Altered Liver Function Tests Research Articles

Approach to the patient with abnormal liver biochemistry

Altered liver function tests are a common finding that requires careful interpretation and thorough correlation with the patient's clinical picture. This paper provides a systematic and practical approach to the management of patients with alterations in their liver biochemistry. The fundamental concepts of liver anatomy and physiology are reviewed, emphasizing the importance of understanding the microscopic organization of the organ and key metabolic processes. The most used liver tests, their interpretation and the patterns of alterations that may occur will be described, and the importance of a detailed anamnesis will be emphasized. Guidelines are provided for the diagnostic approach according to the pattern of alteration observed and the different patterns of transaminase elevation, from mild to moderate and severe, and their possible causes are discussed in detail. The importance of considering fatty liver disease as a frequent cause of mild and persistent transaminase elevations is highlighted, and noninvasive tools for the evaluation of liver fibrosis, such as specialized scores and markers, are mentioned. In summary, this document presents an updated and practical text for the proper interpretation of alterations in liver biochemistry, emphasizing the importance of a close correlation with the clinical context of the patient, which will allow an accurate diagnosis and appropriate management.

Living tape worms in the duodenal lumen: A rare case report

Fascioliasis is an infection caused by a trematode of the liver, Fasciola hepatica, which affects sheep, goats and cattle. Humans become accidental hosts through drinking contaminated water or ingesting raw green vegetables that has been contaminated with encysted metacercariae, which is the infective form. Fascioliasis has a hepatic phase and a biliary phase, each displaying different clinical signs and symptoms. Common signs and symptoms of the hepatic phase are abdominal pain, fever, eosinophilia, and abnormal liver function tests. The biliary phase of the disease usually presents with intermittent right upper quadrant pain with or without cholangitis or cholestasis. However, it is very rare to find a living flukes in the common bile duct (CBD) and duodenal lumen as it usually lives in gall-bladder and smaller biliary tracts. Here we report a case of human infestation of Fasciola hepatica, who presented with respiratory tract infection with abdominal pain & dyspeptic symptoms and eventually during evaluation, an upper gastro-intestinal endoscopy revealed several flat worms at the second part of the duodenum. The worms were sent to microbiology department for identification. The organisms were confirmed to be Fasciola hepatica. The patient was given tablet Nitazoxanide 500mg 12 hourly for 7 days. The symptoms reduced in intensity after two days of nitazoxanide. The patient was then discharged with an advice of a stool routine examination after one month of completion of nitazoxanide. As fasciolosis is non endemic in our country, a high degree of suspicion is required to ensure early detection and management of such cases. Patients with abdominal pain, altered liver function tests & eosinophilia should always be evaluated for a suspected Fasciola hepatica infection and should be kept as a differential in these cases. Bangladesh Crit Care J March 2024; 12 (1): 54-57

Hepatobiliary manifestations in patients with ulcerative colitis: a retrospective analysis.

Inflammatory bowel diseases (IBDs) are often associated with altered liver function tests (LFTs). There is little data on the relationship between abnormal LFT and IBD. Our study aimed to evaluate the prevalence and etiology of elevated LFT in patients with ulcerative colitis (UC) and to determine whether there is an association with clinical and demographic parameters. The clinical records of the Gastroenterology Outpatients Clinic at a single center were reviewed and screened for patients with UC from 2005 to 2014. In total, 263 patients were included. Patients with Crohn's disease (CD), colitis indeterminate, and colitis of other origins were excluded. Abnormal LFT and liver injuries were analyzed. A cohort of 182 patients was analyzed (114 males, 68 females; mean age = 50.2 ± 16.1 years). 58 patients had already been diagnosed with a hepatobiliary disorder. Patients with a known hepatobiliary disorder suffered from UC for a significantly longer duration. Elevated LFT in patients without known hepatobiliary disorders was 69.4%. Liver injury was found in 21.8%. A transient increase in abnormal LFT was shown in 59 patients (68.6%), a persistent increase was found in 27 patients (31.4%). Treatment with thiopurines was a risk factor for persistent elevated LFT (p = 0.029), steroids had a protective impact (p = 0.037). This study clearly highlights the importance of screening for hepatobiliary disorders and abnormal LFT in patients with UC, as the prevalence of hepatobiliary disorders and abnormal LFT is detected very often among this patient group.

Alteration of liver function tests in various liver diseases

Background: The burden of liver diseases in India has witnessed a significant rise, spurred by factors such as viral hepatitis, alcoholic liver disease, non-alcoholic fatty liver disease, and a spectrum of metabolic and genetic disorders. Liver function tests (LFTs) serve as invaluable tools in the hands of clinicians, offering insights into the dynamic interplay between hepatic health and various disease processes. This study aims to provide a detailed exploration of the alterations in LFTs associated with various liver diseases prevalent in India. Aim and Objectives: (i) To Identify the various types of Liver diseases; (ii) To evaluate the various liver function tests in various liver diseases. Materials and Methods: The study involved the collection of samples from 100 liver disease patients who seek medical care at C. U. Shah Medical College and Hospital. Informed consent was obtained from all participants and the study protocol was approved by the institutional ethics committee. Results: Our study shows that the prevalence of cirrhosis of liver was 25% among study participants. Majority of liver disease were prevalent in male whereas, mostly affected age group was 51–60 years. Bilirubin was altered in cirrhosis of liver (88%), obstructive jaundice (100%), alcoholic liver disease (80%), viral hepatitis (75%), and in other liver disease (85%). Conclusion: Altered LFT is a useful tool to reach the Etiology of Liver disease. Alterations in liver enzymes as well as HbsAg reactivity are specific tests for cirrhosis of liver and viral hepatitis.

Phytosterol determination in lipid emulsions for parenteral nutrition

ObjectiveThe presence of phytosterols in vegetal lipid emulsions has been associated with alterations of liver function tests. Determination of phytosterols content, currently undeclared, would allow the development of strategies to prevent or treat these alterations. Method3-4 non-consecutive batches of 6 lipid emulsions from different providers (Clinoleic™, Intralipid™, Lipofundina™, Lipoplus™, Omegaven™ and Smoflipid™) were analyzed. Differences in total phytosterol assay between providers and batches were statistically studied by a one-way ANOVA and Kruskal-Wallis non-parametric approximation and post hoc Scheffe test (p < 0.05) ResultsThe absence of phytosterols was confirmed in Omegaven™, emulsion based on fish oil. The highest assay of phytosterols (422.4 ± 130.5 µg/mL) has been related with the highest percentage of soya bean oil in Intralipid. In the remaining emulsions, concentrations were from 120 to 210 µg/mL related to the percentage of soya bean oil. Statistically significant differences of phytosterol content in lipid emulsions were observed among different providers (F = 23.59; p = 0.000) as well as among non-consecutive batches. Clinolenic™ (F = 23.59; p = 0.000), Intralipid™ (F = 978.25; p = 0.000), Lipofundina™ TCL/TCM (F = 5.43; p = 0.045), Lipoplus™ (F = 123.53; p = 0.000) and Smoflipid™ (16.78; p = 0.000). Except for Lipofundina™ TCL/TCM, the differences between batches were marked. ConclusionsLipid emulsions, registered on Spanish pharmaceutical market, contain variable quantities of phytosterols dependent on commercial brand and batch.

Interactions between Metabolic Syndrome, MASLD, and Arterial Stiffening: A Single-Center Cross-Sectional Study.

Metabolic-associated steatotic liver disease (MASLD), previously termed non-alcoholic fatty liver disease (NAFLD), has emerged as a prominent global cause of chronic liver disease and is increasingly recognized as associated with atherosclerotic vascular illness, consolidating its position along traditional cardiovascular risk factors. Individuals with MASLD exhibit a combination of metabolic syndrome risk factors, carotid atherosclerosis, and increased arterial stiffness, hinting at shared pathogenesis. In this study, we aim to explore liver involvement and arterial stiffness within metabolic syndrome. We enrolled 75 patients (30 male and 45 female) with either liver steatosis on conventional ultrasound, altered liver function tests, or the presence of cardiometabolic risk factors after excluding liver pathology other than MASLD. Clinical evaluation, laboratory measurements, abdominal and carotid ultrasounds, vibration-controlled transient elastography (VCTE, Fibroscan), and assessment with the Arteriograph (Tensiomed) were performed. The 26 patients diagnosed with MetS had significantly higher liver involvement as quantified via the hepatic steatosis index (HSI), Fibrosis-4 (FIB4), aspartate aminotransferase to platelet ratio index (APRI) category, and VCTE measurements, as well as Agile 3+ and Agile 4 scores which use a combination of clinical and laboratory parameters together with results obtained from VCTE to reflect the probability of advanced liver fibrosis or cirrhosis. Patients with MetS also exhibited more pronounced vascular involvement as quantified via arterial stiffness measurements and CIMT (carotid intima-media thickness). We applied a two-step clustering algorithm to enhance our analysis, which gave us pertinent insight into the interplay between metabolic syndrome elements and typologies of hepatic steatosis and arterial stiffness degrees. Notably, of the three obtained clusters, the cluster showing increased levels of hepatic steatosis and arterial stiffness also exhibited the highest prevalence of metabolic syndrome and its constituting components. The results have significant clinical implications, advocating for a comprehensive diagnostic approach when MetS or MASLD is suspected.

Altered liver function test after Covid-19 vaccines: A retrospective control group study.

Liver injury after Covid-19 vaccine has been described, although the incidence was not well established. We aimed to compare cumulative incidence of new onset liver test alteration after Covid-19 vaccination, and to compare with an historical control of influenza vaccination. We conducted a retrospective cohort study which included adults who received at least one dose of Covid-19 vaccine from January 1 to May 30, 2021 and a control group who received a single dose of influenza vaccine during 2019, in a tertiary medical center from Argentina. We included 29 798 patients in Covid-19 vaccine group and 24 605 in influenza vaccine group. Liver function tests were performed in 7833 (26.9%) in Covid-19 vaccine group and 8459 (34.37%) in influenza vaccine group. Cumulative incidence at 90 days of new onset liver enzyme test alteration was 4.7 per 1000 (95% 4.0-5.5) for Covid-19 group, and 5.1 per 1000 (95% 4.3-6.1) for the influenza vaccine group (p value = 0.489). Two patients in the Covid-19 vaccine group developed immune mediated liver injury. We found no difference in liver test alteration between groups. These findings support the safety of Covid-19 vaccines. While we have identified two cases that are consistent with immune mediated liver injury following COVID-19 vaccination, we believe that the available data is insufficient to attribute them solely to the vaccination.

Liver Involvement during SARS-CoV-2 Infection Is Associated with a Worse Respiratory Outcome in COVID-19 Patients.

Coronavirus disease of 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), may be complicated by life-threatening interstitial pneumonia. SARS-CoV-2 infection may also damage several tissues and/or organs beyond the lungs, including the liver. However, controversy still exists as to whether SARS-CoV-2-induced liver alterations can have an impact on the outcome of COVID-19. The aim of this study was therefore to assess whether SARS-CoV-2-infected patients with liver abnormalities at the time of hospital referral had a worse outcome with respect to patients with no liver biochemistry alterations. To this end, the medical records of 123 patients admitted to our COVID center between the end of 2020 and spring 2021 were retrospectively reviewed. Patients were divided into two groups: those with normal liver biochemistries (group 1, 77 patients) and those with altered liver function tests (group 2, 46 patients). Serum levels of aminotransferases (AST and ALT) and bile duct cell injury markers (γ-GT and ALP) were used to dichotomize patients. A higher percentage of patients with liver enzyme alterations were found to develop COVID-19 pneumonia with respect to group 1 patients (74% vs. 65%); moreover, they needed more days of respiratory support and, more importantly, more intensive administration of supplemental oxygen. A statistically significant correlation was also found between aminotransferase levels and duration of respiratory support. The mortality rate was not superior in group 2 vs. group 1 patients. In conclusion, liver abnormalities on admission predisposed COVID-19 patients to development of more severe interstitial pneumonia, because of a longer requirement for supplemental oxygen and a more intensive respiratory support, indicative of a worse disease evolution in these patients.

Hemophagocytic Lymphohistiocytosis Possibly Triggered by Craniotomy Surgery: A Rare Association with Uplifting Ending

Hemophagocytic lymphohistiocytosis (HLH) is an aggressive and life-threatening syndrome of excessive inflammationand tissue destruction due to abnormal immune activation. HLH can occur as a familial or sporadic disorder, as wellas can be triggered by a variety of events that disrupt immune homeostasis. In HLH, natural killer cells and cytotoxiclymphocytes fail to eliminate activated macrophages resulting in excessive CD8+ T cell and activation of moremacrophages with highly elevated levels of interferon-gamma and other cytokines, which drive the pathology of HLH.Here, we present a case of 15 years old boy with HLH, which possibly was triggered after surgical intervention forarachnoid cyst in the right parietal lobe. It was a daunting challenge for us to evaluate and diagnose the patientpromptly since he was critically ill and developed pancytopenia, along with grossly altered liver function test andmarkedly raised ferritin in a short period of time. But it was even more crucial to start treatment in the form ofchemotherapy in such a patient who had very severe neutropenia as well as thrombocytopenia.&#x0D; Bangladesh Crit Care J March 2023; 11 (1): 39-42

Evolution of some liver function markers after treatment in patients with schizophrenia and bipolar disorder

IntroductionThe prevalence of alterations of liver function tests in patients with schizophrenia and bipolar disorders is not well known. These alterations are often considered as side effects of medicationObjectivesOur study aimed to evaluate and compare liver function before and after treatment in patients with schizophrenia (SCZ), schizo-affective disorder (SCA) and bipolar disorder (BD).MethodsThis was a prospective study among patients with SCZ, SCA and BD according to DSM-5 criteria. Patients, from the “C” psychiatry department of Hedi Chaker University Hospital in Sfax, were assessed during both acute and remission phases in their illness. The acute phase (T0) assessment was made in drug-free patients from june 2016 to july 2018. As for the remission phase (T1), it was made between november 2019 and march 2020. Blood tests were performed in the Laboratory of Biochemistry at Habib Bourguiba University Hospital in Sfax. Clinical and biological parameters of patients were compared with those of healthy controls. Biological assessment consisted mainly in Aspartate Aminotransferase (AST), Alanine Aminotransferase (ALT) and Albumine.ResultsThirty patients were included in our study. Their mean age was 35.83 ± 12.24 years and they were all males. They suffered from SCZ in 33.33% of cases, from SCA in 26.66% of cases and from BD in 40% of cases. Psychoactive substance use was common among 80% of patients. In the remission phase, 90% were polymedicated with use of antipsychotics in 83% of cases and mood stabilisers in 53% of cases. Table 1 shows the evolution of the studied liver function markers in our patients.Table 1:evolution of some liver function markers in patientsMarkersT0T1pAST (UI/L)Patients33,22 ± 23,1819,34 ± 4,97&lt;0,001Controls22,27±6,91&lt;0,05e,bALT (UI/L)Patients19,59 ± 13,213,17 ± 11,390,003Controls20,63±11,08&lt;0,05e,a,bAlbumine (g/l)Patients42,35±4,8647,79±3,18&lt;0,001Controls46,19±3,95&gt;0,05a: significant difference between patients with SCZ (T1) and controls; b: significant difference between patients with BD (T1) and controls; e: significant difference between patients (T1) and controlsConclusionsOur results showed an improvement of liver function in patients with SCZ and BD after treatment. This suggests that liver function alterations are due to these diseases rather than the medication.Disclosure of InterestNone Declared

Effects of CFTR modulators on serum biomarkers of liver fibrosis in children with cystic fibrosis.

The cystic fibrosis (CF) transmembrane conductance regulator corrector/potentiator combinations lumacaftor/ivacaftor and elexacaftor/tezacaftor/ivacaftor improve sweat chloride, pulmonary function, and nutrition. Yet it is unclear whether they may also impact the progression of liver fibrosis, which is a substantial source of morbidity and mortality for patients with CF. We conducted a retrospective, single-center analysis of children and adolescents with CF treated with lumacaftor/ivacaftor and/or elexacaftor/tezacaftor/ivacaftor therapy, focusing on alterations in liver function tests and fibrosis indices using previously-established thresholds that corresponded with increased liver elastography. In pairwise comparisons of before and during treatment timepoints, we found that those with CF-associated liver involvement experienced significant decreases in gamma-glutamyl transferase, aspartate aminotransferase-to-platelet index, and gamma-glutamyl transferase-to-platelet ratio while on lumacaftor/ivacaftor. These differences were not observed in patients treated with elexacaftor/tezacaftor/ivacaftor, nor were they observed in patients without underlying CF-associated liver disease. These results provide the first evidence that lumacaftor/ivacaftor may improve liver fibrosis in children and adolescents with CF and suggest it may be beneficial in the treatment of CF-associated liver disease.

Altered Liver Function Test in Type 2 Diabetes Mellitus Subjects and its Association with Dyslipidaemia and Fasting Blood Sugar: A Cross-sectional Study

Introduction: Multiple organ systems are affected due to the metabolic dysregulation associated with Diabetes Mellitus (DM). Altered lipoprotein metabolism and liver enzymes have been identified as independent risk factors for the development of Cardiovascular Disease (CVD). Routine screening of liver function and ultrasound imaging of the liver should be done at the time of diagnosis of type 2 DM and thereafter at regular intervals. Aim: To determine the association between liver function parameters and glycemic status in type 2 diabetics. Additionally, the study aimed to correlate liver enzymes and lipid profiles in Type 2 DM patients. Materials and Methods: A cross-sectional study was conducted from August 23rd, 2021 to October 23rd, 2021 on 100 Type 2 diabetic patients attending the diabetic Outpatient Department of Biochemistry, at Annapoorana Medical College and Hospital, Salem, Tamil Nadu, India. Fasting glucose, total cholesterol, triglyceride, and High-Density Lipoprotein Cholesterol (HDL) were measured using the direct enzymatic method, while LowDensity Lipoprotein Cholesterol (LDL) was calculated using Friedewald’s formula. Total bilirubin, Aspartate Aminotransferase (AST), Alanine Aminotransferase (ALT), Alkaline Phosphatase (ALP), total protein, and albumin were analysed using the ERBA EM-200 auto analyser based-on the wet chemistry principle. Pearson’s correlation analysis was performed to examine the relationship between variables. Results: Among the total of 100 type 2 diabetic patients who participated in present study, 59 were males and 41 were females. The mean±SD age of diabetic patients was 51.23±10.810 years, ranging between 35 and 76 years. The frequency of altered liver enzymes in the study sample was found to be 33, with 25 being males and 8 being females. The mean fasting blood sugar levels with normal liver function and abnormal liver function were observed to be 128.37±13.16 mg/ dL and 133.79±15.68 mg/dL, respectively, but the difference was not statistically significant. The mean values of total cholesterol, triglyceride, and low-density lipoprotein with normal liver function were observed to be 137.18±34.44 mg/ dL, 175.12±65.19 mg/dL, and 75.55±9.78 mg/dL, respectively, while with abnormal liver function, they were observed to be 196.05±52.67 mg/dL, 143.28±47.63 mg/dL, and 138.83±38.11 mg/dL, respectively, showing statistical significance. Conclusion: The present study found a strong association between deranged liver enzymes with fasting blood sugar and dyslipidaemia.

A Comparative Study of Endoscopic Ultrasound Fine-Needle Aspiration (EUS-FNA) and Endoscopic Retrograde Cholangiopancreatography (ERCP)-Based Brush Cytology for Tissue Diagnosis in Malignant Biliary Obstruction.

Background and objective Patients with suspected malignant biliary strictures frequently undergo endoscopic retrograde cholangiopancreatography (ERCP)-based brush cytology and endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) for establishing the diagnosis. The outcomes of these tests aid in the further management of the patient. A comparison of these two modalities in establishing the diagnosis is seldom reported. In light of this, we aimed tocompare the diagnostic efficacy between ERCP-based brush cytology and EUS-FNA for tissue diagnosis in malignant biliary obstruction. Our study involved a retrospective audit of all patients admitted to the Vydehi Institute of Medical Sciences and Research Centre for EUS and ERCP from 2015 to 2019. Methodology A Comparative study was conducted in the Department of Medical Gastroenterology at the VydehiInstitute of Medical Sciences and Research Centre over a five-year period. A total of 77 subjects who presentedduring the study period with biliary obstruction based on clinical presentation with altered liver function test in an obstructive pattern and evidence of biliary obstruction in the form of stricture or pancreaticobiliary mass on cross-sectional imaging were included in the study. All the patients included in the study underwent EUS and ERCP. Results The majority of the patientsin the study were in the fifth decade of life with a slight female predominance. The most common CT finding was a periampullary mass with common bile duct (CBD) stricture (59.7%). In the study, EUS-FNA was more sensitive than ERCP-based tissue sampling. The overall sensitivity was 90.63% for EUS-FNA and 65.63% for ERCP sampling. EUS-FNA was found to have diagnostic accuracy of 92.63% in comparison to 71.43% for brush cytology. Conclusions Based on our findings, EUS-FNA is superior to ERCP-based tissue sampling with excellent sensitivity and diagnostic accuracy. Performing EUS before ERCP in allpatients with suspected malignant biliary obstruction would definitely improve diagnostic accuracy and thereby help in the management of such cases.

Liver Graft Proteomics Reveals Potential Incipient Mechanisms behind Early Renal Dysfunction after Liver Transplantation.

Acute kidney injury (AKI) is frequent after liver transplantation (LT) and correlates with later development of chronic kidney disease. Its etiology is multifactorial and combines pre-, intra-, and postoperative factors. Additionally, the liver graft itself seems an important element in the development of AKI, yet the detailed mechanisms remain unclear. We hypothesized that grafts of LT recipients developing significant early AKI may show distinct proteomic alterations, and we set out to identify proteome differences between LT recipients developing moderate or severe AKI (n = 7) and LT recipients without early renal injury (n = 7). Liver biopsies obtained one hour after reperfusion were assessed histologically and using quantitative proteomics. Several cytokines and serum amyloid A2 (SAA2) were analyzed in serum samples obtained preoperatively, 2–4 h, and 20–24 h after graft reperfusion, respectively. LT induced mild histological alterations without significant differences between groups but uniformly altered liver function tests peaking on postoperative day 1, with a trend towards more severe alterations in patients developing AKI. Global quantitative proteomic analysis revealed 136 proteins differing significantly in their expression levels (p < 0.05, FC 20%): 80 proteins had higher and 56 had lower levels in the AKI group. Most of these proteins were related to immune and inflammatory responses, host defense, and neutrophil degranulation. No differences between the studied pro- and anti-inflammatory cytokines or SAA2 between groups were found at any moment. Our results suggest that grafts of LT patients who develop early AKI reveal a distinct proteome dominated by an early yet prominent activation of the innate immunity. These findings support the hypothesis that AKI after LT may be favored by certain graft characteristics.

A case of coexistent acute severe alcoholic and Q fever hepatitis: The useful contribution of repeated liver biopsies

Acute Q fever is a worldwide zoonotic infection due to C. burnetii that may be associated with hepatitis. Nonspecific clinical and biological manifestations may accompany liver involvement, including hepatomegaly and elevated liver biological tests. However, the presence of jaundice is rare. Therefore, making a diagnosis of Q fever hepatitis may be difficult in an afebrile patient with jaundice of recent onset, altered liver function tests, excessive alcohol intake and no reported contact with animals. We report here the diagnostic work-up and complex clinical management of a patient presenting with acute hepatitis resulting from both C. burnetii infection and severe alcoholic steatohepatitis. Positive serology together with a detailed examination of the liver biopsy was able to reveal the coexistence of both Q fever hepatitis with typical fibrin-ring granulomas as well as florid lesions of alcoholic steatohepatitis. A combination of antibiotics, hydroxychloroquine and steroids, guided by the helpful description of changes in histological alterations on repeated liver biopsies during the course of the disease contributed to the slow but favorable outcome.

Hematological and Biochemical changes in Schistosoma mansoni infected patients at Haik Primary Hospital, North-East Ethiopia: A comparative cross-sectional study.

Schistosomes are blood dwelling parasites that affect more than 260 million people globally, and over 800 million people are at risk of infection in 74 countries. It causes acute and chronic debilitating diseases. The parasite is reported to alter the hematological and biochemical parameters in humans. Therefore, this study was aimed to evaluate the hematological and biochemical changes in S. mansoni infected adult patients compared to apparently healthy controls. A comparative cross-sectional study was conducted at Haik Primary Hospital from February to April 2021. One hundred and eighty study participants consisting of 90 S. mansoni infected patients and 90 apparently healthy controls were recruited using systematic random sampling method. Socio-demographic characteristics and other variables were collected using questionnaires. Stool sample was examined microscopically to detect S. mansoni infection using direct wet mount and Kato Katz technique. In apparently healthy controls, S. mansoni infection was rule out using direct wet mount and Kato Katz technique. Moreover, the intensity of S. mansoni infection was assessed using Kato Katz technique. Blood sample was collected from each study participant to determine the hematological and biochemical profiles. Data were entered in to Epi Data version 3.1 and analyzed using SPSS version 26.0 software. Kolmogorov-Smirnov and Shapiro Wilk normality tests were done to assess the distribution of continuous variables. The Mann-Whitney U test and Kruskal Wallis H test was done to compare the differences among nonnormally distributed variables between S. mansoni infected patients and healthy controls. P-values <0.05 at 95%CI were considered as statistically significant. The mean age (SD) of S. mansoni infected patients and apparently healthy controls was 30.33 (±12.26) and 31.2 (±12.85) years old, respectively. The prevalence of anemia, and thrombocytopenia among S. mansoni infected patients were 23.3% and 26.7%, respectively. Erythrocytic sedimentation rate (ESR) was significantly elevated among S. mansoni infected patients than apparently healthy controls. The median white blood cell count, red blood cell count, red blood cell indices, and platelet indices were significantly lower among S. mansoni infected patients compared to apparently healthy controls (P<0.05). On the other hand, the median eosinophil count was significantly elevated among S. mansoni infected patients compared to apparently healthy controls (P<0.05). This study also showed significantly elevated values of serum alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and direct bilirubin and lower albumin, total cholesterol and triglycerides among S. mansoni infected patients compared to apparently healthy controls. Kruskal Wallis H test showed a significant difference in the median of most hematological and biochemical parameters between moderate and heavy intensity of infection with light intensity of infection and apparently healthy controls. The findings of this study showed significantly altered hematological values and liver function tests among S. mansoni infected patients compared to apparently healthy controls. Therefore, screening of S. mansoni infected patients for various hematological and biochemical parameters and providing treatment to the underlying abnormalities is very crucial to avoid schistosomiasis associated morbidity and mortality.

A Systematic Review of SARS-CoV-2-Associated Hepatic Dysfunction and the Impact on the Clinical Outcome of COVID-19.

Coronavirus disease 2019 (COVID-19) has rapidly spread across the globe since December 2019. The spectrum of clinical manifestations of COVID-19 ranges from mild to life-threatening forms. Alteration of hepatic function in COVID-19 is multifactorial. The objective of this systematic review is to assess the relationship between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-induced hepatic dysfunction and the clinical outcome in patients infected with COVID-19. We methodically explored several electronic databases (PubMed, PubMed Central, MEDLINE, and Google Scholar) in April 2022 using focused words and terms of medical subject headings for appropriate studies. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for conducting our systematic review. Hepatic dysfunction was identified as elevation of liver function tests (LFTs) above the upper limit of normal. The clinical outcome was described as a combination of mortality, intensive care unit (ICU) transfer, and the need for mechanical ventilation (MV). The initial search yielded a total of 7187 studies. After elimination of duplicates, exclusion of studies based on irrelevant titles and abstracts, comprehensive analysis of full-text formats, and evaluation of quality, a total of 16 studies were eligible to be included in our systematic review. In the 16 selected studies, there were 23,962 patients. The SARS-CoV-2 virus can negatively affect several organ systems by interacting with specific receptors widely expressed in the human body. A multifactorial etiology of hepatic dysfunction is observed in COVID-19. SARS-CoV-2 infection is associated with abnormal LFTs. Significantly higher mortality, ICU admissions, and requirement for MV are associated with LFT alterations. For this reason, patients infected with COVID-19 must have their hepatic function closely monitored.

STUDY OF LIVER FUNCTION PARAMETERS IN PREGNANT WOMEN ATTENDING A TERTIARY CARE CENTRE

Introduction: Changes in liver biochemical prole are normal during pregnancy. However, severe liver disease, although rare, can occur and must be recognized at an early stage to reduce morbidity and mortality for mother and infant.The pathological derangement in the liver functions may be related to pregnancy or may coexist with pregnancy and may be divided into three major groups. We aim to nd the incidence and possible (pregnancy-specic liver disorder and pregnancy non-specic liver disorder) of alteration in liver function tests (LFTs) in pregnant women attending tertiary care center. Aim and Objectives: To determine the association between altered Liver function tests and Possible causes of liver disorders in Pregnancy. Materials and Methods: Sampling data was collected over a period time of 1 Year. The study was done at the Clinical Biochemistry Department, tertiary care rural center. All data will be collected from the solace-laboratory Information system of the clinical biochemistry register at the central diagnostic laboratory. The sample size of the study is 83. Then, we plot the data according to the incidence of variable causes of liver disorderspecic and non-specic to pregnancy, also calculate the degree of alteration in LFTs in particular causes. Result: This study included a total of 83 individual cases (females only-age 18 to 35 years). 41 (49%) out of 83cases were related to pre-eclampsia, 12 (14%) cases related to HELLP syndrome, 2 (2%) cases related to AFLP, 3 (4%) cases related to ICP, 7 (8%) cases related to viral hepatitis, 3 (4%) cases related to Hyperemesis, 8 (10%) cases related to Eclampsia &amp; 7 (8%) cases related to Miscellaneous. ALP level increase in viral hepatitis (mean 585.4 u/l, SD± 68.5), pre-eclampsia (mean 239.28 U/L, SD ± 38.25) and decrease level in miscellaneous Causes (mean 82.2 u/l, SD± 37.4) &amp; ICP (mean 103.3 u/l ,SD±30.0). The AST level was rise in viral hepatitis (mean 781.8 µ/l, SD ± 46.14), AFLP (mean 708.5 u/l, SD ± 12.0), ICP (mean 100 u/l, SD ± 4.35), preeclampsia (mean 123.3 u/l, SD ± 22.0) and remain normal in miscellaneous cause (mean 21.2 u/l, SD ± 8.22) &amp; hyper emesis (mean 25.66 u/l, SD ± 4.50). Conclusion: Alterations in Liver function test results were due to Liver disease in pregnancy include -a 3-to-4-fold rise in the level of alkaline phosphatase (ALP) in viral hepatitis, Pre-eclampsia &amp; AFLP. An increase in the total bilirubin level was found in viral hepatitis, pre-eclampsia &amp; HELLP syndrome, whereas a downward trend was seen in the levels of serum albumin and total proteins. Serum ALT &amp; AST levels become a rise in Pre-eclampsia, Viral hepatitis, Eclampsia, and also AFLP. It was found that serum AST level was in normal limits in hyperemesis &amp;miscellaneous.

The Effects of Helicobacter Pylori Eradication on Liver Function and Metabolic Profile in Non-diabetic Non-alcoholic Steatohepatitis: A 5-year Randomized Clinical Trial.

BACKGROUND: To evaluate the effects of Helicobacter pylori (HP) eradication on liver function tests (LFT) and fat content (LFC) in non-diabetic non-alcoholic steatohepatitis (NASH). METHODS: This randomized clinical trial included dyspeptic HP infected non-diabetic NASH participants. The intervention arm received HP eradication treatment, while the control arm did not get any HP treatment. In the meantime, the standard management of NASH was performed in both trial arms. Mean alterations in LFT were the primary outcome and the secondary outcomes included the mean changes in LFC and serum metabolic profile. The trial follow-up period was 5 years. RESULTS: 40 participants (female: 20), with a mean age of 41.58 (±12.31) years, were enrolled in the study. The HP eradication arm included 20 participants (female: 11) with a mean age of 40.25 (±10.59) years, and the control arm consisted of 20 individuals (female: 9) with a mean age of 42.90 (±13.97) years. The tests of within-subjects effects showed a significant decrease in mean serum alanine aminotransferase (ALT; P=0.007), triglyceride (TG; P=0.04), cholesterol (P=0.004), and fasting blood sugar (FBS; P<0.001), and an increase in high-density lipoprotein (HDL; P=0.04) in both research groups during the study period. The tests of between-subjects effects demonstrated a more significant decrement of FBS in HP eradicated patients than the controls (P=0.02). The reduction in waist circumference, aspartate aminotransferase (AST), ALT, alkaline phosphatase, triglyceride, cholesterol, low-density lipoprotein, insulin, and LFC were more prominent in the intervention group than the controls; however, these differences were not statistically significant. CONCLUSION: Adding HP eradication treatment to standard NASH treatment showed more therapeutic effect thanthe standard NASH treatment protocol alone regarding the decrement of FBS in participants with dyspeptic non-diabetic NASH. Considering the non-statistically significant improvement in other metabolic indices and LFT in this trial, further studies are recommended.

FREQUENCY OF HEPATIC FUNCTION ALTERATION IN MEXICAN PATIENTS WITH COVID-19 AND ITS ASSOCIATION WITH THE SEVERITY OF ACUTE RESPIRATORY DISTRESS SYNDROME: PRELIMINARY RESULTS

IntroductionCOVID-19 is a disease caused by the SARS-CoV-2 virus; atypical pneumonia and sepsis are the most severe manifestations of the disease. There is evidence that the virus affects the liver in different ways. The mechanism of liver damage has not yet been clearly established.ObjectivesTo determine the frequency of alterations in the LFT (liver function tests) and its association with the severity of the ARDS (accute respiratory distress syndrome) in patients with COVID-19 and to determine if obesity, DM2 (diabetes mellitus) and HBP (high blood pressure) are associated with the severity of the ARDS.Material and methodsDescriptive, cross-sectional and observational study of 56 patients with dx of ARDS due to COVID-19; Main variables: glucose, LFT and procalcitonin. Secondary variables: age, BMI, DM2, HBP, the severity of ARDS and days of stay. The frequency of qualitative variables was calculated in percentages, measures of central tendency and dispersion were determined for quantitative variables and the association between the increase in the parameters of the LFT and the severity of ARDS by calculating the Spearman correlation coefficient and the Mann-Whitney U test, stratifying according to those who survived or died. The medians of the quantitative values ​​of the LFT between living and deceased were compared with the Mann W. U test for independent samples; due to the small sample size and the fact that the normality requirement was not met, statistically significant values ​​were considered with p <0.05.ResultsOf the 56 patients, 57% are women, all had tomographic data compatible with COVID-19. 41% presented moderate ARDS and 34% severe; 45% died. In the living, the frequency of DM2 and HBP was 22% in severe ARDS; An increase in AST (Aspartate aminotransferase) was found in 67% of admissions and in 100% there was an increase in its maximum peak. In mild ARDS, 33% of the living had increased GGT (gamma glutamyl transferase) at admission and 78% in severe ARDS. There was a statistically significant association between the increase in LDH (lactic dehydrogenase) at the maximum peak and the severity of ARDS (p = 0.047), the GGT at admission almost reached the statistically significant p value (p = 0.053), with a Spearman coefficient of 0.354 (p = 0.051). In the deceased, the frequency of DM2 in severe ARDS was 40%. 100% of those who died with severe ARDS had GGT and LDH increased values at their maximum peak. 100% with moderate ARDS and 90% of the severe ones had hypoalbuminemia upon admission, with a significant association with ARDS severity (p = 0.033). The LDH values at the maximum peak also showed a significant association with ARDS severity (p = 0.043) with a Spearman coefficient of 0.413 (p = 0.040).DiscussionTo date, this study is one of the few that has investigated the effects of the SARS-CoV-2 virus on liver function and its association with the severity of ARDS in Mexican population. Although our study has the weakness of having a small sample size, it has the strength of being carried out in a hospital that was converted into a COVID hospital, with which we will have access to data from a high number of patients, which will allow comparison alterations in liver function in living and deceased patients and relate it to the severity of ARDS.ConclusionsMost of the patients had no history of DM2 or HBP; a large percentage had overweight / obesity and hyperglycemia on admission. There is a high frequency of patients who have alterations in LFT; however, with this sample, it was only possible to determine that the increase in LDH at the maximum peak during hospitalization and hypoalbuminemia on admission are associated with the severity of ARDS.The authors declare that there is no conflict of interest.