Elevated Liver Enzyme Levels Research Articles

Air pollution, alcohol consumption, and the risk of elevated liver enzyme levels: a cross-sectional study in the UK Biobank.

Evidences on the association between exposure to air pollution and liver enzymes was scarce in low pollution area. We aimed to investigate the association between air pollution and liver enzyme levels and further explore whether alcohol intake influence this association. This cross-sectional study included 425,773 participants aged 37 to 73years from the UK Biobank. Land Use Regression was applied to assess levels of PM2.5, PM10, NO2, and NOx. Levels of liver enzymes including AST, ALT, GGT, and ALP were determined by enzymatic rate method. Long-term low-level exposure to PM2.5 (per 5-μg/m3 increase) was significantly associated with AST (0.596% increase, 95% CI, 0.414 to 0.778%), ALT (0.311% increase, 0.031 to 0.593%), and GGT (1.552% increase, 1.172 to 1.933%); The results were similar for PM10; NOX and NO2 were only significantly correlated with AST and GGT Significant modification effects by alcohol consumption were found (P-interaction < 0.05). The effects of pollutants on AST, ALT, and GGT levels gradually increased along with the weekly alcohol drinking frequency. In conclusion, long-term low-level air pollutants exposure was associated with elevated liver enzyme levels. And alcohol intake may exacerbate the effect of air pollution on liver enzymes.

Twin anemia polycythemia sequence in discordant dichorionic twins.

A 23-year-old primiparous woman with spontaneous dichorionic pregnancy was diagnosed by early ultrasonography. She developed hypertensive disorder of pregnancy at 27 weeks of gestation. At 29 weeks and 3 days of gestation, she was transferred to our perinatal center due to increasing discrepancy between the fetal weights (fetus A 1203 g, fetus B 989 g). Notably, polyhydramnios-oligohydramnios sequence was not observed. An emergency cesarean section was performed at 31 weeks 1 day of gestation because of elevated liver enzyme levels. Two male neonates were delivered with birth weights of 1413 and 1098 g, respectively. At birth, twin A was peripherally cyanotic with hemoglobin of 26.4 g/dL and a reticulocyte count of 4.1%. He was treated using partial exchange transfusion for polycythemia. Twin B was pale with hemoglobin of 7.8 g/dL and a reticulocyte count of 20.5%; thus, an emergent red blood cell transfusion was performed for anemia. Based on their hematological values, the twins were diagnosed with twin anemia polycythemia sequence (TAPS). A marked difference in the coloration of the maternal surface was observed in the two placentas on a macroscopic examination (Fig. 1); however, no vascular anastomosis was detected during dye studies. Microscopic histopathology revealed two amniotic layers and two chorionic layers, which confirmed dichorionicity. Recent literature reviews reported that twin-to-twin transfusion syndrome (TTTS) or TAPS occurs in dichorionic twin placentas with evidence of vascular anastomoses, although it is extremely rare.1Kanagaretnam D. Nayyar R. Zen M. Twin anemia polycythemia sequence in dichorionic diamniotic twins: a case report and review of the literature.Clin Case Rep. 2021; 9e04184Crossref Scopus (1) Google Scholar, 2Lanna M. Faiola S. Casati D. Rustico M.A. Twin-twin transfusion syndrome in dichorionic twin pregnancy: rare but not impossible.Ultrasound Obstet Gynecol. 2019; 54: 412-418Crossref Scopus (2) Google Scholar, 3Zilliox M. Koch A. Farve R. Sananes N. Unusual twin anemia-polycythemia sequence in a dichorionic diamniotic pregnancy.J Gynecol Obstet Hum Reprod. 2019; 48: 359-361Crossref Scopus (4) Google Scholar Miniscule anastomoses undetectable by a dye study may have been present in our dichorionic twins. Prenatal diagnosis, close monitoring, appropriate early delivery, and postnatal management are necessary to improve the outcomes of TTTS and TAPS. Thus, this report highlights the importance of prenatal recognition and postnatal confirmation of TTTS or TAPS, regardless of chorionicity. S.H. and S.I. drafted the initial manuscript. S.H., S.I. and S.T. treated the patient, and contributed to the acquisition of clinical data and imaging. M.Y. performed pathological evaluation. S. Y. supervised the manuscript. All authors approved the final manuscript. The authors have no conflicts of interest to declare. We thank the patient's parents for their kind cooperation. We also thank Dr. Chizen Tarui, Department of Neonatology, and Dr. Tomoko Kibara and Megumi Kaneko, Department of Obstetrics, in Hyogo Prefectural Kobe Children's Hospital for their support.

Liver Enzyme Correlated with C-Reactive Protein as a Biomarker of Metabolic Syndrome in Elderly Patients

Metabolic syndrome is a multifactorial disease with various risk factors that arise from insulin resistance associated with obesity, diabetes, hypertension, and dyslipidemias. Objective: To investigate the association between C-Reactive Protein and various risk factors related to CVS and metabolic health in elderly adults. Increased levels of various liver enzymes were found to be indicative of the progression of metabolic syndrome. Methods: In this study, total of 150 individuals with diagnosed metabolic syndrome were included, and they were compared to an equal number of control cases. The participants were selected from individuals visiting the Pathology and Molecular Biology Laboratories in Karachi for lab investigations. before collecting blood samples, basic vital signs, blood pressure, height, and waist circumference measurements were recorded to determine the participants' body mass index. The blood samples were then taken to assess liver enzyme levels and CRP. Results: The study examined and compared the levels of inflammatory marker and liver enzymes in both cases of metabolic syndrome (MetS) and the control group. The findings revealed a significant association (p-value of 0.001) between metabolic syndrome and elevated levels of liver enzymes and CRP. Specifically, the suspected cases of metabolic syndrome showed strong correlations with alanine aminotransferase, gamma-glutamyl transferase, and aspartate aminotransferase. However, alkaline phosphatase did not show substantial differences between the two groups. Conclusions: Our research revealed correlation between metabolic syndrome, liver enzymes and CRP. These findings indicate that high levels of liver enzymes and CRP can be indicative of cardiovascular functional abnormalities in elderly patients with metabolic syndrome.

Clinical and Functional Characterization of Novel AGL Variants in Two Families with Glycogen Storage Disease Type III.

Glycogen storage disease type III (GSDIII) is a uncommon autosomal recessive inherited metabolic disorder, which is caused by variants in the AGL gene. The purpose of this study was to elucidate the clinical and functional features of two novel variants in two families with GSDIIIa. We collected the clinical and laboratory data of the two patients. Genetic testing was performed using GSDs gene panel sequencing, and the identified variants were classified according to the American College of Medical Genetics (ACMG) criteria. The pathogenicity of the novel variants was furthermore assessed through bioinformatics analysis and cellular functional validation experiments. The two patients were hospitalized with abnormal liver function or hepatomegaly, which was characterized by remarkably elevated liver enzyme and muscle enzyme levels, as well as hepatomegaly, and were eventually diagnosed with GSDIIIa. Genetic analysis detected two novel variants of AGL gene in the two patients: c.1484A > G (p.Y495C), c.1981G > T (p.D661Y). Bioinformatics analysis indicated that the two novel missense mutations most likely altered the protein's conformation and therefore made the enzyme it encodes less active. Based on the ACMG criteria, both variants were considered likely pathogenic, in accordance with the functional analysis results, which demonstrated that the mutated protein was still localized in the cytoplasm and that the glycogen content of cells transfected with the mutated AGL was increased compared to cells transfected with the wild-type one. These findings indicated that the two newly identified variants in the AGL gene (c.1484A > G; c.1981G > T) were undoubtedly pathogenic mutations, inducing a slight reduction in glycogen debranching enzyme activity and a mild increase in intracellular glycogen content. Two patients who visited us with abnormal liver function, or hepatomegaly, improved dramatically after treatment with oral uncooked cornstarch, but the effects on skeletal muscle and myocardium required further observation.

The Monoacylglycerol Lipase Inhibitor ABX-1431 Does Not Improve Alcoholic Liver Disease.

Introduction: Excessive alcohol consumption can result in alcoholic liver disease (ALD). There is no FDA-approved drug to specifically treat ALD and current management approaches have limited efficacy. Past studies indicate that monoacylglycerol lipase (MAGL) inhibition can have a positive impact on nonalcoholic fatty liver disease. However, the effect of MAGL inhibition in ALD has not been reported. Materials and Methods: We tested the highly selective and clinically evaluated MAGL inhibitor ABX-1431 in the Lieber-DeCarli liquid alcohol diet-induced model of ALD in C57BL/6 mice. Results: ABX-1431 failed to reduce ALD-associated steatosis and elevated levels of liver enzymes associated with hepatic injury. Furthermore, survival rate declined with increasing doses of ABX-1431 when compared with mice administered vehicle only. Conclusion: These data suggest that MAGL inhibition does not improve ALD and is unlikely to be a good strategy for this condition.

Association between Type 2 Diabetes and Elevaton of Liver Enzymes

Millions of people throughout the world are impacted by T2DM, often known as type 2 diabetes mellitus. This study looked at the relationship between elevated liver enzyme levels and the prevalence of T2DM in certain Iraqis. Only a small amount of research has been done on the connection between liver enzymes and T2DM. Methods: In all, 80 people (40 with diabetes and 40 without) participated in the study. Blood serum was examined to determine the activity of alanine and aspartate aminotransferases (ALT, AST), -Glutamyl transpeptidase (GGT), and alkaline phosphatase (ALP). Fasting blood glucose (FBG) of less than 126 mg/dL or self-reported recent usage of insulin or anti-diabetic drugs were used to define T2DM. Results: When compared to the non-diabetes group, the diabetic group's AST and ALP levels were considerably (P0.05) higher. In contrast, there was no difference in ALT (P&gt;0.05). However, AST and ALT data based on gender revealed no statistically significant difference (P&gt;0.05) between any of the groups for either enzyme. However, as compared to the non-diabetes male and female groups, the ALP enzyme findings showed that there was a significant increase (p0.05) in the diabetes male group. Conclusions: T2DM patients frequently have increased liver enzyme levels.

First-in-Human Study to Evaluate the Safety and Early Efficacy of a Novel Drug and Delivery System for Stabilizing Small to Medium-Sized Infrarenal Abdominal Aortic Aneurysms

To establish that a one-time, local administration of a novel drug, 1,2,3,4,6-pentagalloyl glucose (PGG) to the abdominal aortic aneurysm (AAA) wall is safe and potentially effective in stabilizing or slowing the growth of small to medium-sized AAA in humans in a multicenter study with ≤3 years of follow-up. Patients with AAA of <5.5 cm diameter were recruited. Via transfemoral access, 25 mL of PGG solution were delivered to the aneurysm wall with a weeping balloon over 3 minutes after infrarenal occlusion. Patients were assessed with computed tomography angiography at 1, 6, 12, 24, and 36 months. Core laboratory values of aneurysm sac maximum diameter and sac volume measurements were used to determine growth. Primary endpoints were technical success and safety (major adverse events at 30 days). Secondary endpoint was growth stabilization defined as freedom from aneurysm sac enlargement (diameter >5 mm/year, or volume increase of >10% per year). Twenty-one patients (20 male), mean age 69, were treated at five centers from June 2019 to August 2022. Technical success was 100%. Four patients showed transient elevation of liver enzyme levels, which returned to normal by 30 days with no clinical symptoms. Follow-up computed tomography angiography data showed average AAA diameter change of 0.2 mm (n = 18), 1.1 mm (n = 7), 2.0 mm (n = 5), and 0.8 mm (n = 2) from baseline at 6, 12, 24, and 36 months. Average volume changes were 2.5%, 9.6%, 24.3%, and 11.6% respectively. At 12 months, none of the aneurysms showed growth >5.0 mm and three had volume growth >10%. Local delivery of PGG in small to medium-sized aneurysms is safe and early efficacy data are promising. The potential for PGG to stabilize or slow growth of small to medium-sized AAA merits further evaluation in a randomized, controlled clinical trial.

Non Alcoholic Fatty Liver Disease: A Silent Global Epidemic

Nonalcoholic fatty liver disease (NAFLD) is a common liver disease worldwide affecting adult as well as children with an increasing prevalence. It is associated with insulin resistance and frequently occurs with features of the metabolic syndrome. NAFLD is a spectrum, with NAFL (Non-alcoholic fatty liver) being the initial mildest form, NASH and cirrhosis is being at the other end of the spectrum. Mostly NAFLD is asymptomatic but may present with elevated liver enzyme levels to cirrhosis with its complications and hepatocellular carcinoma. Standard ultrasound including elastography may be used to detect steatosis. Though, liver biopsy is the gold standard for diagnosis of NAFLD but it is not frequently performed. NAFLD patients with evidence of nonalcoholic steatohepatitis and advanced fibrosis are at increased risk of adverse outcomes, including overall mortality. Life style modification and weight loss remains the cornerstone of the management of NAFLD. There are no approved pharmacological drugs for the treatment of NAFLD till now. Although several promising drugs are on the horizon, more trials are needed to validate these medications. Bangladesh J Medicine 2023; 34(2): 73-79

A human iPSC-derived hepatocyte screen identifies compounds that inhibit production of Apolipoprotein B

Familial hypercholesterolemia (FH) patients suffer from excessively high levels of Low Density Lipoprotein Cholesterol (LDL-C), which can cause severe cardiovascular disease. Statins, bile acid sequestrants, PCSK9 inhibitors, and cholesterol absorption inhibitors are all inefficient at treating FH patients with homozygous LDLR gene mutations (hoFH). Drugs approved for hoFH treatment control lipoprotein production by regulating steady-state Apolipoprotein B (apoB) levels. Unfortunately, these drugs have side effects including accumulation of liver triglycerides, hepatic steatosis, and elevated liver enzyme levels. To identify safer compounds, we used an iPSC-derived hepatocyte platform to screen a structurally representative set of 10,000 small molecules from a proprietary library of 130,000 compounds. The screen revealed molecules that could reduce the secretion of apoB from cultured hepatocytes and from humanized livers in mice. These small molecules are highly effective, do not cause abnormal lipid accumulation, and share a chemical structure that is distinct from any known cholesterol lowering drug.

Vancomycin-induced elevation of liver enzyme levels in a 3-year-old boy with bacterial meningitis: A pediatric case report

BackgroundVancomycin as a glycopeptide antibiotic agent plays a vital role in the treatment of gram-positive bacterial infections, especially methicillin-resistant Staphylococcus aureus. Vancomycin-induced liver disease is rarely reported previously; isolated cases have been reported only in adults and none in children except in a 3-month-old girl published in a Chinese journal. Case SummaryA 3-year-old boy received vancomycin for the treatment of bacterial meningitis for more than 3 weeks. The baseline liver enzyme levels of alanine aminotransferase (ALT) (12 U/L), aspartate aminotransferase (AST) (18 U/L), and gamma-glutamyl transferase (GGT) (26 U/L) were obtained after administering vancomycin for 2 days. Liver enzyme levels of ALT (191 U/L), AST (175 U/L), and GGT (92 U/L) were obviously elevated after administering vancomycin for 22 days; this elevation was reversed after vancomycin discontinuation. This case suggested that regular examination of liver function is necessary for all individuals who initiated vancomycin. Practice ImplicationsThis is a rarely known case of vancomycin-induced elevation of ALT and AST and the first reported case of vancomycin causing GGT elevation in children, which suggested that regular examination of liver function is required during the use of vancomycin in children and could help avoid progressive liver injury. This case adds to the limited number of reports on vancomycin-induced liver disease.

End-Stage Renal Disease, Autoimmune Hepatitis, Alveolar Hemorrhage and ANCA Vasculitis as a Complication of Chronic Hepatitis B Virus: An Unusual Case Report

Background: End stage renal disease, autoimmune hepatitis and alveolar hemorrhage have rarely been reported as the complications of hepatitis B virus infection that can potentially be triggered by an antibody-mediated vasculitis as a result of a viral infection. The following was a case report detailing a patient presenting with all three of the above presentations who was cytoplasmic antineutrophil cytoplasmic antibody-positive and a chronic carrier of hepatitis B virus. Case presentation: A 52-year-old Malagasy woman presented in our intensive care unit for acute respiratory failure with end-stage renal disease and deterioration in general condition. She was managed with steroids, non-invasive ventilation, and hemodialysis. Laboratory test showed elevated levels of serum creatinine and liver enzymes. An extensive workup was done to find the etiology of elevated liver enzymes. Only blood work that came back positive was for chronic inactive hepatitis virus B and positive autoantibody suggestive of autoimmune hepatitis. A computed tomography scan of her lung revealed features suggestive of bilateral alveolar hemorrhage. Workup for other causes of vasculitis, including anti-neutrophil cytoplasmic antibodies (ANCA) was positive for c-ANCA antibody to proteinase 3. Medical investigations allowed excluding other infectious diseases, malignancies and other rheumatic and vasculitis affections. Administration of lamivudine® orally was done. The patient was followed for more than one year and there were no other new systematic symptoms. Conclusion: This case report showed the possibility of hepatitis B virus-induced vasculitis as the cause of alveolar hemorrhage, autoimmune hepatitis, and end stage renal disease. The origin of these symptoms was attributed to immune complex-mediated vasculitis induced by antineutrophil cytoplasmic antibody.

Baicalin-Loaded Lipid-Polymer Hybrid Nanoparticles Inhibiting the Proliferation of Human Colon Cancer: Pharmacokinetics and In Vivo Evaluation.

This research work is focused on pharmacokinetic and biochemical experiments to assess baicalin-loaded lipid-polymer hybrid nanoparticles (LPHNPs) with colon-targeting specificity. The nanoprecipitation method was used to develop the LPHNPs, and the characterized formulation revealed the 184.3 nm particle size, PDI of 0.177, spherical shape, and zeta potential of -19.8 mV. The baicalin LPHNPs are said to be poorly absorbed in the stomach and small intestine, and in vitro drug release tests have shown that the drug is released mostly in the caecal fluid. Additionally, the LPHNPs showed stability and nonsignificant drug loss at 25 °C for 3 months. The least viable population of baicalin-loaded LPHNPs was detected at a lower IC50 value after 48 h, and no cytotoxicity was observed by blank suspension and blank LPHNPs up to the concentration of 100 µg/mL. Apart from this, the pharmacokinetics study showed that baicalin from LPHNPs is much less absorbed and least available in the blood plasma and maximum available in the colon. Concurrently, organ distribution studies demonstrated that baicalin-loaded LPHNPs were distributed more widely in the colon compared to baicalin suspension. Moreover, baicalin-loaded LPHNPs were found to be superior to a baicalin suspension in reducing elevated liver enzyme levels. In a nutshell, baicalin-loaded LPHNPs show superior efficacy and can be maximally localized into the colon rectal cancer along with systemic availability of the drug.

Serum liver enzymes and metabolic syndrome from the Rafsanjan Cohort Study.

Our investigation aimed at evaluating the relationship between metabolic syndrome, alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma glutamyl transferase (GGT), and alkaline phosphatase (ALP) in the Rafsanjan cohort study (RCS). We used data obtained from the RCS, as a part of the prospective epidemiological research studies in Iran. In this cross-sectional research, 9895 participants from the baseline phase of RCS who completed medical questionnaire were included. Metabolic syndrome (MetS) defined using NCEP-ATP III criteria. The relationship between elevated serum liver enzymes levels even within the normal range and metabolic syndrome was evaluated by logistic regressions. The prevalence of MetS was 34.42% in the participants of study. The mean concentrations of AST, ALT, ALP, and GGT increased with increasing MetS components. After adjusting for all potential confounders, elevated serum concentrations of ALT, AST, GGT, and ALP even within the normal range were related with an increased odds of MetS. MetS was associated with increased levels of liver enzymes even within the normal range. These results indicated the potential for elevated liver enzymes as biomarkers for the possible presence of MetS.

Prospective association between phthalate exposure in childhood and liver function in adolescence: the Ewha Birth and Growth Cohort Study

BackgroundPhthalate exposure is ubiquitous due to the widespread use of plastic products in daily life, and affects several health outcomes, including metabolic diseases. In this study, we evaluated the effects of phthalate exposure in childhood on liver function in adolescence. MethodsAmong 164 Ewha Birth and Growth Cohort Study participants followed up during two exposure periods (when the children were aged 3–5 and 7–9 years), 126 were followed up at age 10–15 years. To investigate the relationship between phthalate exposure during the two periods and liver enzyme levels (ALT, AST, γ-GTP) in adolescence, differences between groups and the dose–response relationship were analyzed. In addition, we investigated differences in liver enzymes between groups based on the combined exposure levels (high or low) during the two periods. The interaction effect between phthalates and BMI on liver enzyme levels was evaluated, stratified by sex. ResultsIn the 3–5 year-old exposure period, ALT levels tended to increase as MECPP levels increased, while γ-GTP levels tended to increase as MiBP, MnBP, and ∑DBP levels increased. In addition, the group exposed to consistently high levels of phthalates at both time points had higher liver enzyme levels compared to the group that had lower exposure. In particular, the interaction effect between some phthalate metabolites and BMI in 3–5 year olds affected AST and γ-GTP levels in adolescence only in girls.ConclusionsExposure to phthalates in daily life during childhood affects liver enzyme levels in adolescence. Elevated liver enzyme levels are associated with the development of metabolic syndrome, implying that attention should be paid to phthalate exposure during childhood.

Hepatoprotective and antifibrotic effects of trans-chalcone against bile duct ligation-induced liver fibrosis in rats.

Several lines of research have shown that hepatic fibrosis is one of the leading causes of death worldwide. Trans-chalcone is a flavonoid precursor with anti-oxidant and anti-inflammatory effects. The present study was conducted to examine the antifibrotic properties of trans-chalcone on bile duct ligation (BDL)-induced liver cholestasis in rats. Following the BDL operation, trans-chalcone at doses of 12, 24, and 50 mg/kg was administered orally once a day for 45 consecutive days. Serum levels of liver indices, including alkaline phosphatase (ALP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), total and direct bilirubin, and lipid profile in addition to blood urea nitrogen (BUN) and creatinine, were measured. Additionally, catalase (CAT) and superoxide dismutase (SOD) activities were assessed in liver homogenates. Histopathological evaluations were performed using Masson trichrome (MT) and hematoxylin and eosin (H&E) staining. The elevated levels of liver enzymes, total and direct bilirubin, BUN, creatinine, cholesterol, triglyceride, and low-density lipoprotein (LDL) induced by BDL were significantly reduced following trans-chalcone administration; while serum level of high-density lipoprotein (HDL) increased. Besides, treatment with trans-chalcone elevated the activities of CAT and SOD in the liver tissues of the animals with BDL surgery. According to MT and H&E staining, BDL-induced histopathological changes, including infiltration of inflammatory cells, hepatocyte necrosis, ductal hyperplasia, and collagen deposition were ameliorated using trans-chalcone administration. It can be concluded from the present study that trans-chalcone, possibly by its anti-oxidant and anti-inflammatory properties, may exert hepatoprotective and antifibrotic effects in BDL-induced liver fibrosis.

Associations of Serum Uric Acid Level With Liver Enzymes, Nonalcoholic Fatty Liver Disease, and Liver Fibrosis in Korean Men and Women: A Cross-Sectional Study Using Nationally Representative Data.

This study aimed to determine whether serum uric acid (SUA) levels are associated with various indices of liver damage in the adult Korean population. We used the Seventh (VII) Korean National Health and Nutritional Examination Surveys. Our study population comprised 6,007 men and 8,488 women. Levels of SUA were divided into four groups (≤ 5.3, 5.3-6.0, 6.0-7.0, and > 7.0 mg/dL for men and ≤ 4.0, 4.0-4.8, 4.8-6.0, and > 6.0 mg/dL for women). Elevated liver enzyme levels were defined as > 35 (men) and > 31 (women) IU/L for aspartate aminotransferase (AST), > 45 (men) and > 34 (women) IU/L for alanine aminotransferase (ALT). Hepatic steatosis index and fibrosis (FIB)-4 index was used to determine nonalcoholic fatty liver disease (NAFLD) and liver FIB, respectively. Adjusted odds ratios (aORs) were calculated by logistic regression analysis for liver enzymes, NAFLD, and liver FIB, according to the SUA level. Among women, the 4.8-6.0 and > 6.0 mg/dL SUA groups showed higher ORs of elevated AST (aOR, 1.78 and 2.03; 95% confidence interval [CI], 1.37-2.32 and 1.40-2.96, respectively; P < 0.001) and the 4.0-4.8, 4.8-6.0, and > 6.0 mg/dL SUA groups showed a higher ORs of ALT elevation (aOR, 1.35, 2.26, and 2.37; 95% CI, 1.02-1.79, 1.72-2.97, and 1.60-3.50, respectively; P < 0.001) compared to the lowest level SUA group. Among women with normal ALT, > 6.0 mg/dL SUA group showed higher OR of NAFLD status (aOR, 1.52; 95% CI, 1.06-2.19). Among men and women with NAFLD, hyperuricemia showed higher ORs of liver FIB (aOR, 2.25 and 1.89; 95% CI, 1.21-4.19 and 1.09-3.27, respectively) than the lowest level SUA group. High SUA levels may be associated with elevated liver enzymes and NAFLD, mainly in women. Even in women with normal ALT levels, SUA levels may predict the NAFLD status. Hyperuricemia may predict advanced liver FIB in both men and women with NAFLD. Further studies investigating the causal effects of SUA on liver damage are required.

Evaluating the differences among dermatologists’ approaches to abnormal laboratory results of patients using oral isotretinoin treatment for acne

Background: Oral isotretinoin is one of the most frequently used treatment options in moderate and severe acne. Abnormal laboratory results may occur during the treatment and there may be differences in approach to these abnormal laboratory results among dermatologists. Aim: In this study, we aimed to retrospectively evaluate the differences in approach to abnormal laboratory results and treatment modifications of dermatologists during oral isotretinoin treatment. Materials and Methods: Data of 207 patients who had oral isotretinoin treatment for acne between January 2013 and October 2020 were included in this study. Baseline and follow-up laboratory results were reviewed. All treatment modifications were noted and evaluated with relevant literature. Results: Among 207 patients, 28 (13.5%) had treatment modifications due to the abnormal laboratory results, and all of them were due to elevation of lipid and liver enzyme levels. The dose was reduced in 24 (11.6%) patients and the treatment was discontinued in 4 (1.9%) patients. Treatment modification was not compulsory in the vast majority of patients (26 of 28) according to the relevant literature. Conclusion: The results of the present study showed that unnecessary treatment modifications due to the abnormal laboratory results can be made by dermatologists during oral isotretinoin treatment for acne. Educational programs for dermatologists and more detailed guidelines may prevent these unnecessary treatment modifications.

The needle in the haystack: deciphering diagnostic data in a case of acute on chronic liver failure

The needle in the haystack: deciphering diagnostic data in a case of acute on chronic liver failure

Clinical and laboratory characteristics of multisystem inflammatory syndrome in children associated with COVID-19 in Egypt: A tertiary care hospital experience.

We aimed to evaluate MIS-C patients' clinical manifestations, laboratory test results and mortality outcomes in an Egyptian tertiary care university hospital. We conducted a 12 month cross-sectional study in a tertiary-care university children's hospital. All paediatric patients (1month to 16 years old) who met the CDC criteria for MIS-C were enrolled in thestudy. We assessed patients' clinical presentations, complications, treatments, imaging studies, laboratory test results and outcomes. The baseline clinical and laboratory findings of survivors and non-survivors were compared. Of 45 MIS-C patients, 24 (53.3%) were males, and the median (interquartile range) age was 4 (1.25-10) years. All patients had fever, 64.4% had respiratory manifestations, 48.9% presented with coma, 44.4% presented with shock, 33.3% presented with seizures, 31.1% had abdominal pain, 28.9% had vomiting and 22.2% presented with cerebrovascular stroke. A total of 15 (33.3%) patients died, and the non-survivors had a significantly higher incidence of respiratory manifestations (P=0.028), shock (P=0.034), cerebrovascular stroke (P=0.043) and seizures (P=0.044) as compared to the survivors. In addition, the serum levels of ferritin (P=0.047), alanine aminotransferase (P=0.047) and aspartate aminotransferase (P=0.05) were significantly higher in the non-survivors as compared to the survivors. Based on our findings, MIS-C associated with COVID-19 is a potentially fatal illness. Hospitalised patients with MIS-C often have multi-organ injuries affecting the respiratory, cardiovascular, gastrointestinal and neurological systems. The deceased are more likely to exhibit respiratory manifestations, shock, cerebrovascular stroke, seizures and elevated serum levels of ferritin and liver enzymes.

Protective effect of cinnamon oil against ciprofloxacin toxicity on liver and kidney of male Wistar rats

Cinnamon zeylanicum is one of many herbal medications. This herb contains different materials like, cumarin, cinnamaldehyde and cinnamic acid. The plant plays a role as antiallergic, antiviral, antimicrobial, anti-inflammatory and antioxidant and other health conditions. This study focused on the therapeutic effect of cinnamon oil on hepatorenal toxicity induced by ciprofloxacin in male rats. Forty rats were housed in the animal house of the College of Pharmacy, University of Kerbala, Karbala city, Iraq. The animals were separated into four groups: Group 1. Control group (not taken drug nor cinnamon oil), Group 2. Ciprofloxacin group (drenched 250 mg/kg/day of ciprofloxacin for 30 days), Group 3. Cinnamon oil group (drenched 1ml/kg/day of cinnamon oil for 30 days) and Group 4. Cinnamon+ciprofloxacin group (drenched 1ml/kg/day of cinnamon + 250 mg/kg/day of ciprofloxacin for 30 days). Finally, 2ml of blood was collected from each rat and the serum was separated for estimating the biochemical parameters of the liver like, Aspartate transaminase (AST), alanine transaminase(ALT) and alkaline phosphatase(ALP) and the kidney (Creatinine, Urea and albumin) . The results proved that ciprofloxacin significantly elevates the parameters of the liver and kidney (p≤0.05). The results also proved the benefit of cinnamon oil in improving health by reducing the toxic effect of ciprofloxacin by lowering the elevated levels of (liver enzymes, creatinine, urea and albumin). The study showed that this oil reduced the toxic effect of ciprofloxacin on the kidney and liver.