Elevated Liver Enzymes Research Articles

Meta-Analysis: Global Prevalence and Mortality of Cirrhosis in Metabolic Dysfunction-Associated Steatotic Liver Disease.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is responsible for a significant global health burden. Despite this burden, the prevalence and mortality of MASLD-related cirrhosis remain inadequately defined, hindering effective public health strategies. This study aimed to estimate the global prevalence and mortality associated with MASLD-related cirrhosis. A systematic search of PubMed, Ovid MEDLINE, EMBASE, Web of Science and SCOPUS was conducted using keywords related to MASLD and cirrhosis from inception of each database used through June 2024. COVIDENCE was used for abstract and manuscript review. MASLD populations were categorised into 'general practice setting' and 'high risk setting', which indicated studies from inpatient setting or those referred for liver biopsy for an indication (elevated liver enzymes). Our data extraction and quality assessment followed PRISMA guidelines. A random-effects model was utilised for meta-analysis. From 7924 identified articles, 35 studies comprising 513,742 patients with MASLD met the inclusion criteria. The pooled global prevalence of cirrhosis among MASLD patients was 3.26% (95% CI: 2.47%-4.31%) in general practice settings (4 studies) and 14.51% (95% CI: 11.22%-18.57%) among those in inpatient settings or referred for liver biopsy (31 studies). Regionally, higher prevalence rates in high-risk settings were observed in North America and Australia (18.38%; 95% CI: 9.06%-33.75%), followed by Europe (10.16%; 95% CI: 5.71%-17.44%) and Asia (9.12%; 95% CI: 6.11%-13.40%) (p = 0.007). Notably, ICD-based diagnoses indicated a significantly higher prevalence of cirrhosis (27.43%) compared to those diagnosed by liver biopsy (13.24%; p < 0.001). The pooled all-cause mortality rate for MASLD-cirrhosis patients was estimated at 7.91 per 100 person-years (95% CI: 4.44-13.71) (9 studies). This meta-analysis underscores the substantial prevalence of cirrhosis among MASLD patients and highlights significant geographic and demographic variability, calling for improved screening and management strategies.

Impact of metabolism-disrupting chemicals and folic acid supplementation on liver injury and steatosis in mother-child pairs.

Scarce knowledge about the impact of metabolism-disrupting chemicals (MDCs) on steatotic liver disease limits opportunities for intervention. We evaluated pregnancy MDC-mixture associations with liver outcomes, and effect modification by folic acid (FA) supplementation in mother-child pairs. We studied ∼200 mother-child pairs from the Mexican PROGRESS cohort, with measured 43 MDCs during pregnancy (estimated air pollutants, blood/urine metals or metalloids, urine high- and low-molecular-weight phthalate [HMWPs, LMWPs] and organophosphate-pesticide [OP] metabolites), and serum liver enzymes (ALT, AST) at ∼9 years post-parturition. Outcomes included elevated liver enzymes in children and established clinical scores for steatosis and fibrosis in mothers (i.e. ALT, FLI, HSI, FIB-4). Bayesian Weighted Quantile Sum regression assessed MDC-mixture associations with liver outcomes. We further examined chemical-chemical interactions and effect modification by self-reported FA supplementation. In children, many MDC-mixtures were associated with liver injury. Per quartile HMWP-mixture increase, ALT increased by 10.1% (95%CI: 1.67%, 19.4%) and AST by 5.27% (95% CI: 0.80%, 10.1%). LMWP-mixtures and air pollutant-mixtures were associated with higher AST and ALT, respectively. Air pollutant and non-essential metal/element associations with liver enzymes were attenuated by maternal cobalt blood concentrations (p-interactions<0.05). In mothers, only the LMWP-mixture was associated with odds for steatosis [OR=1.53 (95%CI: 1.01, 2.28) for HSI>36, and OR=1.62 (95%CI: 1.05, 2.49) for AST:ALT<1]. In mothers and children, most associations were attenuated (null) at FA supplementation≥600mcg/day (p-interactions<0.05). Pregnancy MDC exposures may increase risk for liver injury and steatosis, particularly in children. Adequate FA supplementation and maternal cobalt levels may attenuate these associations. The effects of environmental chemical exposures on steatotic liver diseases are not well understood. In a parallel investigation of mothers and children, we found that pregnancy exposures to metabolism-disrupting chemicals may increase the risk for liver injury and steatosis, especially in the child, and that these associations could be attenuated by higher folic acid and/or cobalt levels. These findings can inform policies to decrease environmental chemical pollution and contribute to the design of clinical interventions addressing the MASLD epidemic.

Metabolic abnormalities, liver enzymes increased risk of gallstones: a cross-sectional study and multivariate mendelian randomization analysis.

Some studies have explored the relationship between metabolic abnormalities, elevated liver enzymes and gallstone risk, but the results have been inconsistent. The aim of this study was to comprehensively assess the relationship between metabolic abnormalities, liver enzymes, and gallstone risk through a cross-sectional study and Mendelian randomization analysis. Firstly, a cross-sectional study was conducted involving 555,31 subjects who underwent physical examinations at the Second Affiliated Hospital of Xi'an Jiaotong University between January 2021 and December 2021. The diagnosis of gallstones was based on ultrasound findings. Multivariable logistic regression analysis was employed to investigate the associations between metabolic abnormalities, liver enzymes, and the risk of gallstones. Additionally, two-sample and multivariate Mendelian randomization analyses were performed to further explore the genetic causal associations. In the cross-sectional analysis, the detection rate of gallstones was 4.8%, showing a gradual increase with age and BMI (body mass index) in both men and women. Gallstones were found to be comorbid with various metabolic disorders and were associated with elevated liver enzymes. Multivariate analysis showed that female sex, age, body mass index, diastolic blood pressure, fatty liver, alanine aminotransferase, and gamma-glutamyltransferase may be independent risk factors for gallstones, whereas high-density lipoprotein cholesterol may be a protective factor. Two-sample and multivariate Mendelian randomization analyses further revealed a causal association between genetically predicted BMI, type 2 diabetes mellitus, alanine aminotransferase, gamma-glutamyl transferase, and an increased risk of gallstones. The findings suggest that metabolic abnormalities and elevated liver enzymes may increase the risk of developing gallstones.

Preclinical evaluation of an anchored immunotherapy strategy with aluminum hydroxide-tethered interleukin-12 in dogs with advanced malignant melanoma.

Melanoma is an aggressive cancer in dogs involving skin and mucosa similar to people. Anchored immunotherapeutics offer a novel approach to increase intratumoral retention of therapeutic payloads while decreasing systemic exposure, and this strategy can be critically evaluated through a comparative oncology approach. JEN-101 is an anchored canine interleukin-12 (IL-12) tethered to aluminum hydroxide administered by local injection. A Phase I study was conducted to determine the tolerability, activity, and immune responses of JEN-101 in dogs with advanced melanoma. A 3+3 dose escalation design was used to evaluate intratumoral injection of JEN-101 at 1, 3, 10, or 20 μg/kg every three weeks for four cycles. A second course was allowable in the absence of disease progression or toxicity. Peripheral blood, serum, and tumor biopsies were collected at baseline and at pre-specified timepoints for pharmacokinetic and immune analyses, which included serum cytokines, immunohistochemistry, and gene expression assessment. JEN-101 was well tolerated with adverse events being fever, lethargy, and isolated elevated liver enzymes. Five dogs experienced grade 3 events and no grade 4 events were observed. Pharmacokinetic analysis showed a trend towards dose-related Cmax within 8 hours of injection. Responding dogs demonstrated increased systemic interferon-γ and IL-10 AUC levels and local recruitment of CD3+ T cells. Increased pro-inflammatory and antigen processing gene expressions were identified in responding lesions. JEN-101 was well tolerated with evidence of biologic and therapeutic activities. Anchored IL-12 immunotherapy merits further investigation in dogs with melanoma and our approach represents an immune competent model to inform human clinical trials.

Acute Fatty Liver of Pregnancy

Acute fatty liver of pregnancy (AFLP), although rare, is a potentially fatal obstetrical disorder. It is characterized by acute liver failure of varying degrees with associated coagulopathy that occurs often in the third trimester of pregnancy. The following review discusses the history, etiopathogenesis, and subsequent clinical and laboratory findings that are associated with this disorder. It additionally attempts to aid in differentiating AFLP from other common obstetrical and non-obstetrical diseases with special emphasis on its differentiation from hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome. This review also discusses recommendations for delivery and postpartum care with focus on return to baseline and additional life-saving measures that may need to be pursued in the most difficult and refractory cases. Finally, it addresses maternal and perinatal outcomes associated with the disorder and the effect that this disorder can have on future pregnancies.

A likely pathogenic homozygous frameshift variant in BLOC1S6 associated with a rare form of congenital Hermansky-Pudlak syndrome 9

Hermansky-Pudlak syndrome (HPS) is a collection of autosomal recessive multisystemic disorders with at least 11 different types, categorized on the basis of involved genes. The disease is mostly characterized by tyrosinase-positive oculocutaneous albinism (OCA), platelet storage deficiency, absence of platelet dense bodies, and immune deficiency. Here we described a 2-month-old female infant with generalized hypotonia, recurrent infections, bilateral optic atrophy, nystagmus, cerebral atrophy, and elevated liver enzymes. Unlike her parents, she had chestnut colored hair, fair skin, and brown eyes. Parents had a consanguineous marriage, and their first child had died with similar symptoms at the age of 5 months. Whole exome sequencing (WES) was performed on DNA extracted from the patient's peripheral blood. Following the bioinformatics analysis, a likely pathogenic novel variant in the fifth exon of the BLOC1S6 gene (NM_001311255: c.506dupT: p. L169Ffs*33) was introduced by the Sadra Medical Genetic Laboratory. This variant was confirmed in the patient and segregated in both parents by Sanger sequencing.This report presented the first congenital case of HPS-9 worldwide that might have led to early neonatal death. Our current patient shows new considerable features related to the BLOC1S6 gene variant and HPS-9, which is a valuable source for future research, prediction, clinical management, genetic counseling, and prenatal diagnosing.

Hepatoprotective and neuroprotective effects of quinacrine against bile duct ligation-induced hepatic encephalopathy in rats: Role of bone morphogenetic proteins signaling

AimsThis study aimed to assess the potential protective effect of quinacrine, an FDA approved antimalarial drug with reported anti-inflammatory effects, on hepatic encephalopathy (HE) in a bile duct ligation (BDL) experimental model and to investigate the mechanisms responsible for this effect, namely those associated with the liver-brain axis, particularly, bone morphogenetic protein 2 (BMP2) signaling. Materials and methodsFive groups of rats were selected at random: sham, BDL, (BDL+ quinacrine 5), (BDL+ quinacrine 10), and (quinacrine 10 + sham). Daily Intraperitoneal (I.P.) administration of quinacrine was initiated on the surgery day and continued for 28 days. Key findingsResults showed that rats that underwent BDL exhibited marked elevation of serum liver enzymes, ammonia, total bilirubin, together with oxidative stress, inflammation, dysregulated farnesoid x receptor (FXR), dysregulated BMP2 signaling and escalated fibrotic markers indicating hepatotoxicity, cholestasis and fibrosis. Besides, neurotoxicity was detected as manifested by cognitive deficits and dysregulation of hippocampal FXR, BMP2 signaling, WNT3A signaling, brain derived neurotrophic factor (BDNF), phospholipase A2 (PLA2) and glial fibrillary acidic protein (GFAP). In contrast, co-treatment with quinacrine mitigated BDL-induced hepatotoxicity, cholestasis, fibrosis, and neurotoxicity. Notably, quinacrine improved learning and memory and restored FXR, BMP2 signaling in the liver and hippocampus. In addition, quinacrine restored hippocampal WNT3A signaling, BDNF, whereas it downregulated expression of hippocampal PLA2 and GFAP. SignificanceThese findings demonstrated implication of BMP2 signaling in the molecular process of BDL-induced HE and proposed that quinacrine has potential hepatoprotective and neuroprotective properties against HE.

The Impact of Methamphetamine on Liver Injury in Iraqi Male Addicts

Methamphetamine (METH) is a powerful stimulant that affects neurochemical processes controlling heart rate, appetite, blood pressure, body temperature, and wakefulness, making it highly susceptible to abuse. Liver enzymes such as ALT, AST, ALP, and GGT are crucial for liver function. Albumin, a protein synthesized by healthy liver cells, serves as an indicator of chronic liver disease. Additionally, hepatocytes produce bile acids, which are essential for the secretion of bile salts into the bile canaliculi. Disruption in this secretion results in the accumulation of bile salts in the canaliculi, leading to intrahepatic cholestasis. METH-induced liver toxicity involves disruptions in hepatic metabolism, oxidative stress, and increased body temperature, affecting cellular processes such as cell division and the cell cycle and potentially accelerating liver cell apoptosis. The study explores the link between liver toxicity and hepatocyte damage in Iraqi males suffering from addiction. This is a case-control study, conducted at Ibn-Rushed Psychiatric Hospital in Baghdad from July 2023 to February 2024, involved 196 males, with addiction durations exceeding 24 months with varying degrees of methamphetamine (METH) addiction. The study included 187 healthy male controls with no history of drug addiction. Participants were aged 18 to 40 years. Diagnosis was confirmed using a drug test screening card administered by a specialist. The study included liver function tests (ALT, AST, ALP, and GGT), total bilirubin, and albumin concentration assessments. Significant differences were observed between the addicts and controls, particularly a marked decrease in serum albumin concentration in the addicted males. The ROC curve classification model at various thresholds demonstrated that liver enzymes, especially ALT, ALP, and GGT, exhibited increased sensitivity to METH addiction. A histopathological examination was conducted on a deceased 38-year-old male who had a six-year history of chronic amphetamine addiction to confirm liver injury and the resulting elevation of liver enzymes. The findings of this study indicate that METH greatly affects liver function, suggested to the importance of following a preventative measures and effective treatment approaches for monitoring METH addiction progress.

Drug-induced Steatohepatitis Caused by Long-term Use of Topical Steroids for Atopic Dermatitis.

Atopic dermatitis is common in children and often treated with topical corticosteroids (TCs). A boy in his late teens who had been using TCs for atopic dermatitis was diagnosed with liver damage during a health checkup. A medical examination revealed severe steatotic liver disease and elevated liver enzyme levels despite the absence of typical symptoms such as central obesity. After discontinuation of TCs, an improvement in liver enzyme levels was observed, leading to the diagnosis of drug-induced steatohepatitis. This case underscores the potential liver risks associated with prolonged TC use in children, highlighting the need for parental education.

A comprehensive analysis of demographics, comorbidities, and laboratory findings in adult celiac disease patients: a single center experience

Aims: This study aims to evaluate the demographics, comorbidities, and laboratory findings of patients with celiac disease in our clinic. Methods: A total of 91 celiac patients who were followed in our centre between January 2020 and September 2023 were included in the study. Demographic, laboratory and comorbidities data were analysed retrospectively. Results: 72 (79.1%) patients were female, and the mean age of the participants was 42.3 (+-) 15.1 years. Deficiency of iron was observed in 46 (50.6%) participants, vitamin B12 in 9 (9.9%) participants, folat in 11 (12.1%) participants, and vitamin D in 37 (40.7%) participants. Hypothyroidism and diabetes mellitus were found to be the two most common comorbidities of celiac disease. In addition, liver enzymes were demonstrated to be elevated in the 9 (9.9%) patients. Conclusion: Celiac disease is associated with mineral and vitamine deficiency. In addition, mildly elevated liver enzymes may be observed in the clinical course. Notably, extraintestinal manifestations, especially hypothyroidism and diabetes, may accompany the disease.

A Model to Predict the Risk of Adverse Ocular Outcomes in Pregnant Women

Aims/Background Pregnancy can affect various bodily functions, including metabolism, cardiovascular function, and eyesight. Pathological ocular changes observed during pregnancy are linked to the development of pregnancy-specific conditions, such as preeclampsia/eclampsia and gestational diabetes. This study aims to analyze clinical data disease history and maternal characteristics collected during pregnancy, to determine ocular parameters and develop a risk prediction model for adverse ocular outcomes. Methods We retrospectively analyzed the medical records of 760 pregnant women (1520 eyes) from September 2020 to September 2022 at The Third Affiliated Hospital of Guangzhou Medical University. We identified maternal variables that could influence adverse ocular outcomes, including maternal age, pregnancy-induced hypertension (PIH), gestational diabetes mellitus (GDM), eclampsia, pre-eclampsia, uterine disease, fetal abnormalities, in vitro fertilization with embryo transfer, hypoproteinemia, and major comorbidities during pregnancy. Univariate and multivariate logistic regression analyses were conducted to evaluate the effects of these independent predictors on adverse ocular outcomes. Additionally, receiver operating characteristic (ROC) curve analysis was performed to determine the cut-off probability with for optimal sensitivity and specificity. Results Eclampsia, pre-eclampsia, GDM, a history of chronic hypertension, and hypoproteinemia were identified as independent predictors of adverse ocular outcomes during pregnancy (p &lt; 0.05). Maternal age, PIH, intrauterine growth retardation (IUGR), obesity, and pregnancy with immunoglobulin A nephropathy were predictors of moderate and severe retinal arteriole sclerosis during pregnancy (p &lt; 0.05). Additionally, hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome were predictors of retinal hemorrhage and exudate during pregnancy (p &lt; 0.05). The area under the ROC curve for adverse ocular outcomes were 0.75 and 0.74, respectively. Conclusion Our predictive model effectively forecasts adverse ocular outcomes during pregnancy, incorporating risk factors such as maternal age, eclampsia and pre-eclampsia, GDM, obesity, a history of chronic hypertension, hypoproteinemia, IUGR, pregnancy with immunoglobulin A nephropathy, and HELLP syndrome.

Pregnancy-related acute kidney injury leads to hypertension, reduced kidney function and cognitive impairment in postpartum rats.

Women with hypertensive disorders of pregnancy such as HELLP (hemolysis, elevated liver enzyme, low platelet) Syndrome are affected by acute kidney injury during pregnancy (PR-AKI) at higher rates than women without hypertension. Both hypertensive disorders of pregnancy and Acute Kidney Injury (AKI) outside the context of pregnancy have been associated with an increased risk of developing Chronic Kidney Disease (CKD) and cognitive impairment. In our current study, we set out to determine if PR-AKI led to the development of CKD and impaired cognition in the postpartum period and if HELLP syndrome exacerbates the impairments. Using timed-pregnant Sprague Dawley rats, on gestational day (GD) 12, mini-osmotic pumps infusing anti-angiogenic factors were surgically placed in the intraperitoneal cavity to induce HELLP. On GD18, AKI was induced via bilateral renal reperfusion ischemia surgery. Mean arterial pressure and birth outcomes were used to assess the global effects of AKI, and liver enzymes were used to assess HELLP. CKD was assessed by measuring glomerular filtration rate (GFR), urinary output, and renal fibrosis. Anxiety-like behaviors, object recognition memory, spatial memory, and avoidance memory were assessed via behavioral experiments. HELLP + AKI rats demonstrated more evidence of renal injury, hypertension, and behavioral deficits compared to normal pregnant animals. In addition, AKI had a negative impact on birth outcomes and maternal survival. HELLP + AKI together led to evidence of persistent hypertension, progressive renal dysfunction, and cognitive impairment, which were exacerbated compared to AKI or HELLP alone. These findings suggest that PR-AKI in the presence of a hypertensive disorder of pregnancy, such as HELLP, leads to the development of CKD, cognitive dysfunction, and hypertension.

Preparation of gallic acid-loaded chitosan nanoparticles and their chemoprotective effects on N-ethyl-N-nitrosourea-induced hepatotoxicity and mortality in rats.

N-ethyl-N-nitrosourea (ENU) as n-nitrosamine and alkylating agent, ubiquitous within living cells and in the environment can act as a full carcinogen and induce tumor formation in various tissues such as liver. In this study, gallic acid-loaded chitosan nanoparticles (GANPs) were synthesized and evaluated for their chemopreventive effect against ENU-induced hepatotoxicity and mortality in rats. Twenty-four male Wistar rats were divided into four groups including: control, ENU (single doses of 50mg/kg via intraperitoneal injection), GA + ENU and GANPs + ENU. Animals were orally pretreated with GA (50 mg/kg) and GANPs (50 mg/kg) for 30 days, and liver injuries induced by ENU on the 31st day of study. After ENU administration, weight changes and mortality were monitored during 30 days, and then the animals were sacrificed and alpha-fetoprotein (AFP) as a tumor marker, liver function tests (ALT, AST and ALP), oxidative stress markers (GSH and MDA), mitochondrial toxicity parameters, and histopathological assessment were evaluated. Except for AFP and MDA, ENU caused significant elevation of liver enzymes, mitochondrial ROS formation, collapse of mitochondrial membrane potential depletion of GSH, histopathological abnormalities and mortality in rats. Our data showed that GANPs significantly increased the survival of rats by up to 66%, delayed in death time and prevented weight changes after exposure to ENU. Moreover, GANPs restored liver enzyme levels, ROS formation, mitochondrial dysfunction, GSH levels, and histopathological abnormalities towards normal. Our findings suggest that GANPs revealed a significant protective effect against deadly toxicity induced by ENU as an alkylating full carcinogen agent in liver tissue.

Atypical Presentation of Subcapsular Liver Hematoma With a Delayed Onset of Hemolysis, Elevated Liver Enzymes, Low Platelet Count (HELLP) Syndrome

Atypical Presentation of Subcapsular Liver Hematoma With a Delayed Onset of Hemolysis, Elevated Liver Enzymes, Low Platelet Count (HELLP) Syndrome

Human papillomavirus infections during pregnancy and adverse pregnancy outcomes: a Scandinavian prospective mother-child cohort study.

Human papillomaviruses are common in the urogenital tract amongst women of childbearing age. A few studies indicate a possible association between human papillomavirus infections in pregnancy and adverse pregnancy outcomes whilst other studies find no such association. We aimed to investigate the association between human papillomavirus infections during pregnancy and adverse pregnancy outcomes linked to placental dysfunction, including hypertensive disorders of pregnancy, gestational diabetes mellitus and newborns small for gestational age. Pregnant women from the general population in Norway and Sweden were enrolled at the time of routine mid-gestational ultrasound examination. Urine samples collected at mid-gestation in 950 and at delivery in 753 participants, were analyzed for 28 human papillomavirus genotypes, including 12 high-risk genotypes. Participants completed electronic questionnaires at enrollment and medical records were reviewed for background characteristics and for the following adverse pregnancy outcomes: hypertensive disorders of pregnancy including gestational hypertension, preeclampsia, superimposed preeclampsia, eclampsia and Hemolysis Elevated Liver enzymes and Low Platelets (HELLP) syndrome, gestational diabetes mellitus, and newborns small for gestational age. Associations between adverse pregnancy outcomes and (a) any human papillomavirus, high-risk human papillomavirus and human papillomavirus genotype 16 infection at mid-gestation, (b) multiple genotype infections at mid-gestation, and (c) persisting infections during pregnancy were assessed with univariable and multivariable logistic regression models. Missing covariates were imputed using multiple imputation. At mid-gestation, 40% (377/950) of women were positive for any of the 28 genotypes, 24% (231/950) for high-risk genotypes and human papillomavirus 16 was found in 6% (59/950) of the women. Hypertensive disorders of pregnancy was observed in 9% (83/950), gestational diabetes mellitus in 4% (40/950) and newborns small for gestational age in 7% (67/950). Human papillomavirus infection with any genotype, high-risk or human papillomavirus genotype 16 at mid-gestation was not associated with adverse pregnancy outcomes. No associations were found for multiple genotype infections at mid-gestation or persisting infections. In a general population of pregnant women, we found no evidence of human papillomavirus infections during pregnancy being associated with hypertensive disorders of pregnancy, gestational diabetes mellitus, or newborns small for gestational age. Trial registration The study is registered at ClincialTrials.gov; NCT02449850 on May 19th, 2015.

Gentamicin Induced Damage in Nephrotoxicity and Hepatotoxicity in Male Rabbits: The Protective Effect of Cinnamon

One common aminoglycoside antibiotic that is well-known for its ability to treat gram-negative bacterial infections is gentamicin. Its nephrotoxic and hepatotoxic side effects, which are mostly brought about by the production of free radicals that harm kidney and liver cells, frequently restrict its therapeutic application. On the other hand, strong antioxidants found in cinnamon, a popular spice and therapeutic plant, have been demonstrated to have protective properties against oxidative stress. In order to assess the protective role of cinnamon, the current study examines how cinnamon affects gentamicin-induced changes in biochemical markers, liver enzymes in male rabbits. Treatment groups included a control group, a gentamicin-only (GIN) group, a cinnamon-only (CIN) group, and a combined cinnamon-gentamicin (CIN+GIN) group. The results showed that GIN group elevated liver enzymes, specifically aspartate transaminase (AST) and alanine transaminase (ALT), suggesting possible hepatotoxicity. The dose of cinnamon decreased these enzyme levels, while the combination therapy kept the AST levels close to control. Biochemical examination revealed that cinnamon reduced these alterations, particularly in the combination therapy group, while gentamicin increased total protein, urea, and creatinine levels, indicating renal and hepatic stress. The study concludes by highlighting the potential of cinnamon in reducing gentamicin-induced toxicity, specifically through its effects on lipid profiles, liver enzyme activities, body weight, blood profiles, and biochemical markers. This suggests that cinnamon could be used as an adjuvant therapy to reduce the negative effects of gentamicin".

Transient Elevation of Liver Function Tests and Bilirubin Levels After Laparoscopic Cholecystectomy.

Background and Objectives: Laparoscopic cholecystectomy constitutes the current "gold standard" treatment of symptomatic gallstone disease. In order to avoid intraoperative vasculobiliary injuries, it is mandatory to establish the "critical view of safety". In cases of poor identification of the cystic duct and artery leading to a missed intraoperative injury, patients present with elevated liver function tests (LFTs) or increased bilirubin postoperatively. The aim of this study is to present a series of patients of our institute with elevated liver enzymes and bilirubin after laparoscopic cholecystectomy in the absence of intraoperative injury or any other obvious etiology and to provide a possible explanation of this finding. Materials and Methods: From 2019 to 2023, 200 patients underwent elective laparoscopic cholecystectomy at the Papageorgiou General Hospital and at the European Interbalkan Medical Center of Thessaloniki utilizing the "critical view of safety" method. We retrospectively collected the intraoperative reports, and the pre- and postoperative imaging and laboratory studies of the patients included in this series. Postoperative LFTs and bilirubin levels were extracted and the reason for their transient elevation was examined. Results: From 200 cases of laparoscopic cholecystectomy, elevated LFTs and bilirubin were found in six patients on the first postoperative day, which is suggestive of a missed intraoperative injury. All patients were asymptomatic. During the investigatory workup, a triple-phase CT of the liver and/or an MRCP were ordered, but no pathological findings, such as biliary injury, hepatic artery injury or choledocholithiasis, were found. On postoperative day 3, LFTs and bilirubin levels decreased or normalized without any intervention. No postoperative complications were reported. Conclusions: In select cases, a transient increase in LFTs and/or bilirubin may be observed in the early postoperative period after elective laparoscopic cholecystectomy in the absence of an obvious etiology. A possible interpretation of these findings could involve the pneumoperitoneum or the anesthesia regimens used intra- or perioperatively. The specific cause, however, remains undetermined and yet to be examined by future studies.

Genetic, Clinical, and Biochemical Characterization ofa Large Cohort of Palestinian Patients With Fanconi-Bickel Syndrome.

This study aims to investigate the clinical, biochemical, and genetic characteristics of Fanconi-Bickel syndrome (FBS) in a cohort of 20 individuals from Palestine and to identify novel pathogenic variants. A retrospective analysis was conducted on medical records from Al-Makassed Hospital's pediatric department spanning 2015 to 2023. Individuals diagnosed with FBS via molecular genetic testing were included in the study. Among the 20 genetically confirmed FBS patients, hepatomegaly was prevalent in 95%, whereas 70% exhibited both developmental delay and hypophosphatemic rickets, and 68.4% experienced growth retardation. Hypertriglyceridemia (HTG) was universal. Elevated liver enzymes and alkaline phosphatase were common, along with hypophosphatemia (95%) and urinary abnormalities. Genetic analysis revealed five distinct SLC2A2 pathogenic variants, including three previously unreported variants: p.Gln23Arg (c.68A > G), p.Thr353Arg (c.1058_1059delinsGG), and an exon 7 deletion. This study presents the largest single-center cohort of FBS patients, expanding our understanding of the disorder's phenotypic and genotypic spectrum. Despite FBS generally carrying a favorable prognosis, timely diagnosis remains crucial to prevent severe complications.

Lactate dehydrogenase as a biochemical marker for prediction of maternal and perinatal outcomes in hypertensive disorders in pregnancy

Hypertensive disorder of pregnancy includes new onset hypertension in pregnancy that is gestational hypertension and already existing hypertension that is chronic hypertension and gestational hypertension sometimes worsened by preeclampsia. Preeclampsia can cause complications such as eclampsia, HELLP syndrome, renal failure, pulmonary edema, stroke, and left ventricular failure. We aim to assessthe predictive role ofLactate Dehydrogenase value in Hypertensive disorders in pregnancy.After obtaining the informed consent, pregnant patients who were visiting Tertiary care centre and who were more than 28 weeks period of gestation were enrolled. Patients from both antenatal OPD clinics and from those who were presenting in emergency were included in this study. Serum levels of LDH were tested. Patients were monitored till delivery and 6 weeks following childbirth.The Mean serum levels of lactate dehydrogenase (LDH) in eclamptic group was 1495.000±859.1230, 804.569±224.5519 in severely preeclamptic group and in mild preeclamptic group ,mean LDH levels were 520.062±110.3944. The difference between both the groups was statistically significant (p &amp;#60; 0.001).Women with serum LDH levels &amp;#62; 800 IU/L and LDH levels between 601-800 IU/L, experienced considerably greater complications in preeclamptic-eclamptic group as compared to those with serum LDH levels &amp;#60; 600 IU/L.Thepreeclamptic-eclamptic group of women had increased serum LDH levels. Greater LDH levels were linked to worse outcomes for mothers including placental abruption, hemolysis elevated liver enzymes low platelet count (HELLP syndrome), pulmonary edema and maternal death and they were also linked to fetal complications including intrauterine fetal death (IUFD), intrauterine growth restriction and neonatal intensive care unit (NICU) admission.

Ultrasound evaluation of kidney and liver involvement in Bardet–Biedl syndrome

BackgroundBardet–Biedl syndrome (BBS) is a rare autosomal-recessive ciliopathy with pathogenic variants in 26 BBS genes. It affects multiple organs, including the kidney and liver, with varying degrees regarding extent and time of first manifestation. Structural renal anomalies are an early feature and end-stage kidney disease (ESKD) cumulates to 25% in adulthood. Early-onset hyperphagia-associated obesity is another major symptom and contributes to liver pathology, presenting as steatosis/fibrosis. Aim of this study is the evaluation of high-end ultrasound (US) technologies in BBS patients regarding their potential to discriminate liver and kidney tissue pathology at an early stage.Materials and methodsPatients with genetically proven BBS were recruited from the University Children’s Hospital of Essen and from BBS patient days hosted in Germany. Acute illness was an exclusion criterion. Clinical and laboratory data were extracted from patients’ digital records or medical letters. High-resolution ultrasound (US) imaging was utilized, including attenuation imaging (ATI), shear wave elastography (SWE) and dispersion (SWD) of liver tissue.Results49 BBS patients (24/49 male; 1.1–51.0 years, mean 17.8 years) were included in the study. Mean body weight (SDS 2.13 ± 1.33) and BMI (SDS 2.64 ± 1.18) were increased. Structural kidney abnormalities (dysplasia, cysts) were present in 75% (36/48), and persistent fetal lobulation in 44% (21/48). Renal function was impaired in 27% (13/49) of whom 3 had ESKD (kidney transplantation (n = 2), hemodialysis (n = 1)). Elevation of liver enzymes was detected in 38% (16/42). In 51% (25/49) ATI of liver tissue was increased, indicating hepatic steatosis, and correlated with BMI SDS, liver size, and enzymes. SWE was elevated in 61% (30/49), suggesting hepatic fibrosis, and it correlated with BMI and GGT. Patients with pathogenic variants in BBS10 showed a tendency towards higher ATI, reduced GFR, and higher BMI SDS.ConclusionsWe detected kidney and liver abnormalities in a higher percentage of BBS patients than previously reported, indicating a high sensitivity and diagnostic yield of the evaluated high-end US applications. ATI detected liver pathology early (partially prior to liver enzymes) and revealed differences related to the affected genes. Evidence of tissue pathology at an early stage may improve diagnostics and the evaluation of therapeutic approaches.