noninvasive biomarker correlating positively with endoscopic findings in the gastrointestinal tract of dyspepsia patients.
Frecuencia de la intolerancia a la lactosa y síndrome de sobrecrecimiento bacteriano en pacientes con dispepsia sin signos de alarma. Estudio observacional descriptivo
(2023) Lopez Dominguez, Guillermo Estuardo
Introduction The prevalence and incidence of patients in private practice, presenting with dyspeptic symptoms as a chief complaint, is increasing, so we propose to determine the etiology in each patient, determining, lactose intolerance (LI) and intestinal bacterial overgrowth syndrome (SIBO), as the highest in prevalence. The exhaled H2 test is a practical and accessible method and has been validated in numerous studies as a diagnostic method. Objectives To establish the frequency of lactose intolerance and bacterial overgrowth in patients with dyspepsia without alarm signs in the Gastroenterology González specialty center in the city of Cuenca-Ecuador. Methodology This is a descriptive observational study, cross-sectional, which collected data through documentary analysis (medical records) and H2 exhaled test applied to 310 individuals of both sexes with an average age of 50±17 years, in the period February 2019 to February 2020. Results Lactose intolerance was observed in 29% of cases, while intestinal bacterial overgrowth in 20.3%.. Conclusions Lactose intolerance as well as bacterial overgrowth syndrome (SIBO), are frequent syndromes occurring in private practice, and should therefore be taken into account, when investigating a patient with dyspeptic symptoms, and should not be ruled out before performing a diagnostic test such as the exhaled H2 test.
Protocolo de inmunosupresión en trasplante hepático: revisión de la literatura.
(2022) Gonzalez Dominguez, Esteban Horacio; Cordova Reyes, Diego Andres; Abad Polo, Paula Gabriela; González, Eduardo; Gonzalez Dominguez, Camila Maria; Cordero Velastegui, Juan Jose; Flores Siguenza, Luis Francisco; Aguirre Bermeo, Hernan Marcelo
Liver transplantation is the last option for the treatment of liver disease. Immunosuppression schemes are required to avoid graft rejection, which have evolved over the years. A literature review was carried out in PubMed on the immunosuppressive therapies available to avoid graft rejection in liver transplantation, as well as on the schemes used, adverse effects, interactions and their modifications from the induction phase to subsequent follow-up. The usual induction was found to be with steroids or clonal immune therapy. In maintenance, calcineurin inhibitors are the most widely used, and their doses should be adjusted according to their serum levels and the presence of adverse effects such as nephrotoxicity or diabetes. On the other hand, mTOR inhibitors have been considered to reduce the risk of hepatocellular cancer recurrence. The characteristics of the patient and their comorbidities (pregnancy, kidney failure, diabetes, sepsis, hepatocellular carcinoma) require modification and individualization of the treatment
Second look» en el tratamiento endoscópico de hemorragia digestiva
(2014) Gonzalez Dominguez, Esteban Horacio; Navarro Rodríguez, Tomás; Gonzalez Abad, Germanico Horacio
Introduction: Based on the lack of a formal recommendation of a particular endoscopic technique for the treatment of gastrointestinal bleeding for Dieulafoy’s lesion. Objective: To evaluate the effectiveness and the impact on the prognosis of endoscopic injection therapy (adrenalin/polidocanol) applied two times («second look») in gastrointestinal bleeding for Dieulafoy’s lesion. Methods: Prospective studies, conducted at the regional hospital «Vicente Corral Moscoso» University of Cuenca. Eighteen patients diagnosed with gastrointestinal bleeding from Dieulafoy’s lesion, were separated into 2 groups: Group A with 9 patients, who received a single endoscopic injection therapy with adrenaline and polidocanol. And group B with 9 patients, who received the same treatment, in the first instance, and were subsequently subjected to new session 7 days later. We analyzed and compared the clinical, endoscopic and laboratory results, with follow-up for 6 months. Results: In both groups is achieving 100% of primary hemostasis. In Group A re-bleeding was present in 22% (2/9) and in Group B 100% (9/9) of pat patients had no further episodes of gastrointestinal bleeding. In both groups there were no complications secondary to endoscopic procedure performed. Conclusions: Endoscopic injection treatment with a solution of a sclerosing and vasoconstrictor is 100% effective for primary hemostasis. A single intervention has a 22% rate of re-bleeding. Applying a «second look» with new injection therapy based on a vasoconstrictor and a sclerosing is 100% effective in preventing re-bleeding without adverse side effects. © 2013 Asociación Mexicana de Endoscopia Gastrointestinal. Published by Masson Doyma México S.A. All rights reserved.
Trastornos de la coagulación en cirrosis hepática: artículo de revisión
(2022) Abad Polo, Paula Gabriela
The pathophysiological events of liver cirrhosis drastically alter the processes of primary and secondary hemostasis and fibrinolysis. Previously, it was conceptualized that these alterations exclusively predisposed to hypocoagulation, due to the low hepatic production of procoagulant factors and the characteristic thrombocytopenia. Currently, there is evidence of compensation mechanisms that lead to a hemostatic rebalancing, which is unstable and easily dysregulated in the presence of comorbidities, complications and progression of the disease, leading to prohemorrhagic or prothrombotic phenomena, such as portal vein thrombosis, venous thromboembolism, etc. To effectively determine whether a cirrhotic patient is at risk for bleeding, conventional coagulation tests are not helpful. Treatment will depend on the hypo or hypercoagulable state of the patient. In this manuscript, we review the hemostatic phenomena in cirrhosis, to reveal its characteristics, effective diagnostic methods and treatment
Uso de albúmina a largo plazo en el paciente cirrótico. Revisión sistemática
(2023) Gonzalez Dominguez, Esteban Horacio; Marin Tirado, Henry Ariel; Torres Cueva, Gabriela De los angeles
Cirrhosis is the final stage of chronic liver disease, has a high mortality and can be due to different etiologies. Albumin has three well-established indications: prevention of circulatory ysfunction induced by paracentesis, spontaneous bacterial peritonitis, and hepatorenal syndro-me, however, its long-term use is controversial. The objective of this review was to identify if the prolonged use of albumin has beneficial effects in the treatment of cirrhotic patients. Methodology. PubMed database was searched using the following terms: ("Liver Cirrhosis"[Mesh]) AND ("Serum Albumin"[Mesh] OR "Serum Albumin, Human"[Mesh]). Articles that did not meet the topic and those that were more than 5 years old were excluded, except for those relevant to the review. Results.It has been shown in several studies within the previous 4 years, that prolonged administration of albumin reduces mortality in cirrhotic patients. In addition, it results in a decrease in hospital ad-missions due to complications of cirrhosis, a decrease in the need for paracentesis and less use of albumin for other established indications, which offsets the costs derived from therapy. Conclusion. It is concluded based on the evidence presented, that the long-term use of albumin could be beneficial in patients with decompensated liver cirrhosis. However, other aspects of the therapy need to be addressed in further studies.