Background Inflammatory bowel disease (IBD) is often diagnosed during reproductive age, requiring adequate management during pregnancy. Physiological changes during pregnancy affect liver enzymes, complicating interpretation in a population prone to liver test abnormalities. This study aims to investigate liver enzyme trends throughout pregnancy in women with IBD. Methods A retrospective cohort study was conducted in three Dutch university hospitals. Pregnant women with IBD were included; liver enzyme levels were analyzed throughout pregnancy using Bayesian modeling. The association between liver enzymes and IBD disease activity, medication, pregnancy and adverse pregnancy outcomes was assessed, with estimated marginal means (EMMs) reported across trimesters and clinical subgroups. Results Liver enzyme levels exhibited significant trimester-specific variations in pregnant individuals with IBD. Levels of aminotransferases, γ-glutamyl transferase (γGT) and bilirubin generally declined, particularly in the second trimester, whereas alkaline phosphatase (ALP) levels increased markedly in the third trimester, mirroring physiological changes observed in healthy pregnancies. Adverse pregnancy outcomes were not associated with differences in liver enzyme levels. Several medications – particularly ustekinumab, vedolizumab, thiopurines, corticosteroids and amino salicylates – were associated with liver enzyme values or interacted with pregnancy, modulating the direction or magnitude of change. However, these effects were generally modest and remained within reference values. Conclusions In pregnant women with IBD, changes in liver enzyme levels reflect physiological gestational adaptations rather than pharmacologic effects. Although medication-specific interactions were detected, their clinical significance appears limited. Marked elevations in liver enzymes during pregnancy cannot routinely be attributed to IBD activity or medication and warrant urgent analysis.

Background: Dengue fever, a mosquito-borne viral disease, imposes significant public health challenges globally, particularly in Bangladesh. It has been experiencing its most severe outbreak of dengue on record in 2023 and putting huge pressure on the health system. Objective: Tto investigate the demographic characteristics, clinical manifestations, laboratory findings in dengue patients. Methods: This observational study was conducted at tertiary level Kurmitola General Hospital, Dhaka over six months, involving 1000 patients diagnosed with dengue fever. Data on demographics, clinical symptoms and laboratory parameters were collected and analyzed. Results: The majority of participants were in the 21-30 age group (40%), Female (55%) predominance with 98% being Muslim and 85% residing in urban areas. All patients exhibited fever, with other common symptoms including vomiting (42%), loose motion (32%), and abdominal pain (27%). Laboratory findings showed significant thrombo- cytopenia and elevated liver enzymes, while renal function remained normal. Conclusion: The study highlights the prevalence of dengue fever among young urban population, with fever as a predominant symptom in patients with marked thrombo- cytopenia. These findings emphasize the need for a nuanced approach to assessing and managing dengue fever on the basis of clinical and laboratory findings. JAFMC Bangladesh, Vol 21, No 1 (June) 2025:32-35

Ingestion of superabsorbent polymer beads (SAPBs) poses a unique and serious risk of intestinal obstruction in young children due to their rapid expansion within the gastrointestinal tract. Data regarding the ingestion of SAPBs remain scarce, with the existing literature primarily drawn from isolated case reports. This study retrospectively reviewed cases of SAPBs ingestion in pediatric patients treated at our institution to summarize clinical characteristics and share management experience. We conducted a retrospective review of medical records for patients aged < 18 years who presented to our hospital due to SAPBs ingestion between September 2018 and September 2025. Demographic information, clinical presentation, imaging findings, treatment modalities, and complications were collected and analyzed. Eleven patients (7 males, 4 females) met the inclusion criteria and were analyzed. The median age was 1 year 4 months. The median time from ingestion to presentation was 12h (range, 2-48), and from ingestion to symptom onset was 5h (range, 2-24). The most common presenting symptoms were vomiting (6/11), fever (5/11), and irritability (4/11); abdominal distension was noted in 3 patients (27%). Three patients remained asymptomatic throughout. Computed Tomography (CT) and ultrasound were useful for diagnosis in 5/7 and 2/3 cases, respectively. SAPBs were commonly located in the duodenal ascending segment (n = 2) and ileum (n = 2). Management included laparotomy with transmural fragmentation (3/11), gastroduodenoscopy with intraluminal fragmentation (1/11), gastroduodenoscopy converted laparotomy with fragmentation (1/11), gastroduodenoscopy only (3/11) and enemas only (3/11). Complications included intestinal obstruction (5/11), elevated liver enzymes, anemia, and headache (1 each). Ingestion of SAPBs can lead to significant morbidity in children, often requiring endoscopic or surgical intervention. In our small series, for expanded SAPBs accessible during laparotomy, manual fragmentation and advancement into the colon for subsequent transanal expulsion allowed us to avoid enterotomy in selected cases. CT and ultrasound are valuable for diagnosis. Enhanced public awareness and stricter product regulations may help reduce the occurrence of such accidental injuries.

BackgroundTyphoid fever is still a major health issue in many parts of the world. Traditional tests like blood culture and the Widal test are often slow or unreliable. This study explores whether Complete Blood Count (CBC) and Liver Function Tests (LFTs) can help in the early and affordable diagnosis of typhoid.CBC Parameters NotedLFT Parameters observedMethodsA retrospective review was done on patients with symptoms like fever, weakness, and abdominal pain. CBC and LFT results were collected and compared with confirmed typhoid cases. Key parameters included hemoglobin, WBC and platelet counts, ESR, and liver enzymes (ALT, AST, bilirubin).ResultsOut of 90 confirmed typhoid patients (ages 1–82), many had abnormal lab results. Low hemoglobin was seen in 31%, low WBC in 15%, high WBC in 18%, and low platelets in 23% [Table 1]. Elevated AST and ALT were found in 34% and 28% of cases, respectively, and 46% had high ESR [Table 2]. A few severe cases had complications, including two deaths.ConclusionCBC and LFT tests provide valuable early diagnostic clues for typhoid fever. A combination of leukopenia, thrombocytopenia, high ESR, and elevated liver enzymes can serve as a rapid, accessible, and cost-effective preliminary diagnostic approach before confirmatory testing. This can aid in early intervention and better clinical management, especially in resource-limited settings.DisclosuresAll Authors: No reported disclosures

Benefit-risk profiles and mode/frequency of administration vary among the four US-approved treatments for anti-aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder (AQP4-Ab+NMOSD), but no published studies have reported treatment preferences among patients with NMOSD in the USA. Therefore, the objective of this study was to quantify preferences and predict treatment choices among patients with AQP4-Ab+ NMOSD in the USA. A cross-sectional, web-based discrete choice experiment survey was administered to patients with self-reported AQP4-Ab+ NMOSD. Respondents evaluated hypothetical AQP4-Ab+ NMOSD treatment profile pairs defined by efficacy, safety, process-related attributes, and administration mode/frequency. Data were analyzed using a random-parameters logit model to estimate conditional relative importance of attributes, minimum acceptable benefit, and predicted treatment choice in pairwise treatment profile (ravulizumab-like, eculizumab-like, inebilizumab-like, and satralizumab-like) comparisons. Preference heterogeneity was investigated by exploratory subgroup analysis using interaction terms in the regression analysis. The 255 survey completers (mean ± standard deviation [SD] age, 41.4 ± 13.7 years) averaged 6.6 ± 5.4 years since diagnosis, and 63.5% identified as female and 46.7% as Black or African American. Rituximab was the most common treatment (34.1% of respondents), and 15.7%, 9.4%, or 7.1% of respondents were receiving eculizumab, inebilizumab, or satralizumab, respectively. Respondents placed greater importance on reducing chance of relapse within the first year of treatment compared with other attributes such as reducing administration frequency from every 2 weeks to every 8 weeks (Q8W); safety attributes (risks of serious opportunistic or recurrent infection, elevated liver enzymes, and meningococcal infection) were rated similar to each other in importance. Pairwise comparisons favored the ravulizumab-like profile (67.8-87.7%) over the other three treatment profiles (12.3-32.2%). Preferences did not vary by age, disease duration, disease impact, or relapses in the past 12 months, but subgroups defined by current treatment type demonstrated different (p = 0.066) preferences. Respondents receiving intravenous/subcutaneous injections alone or with oral immunosuppressive therapy/corticosteroid treatments placed greater importance on reducing chance of relapse versus those receiving oral treatments alone, but they were not more likely to select a Q24W treatment over a Q8W treatment. Respondents with AQP4-Ab+ NMOSD placed the highest importance on reducing chance of relapse, placed a high importance on reduced administration frequency, and rated the safety attributes (avoiding treatments with a risk of meningococcal infection, risk of elevated liver enzymes, and risk of other infections) as comparable to each other but less influential than relapse prevention. Respondents were more likely to select a ravulizumab-like profile over comparators. These findings can inform shared decision-making in selecting treatments.

Women are born with a limited number of eggs, which decline over time. Premature ovarian insufficiency (POI) occurs when this decline happens before age 40, causing infertility. Bone marrow (BM) stem cells may help restore ovarian function, as some women conceive after BM transplants. Studies suggest that mobilizing stem cells with Granulocyte Colony-Stimulating Factor (G-CSF) can improve ovarian response in women with diminished ovarian reserve, possibly without needing ovarian infusion. Our study aimed to evaluate if G-CSF injections alone could improve ovarian function in women with POI. This was a pilot, non-randomized, open-label clinical trial including 11 women aged 25-40 years with clinical POI and menopausal symptoms, defined by elevated follicle-stimulating hormone (FSH) on two occasions, low anti-Müllerian hormone (AMH), and reduced antral follicle count (AFC). Participants received up to three rounds of subcutaneous G-CSF administered daily for four days per month over 60 days. Ovarian reserve markers (FSH, AMH, AFC), menstruation resumption, and menopausal symptoms were assessed at baseline and multiple follow-up points over 12 months. The mean age of participants was 34.1 ± 5.2 years (BMI 23.96 ± 4.0kg/m²). GCS-F injections resulted in significant increases in white blood cells and mild elevation of liver enzymes which returned to baseline within one month. By four months, significant improvements in menopausal symptoms were reported. Exploratory analyses did not identify consistent correlations between clinical response and baseline characteristics. Mean FSH decreased from 54.3 ± 24.6 IU/L at baseline to 29.0 ± 8.1 IU/L at six months (p = 0.008). AMH and AFC rose modestly (0.21 ± 0.15 to 0.49 ± 1.13 pmol/L; 1.09 ± 1.0 to 2.18 ± 2.60) but did not reach statistical significance. Menstruation resumed in 7 of 11 women (63.6%, p = 0.031). One participant showed marked response including retrieval of three mature oocytes. G-CSF injections were associated with menstrual resumption and symptom relief in most women with POI, suggesting biological activity. Although improvements in ovarian reserve markers were modest and disappointing in terms of the potential for assisted reproduction, these findings may support further evaluation of G-CSF in larger, controlled trials to clarify its clinical benefit and therapeutic potential. NCT06117982. https://clinicaltrials.gov/study/NCT06117982?cond=The%20Impact%20of%20Granulocyte%20Colony%20Stimulating%20Factor%20on%20Premature%20Ovarian%20Insufficiency&rank=1.

Background:Obesity impairs liver regeneration by promoting chronic inflammation and metabolic dysfunction, especially in conditions like non-alcoholic fatty liver disease. Portal vein embolization (PVE), used to stimulate liver growth pre-hepatectomy, is less effective in obese subjects. Nicotinamide riboside (NR), a NAD+ precursor, improves mitochondrial function and lipid metabolism, but its role in liver regeneration under obese conditions remains unclear. Our study tried to investigate the effects and underlying mechanisms of NR on liver regeneration after PVE in high-fat diet (HFD)-induced obese rats.Methods:HFD-fed rats underwent PVE and were treated with or without NR. Liver regeneration was assessed by histology, 5-ethynyl-2′-deoxyuridine (EdU) incorporation, immunohistochemistry, and liver function tests. NAD+ levels were quantified to confirm NR activity. Proteomics, Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis, Gene Ontology (GO) analysis, quantitative real-time PCR (qPCR), and western blotting were used to explore molecular mechanisms, focusing on the MCART1/ASB3 axis.Results:Obesity impaired liver regeneration post-PVE, as evidenced by lipid accumulation, inflammation, reduced hepatocyte proliferation, and elevated liver enzymes. NR supplementation restored NAD+ levels, improved liver function, increased proliferative activity, and reduced steatosis. Mechanistically, NR upregulated MCART1 and ASB3 expression, promoting energy and lipid metabolism essential for regeneration.Conclusions:NR promotes liver regeneration after PVE in obese rats by enhancing NAD+-dependent metabolic pathways through the MCART1/ASB3 axis, offering a potential therapeutic strategy for obesity-associated liver dysfunction.

Wernicke–Korsakoff syndrome (WKS) is an acute neuropsychiatric illness produced by chronic deficiency of thiamine (vitamin B1), usually in association with chronic alcoholism. It is characterized by the sudden onset of Wernicke’s encephalopathy (WE) with subsequent chronic Korsakoff’s psychosis if untreated. Here, we describe a 68-year-old man who presented with slurred speech, ataxic gait, memory loss, bewilderment, and disorientation. A past history of alcohol dependence, clinical assessment, elevated liver enzymes, and magnetic resonance imaging findings of mammillary bodies and thalamus involvement led to a Wernicke–Korsakoff psychosis diagnosis. The patient responded well to thiamine replacement therapy and supportive management. The case again emphasizes early identification and treatment of WKS, especially in elderly patients with a history of chronic alcohol use.

ABSTRACTMalignancy and ischemic stroke are major causes of global morbidity and mortality. Thromboembolic strokes secondary to malignancy are uncommon but represent a critical consideration in cryptogenic stroke. We report the case of a 46‐year‐old female with no significant past medical history who presented with acute rightward gaze deviation. Brain MRI confirmed acute multifocal ischemic infarcts. An extensive workup, including CT angiography and echocardiography, ruled out common stroke mechanisms, leading to a diagnosis of embolic stroke of undetermined source (ESUS) per 2021 AHA guidelines. This prompted a hypercoagulability workup, which revealed a markedly elevated D‐dimer. Subsequent investigation showed elevated liver enzymes, and abdominal imaging identified a hepatic mass with contrast‐enhanced CT features highly suggestive of hepatocellular carcinoma (HCC). The patient was transferred to oncology services for HCC management. At discharge, her neurological symptoms had partially improved, but she was lost to long‐term follow‐up, and thus her final oncological outcome is unknown.

Intraperitoneal infusion of stem cell-derived natural killer cells in recurrent epithelial ovarian cancer patients: Results of the phase 1 INTRO-01 trial.

Mitigation conferred by banana flower extract against aflatoxin-induced oxidative stress, inflammation, apoptosis, molecular docking, and histological disturbances in rabbits.

Severe maternal morbidity and mortality across subtypes of hypertensive disorders in pregnancy.

P1090Drug retention in Vedolizumab-treated patients with active UC after the addition of adjunct curcumin-QingDai: An interim analysis of a retrospective real-world cohort study

Integrating biochemical and computational approaches to identify targeted therapeutic strategies for liver fibrosis: Effects of Telaglenastat (CB-839) on the glutaminase pathway.

Toxoplasma gondii is an intracellular protozoan that may disrupt the traditional cell barriers against cancer, allowing the accumulation of oncogenic mutations over time. Our research aimed to explore the relationship between T. gondii infection and liver cancer development. The present study, conducted in the city of Nasiriya, Iraq, involved 80 blood samples collected from individuals aged 18 to 70 years, of both sexes. The samples were divided into two groups: 40 from patients diagnosed with liver cancer and 40 from healthy individuals. All samples were tested using ELISA to detect anti-Toxoplasma gondii antibodies (IgG and IgM). The results showed that 21 liver cancer patients and 14 healthy individuals tested positive for T. gondii. Furthermore, liver enzyme levels (ALT, AST, and ALP) were assessed in all participants. The findings revealed a notable elevation in enzyme levels among liver cancer patients co-infected with T. gondii, compared to both non-infected liver cancer patients and the healthy control group. Using PCR, the B1 gene was amplified to confirm infection in selected samples. Ten B1-positive samples (5 from liver cancer and 5 from control) were tested for the GRA6 gene using nested PCR. DNA was extracted with a commercial kit, and amplification was performed using specific primers. Genotyping was conducted via PCR-RFLP targeting the GRA6 gene, using the MseI enzyme to distinguish T. gondii strains based on fragment sizes. RFLP analysis using MseI differentiated genotypes I, II, and III. This study genotyped Toxoplasma gondii in liver cancer patients using nested-PCR and RFLP targeting the GRA6 gene. Genotype I predominated among liver cancer patients, whereas control Genotypes II was predominance in the control group.

The neonicotinoid Imidacloprid provokes Ferritinophagy/Ferroptosis Axis disruption in rats' liver: The attenuation impact of Berberine chloride-loaded nano-liposomes.

Alzheimer's disease (AD) is a prevalent neurodegenerative disorder affecting approximately 55.2 million individuals globally, with complex pathogenesis involving amyloid-β (Aβ) aggregation, tau pathology, neuroinflammation, oxidative stress, and synaptic dysfunction. Current treatments offer only symptomatic relief without halting disease progression. Dl-3-n-butylphthalide (NBP), a small-molecule compound originally derived from celery seeds, has emerged as a promising multi-target therapeutic candidate for AD. Preclinical studies demonstrate that NBP exerts its therapeutic effects in AD by alleviating oxidative stress, enhancing superoxide dismutase (SOD) and glutathione activities, suppressing neuroinflammation by inhibiting NLRP3 inflammasome activation and pro-inflammatory cytokine release (e.g., IL-1β, TNF-α), reducing Aβ deposition and tau hyperphosphorylation, promoting autophagy, and improving synaptic plasticity. A meta-analysis of six trials (n = 851) confirmed that NBP improves Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores with a favorable safety profile, primarily mild gastrointestinal symptoms and transient liver enzyme elevations. This review systematically summarizes recent advances in NBP research, integrating both preclinical mechanisms and clinical evidence, and highlights its potential as a novel multi-target strategy for AD treatment. Further large-scale, long-term trials are warranted to validate its efficacy and explore optimized delivery systems and combination therapies.

Venom-induced consumption coagulopathy (VICC) is a life-threatening complication following pit viper bites and remains a significant health concern in Southeast Asia. VICC has a distinct pathophysiology compared to typical disseminated intravascular coagulation (DIC), requiring a tailored management approach. This case highlights the successful treatment of severe VICC following a red-tailed green viper bite. A 64-year-old woman presented with left hand swelling three days after a red-tailed green viper bite to the wrist. She also had vomiting and fever on first day. She was alert and hemodynamically stable. Laboratory tests revealed severe thrombocytopenia (50 x 10³/μL), markedly elevated D-dimer (&gt;10,000 ng/mL), and prolonged coagulation times. Complications included acute kidney injury, elevated liver enzymes, and gross hematuria. She received an initial dose of 2 vials of antivenom with close monitoring. As her coagulopathy progressed, additional antivenom was administered every 8 hours. Her condition began improving on day five without requiring blood transfusion. Unlike typical DIC, VICC should be managed primarily with antivenom, which neutralizes circulating venom and halts further coagulopathy. Anticoagulants are contraindicated, as pit viper venom contains both procoagulant and anticoagulant components that can worsen bleeding. The use of blood products in VICC is selective and symptom-based. Fresh frozen plasma (FFP) may be considered in patients with active bleeding or severe coagulopathy, thrombocyte concentrate (TC) is indicated if thrombocytopenia persists despite adequate antivenom, and packed red cells (PRC) are reserved for life-threatening anemia. VICC is a distinct coagulopathy requiring prompt antivenom administration, careful avoidance of anticoagulants, and judicious use of transfusions.

Objective: This study aimed to assess the prevalence and severity of hepatic steatosis and fibrosis in patients with transfusion-dependent thalassemia major (TM) using transient elastography (TE) and to investigate their correlations with serum ferritin, liver enzymes, and body mass index (BMI). Methods: A cross-sectional study was conducted at the Thalassemia Centre in Najaf, Iraq, from January to June 2024. Eighty TM patients aged ≥12 years were enrolled. Liver stiffness and controlled attenuation parameter (CAP) were measured via TE to stage fibrosis (F0-F4) and grade steatosis (S0-S3). Serum levels of alanine transaminase (ALT), aspartate transaminase (AST), and ferritin were analysed. Statistical analyses included Spearman's correlation and binary logistic regression. Results: The mean age of participants was 22±6.3 years, with a mean BMI of 20.5±3.0 kg/m². Significant fibrosis (F3-F4) was present in 32.5% of patients, while 67.5% had no or mild fibrosis (F0-F2). Severe steatosis (S3) was found in 8.6% of patients. ALT and AST levels showed a significant positive correlation with fibrosis stage (p&lt;0.001 for both). Serum ferritin was significantly higher in patients with significant fibrosis (p=0.012). No significant correlations were found between steatosis and ALT (p=0.275), AST (p=0.375), BMI (p=0.835), or ferritin (p=0.323). BMI was not correlated with fibrosis (p=0.193). Conclusions: Elevated liver enzymes and serum ferritin are significantly associated with liver fibrosis in TM patients, while steatosis appears less prevalent and is not correlated with traditional metabolic risk factors like BMI. Transient elastography is a crucial non-invasive tool for the simultaneous assessment of fibrosis and steatosis in high-risk populations.

Gram-positive sepsis remains a leading cause of morbidity and mortality in neonates. Vancomycin is the standard of care, yet drug monitoring challenges and rising resistance demand alternatives. Daptomycin has potent bactericidal activity, low resistance development and high efficacy in biofilm-associated infections. Experience in the neonatal period is scarce. This retrospective study focuses on infants with confirmed Gram-positive infection admitted between January 2019 and December 2024. All patients received daptomycin (6 mg/kg every 12 hours) after vancomycin treatment failure or contraindication due to side effects. Demographic, microbiologic, antibiotic treatment features, adverse events and neonatal outcome data were extracted from the infants' medical records. Fifty-three infants (median gestational age 29 weeks; interquartile range [IQR] 25-37.5) received daptomycin. Staphylococcus epidermidis accounted for 77.4% of isolates; 90% were methicillin-resistant. Median vancomycin exposure before antibiotic switch was 5 days. Blood cultures cleared in 47/52 assessable episodes (90.4%) after a median of 4 days on daptomycin; 1 additional case required adjunctive linezolid. Liver enzyme elevations occurred in 24% of infants, and a self-limited rash occurred in 2%; all were transient and resolved without treatment discontinuation. No muscular or neurologic toxicity was observed. Overall mortality was 24.5% (13/53), but infection-attributable mortality was confined to 4 cases (7.5%); no infection-related deaths occurred after 2020. In this neonatal cohort, which included a high proportion of very preterm infants, daptomycin achieved rapid microbiologic clearance and was generally well tolerated, although liver enzyme elevations were observed in approximately 1 out of 4 patients. These findings support its potential role as an alternative when vancomycin fails or cannot be used. Earlier use in high-risk, catheter-associated infections merits prospective evaluation.