Hepatic Function Tests Research Articles

Cilostazol Can Increase Skin Oxygen Supply Assessed by Transcutaneous Oxygen Pressure Measurement in Type 2 Diabetes With Lower Limb Ischemic Disease: A Randomized Trial.

The purpose of this study was to compare the efficacy and safety of cilostazol versus acetylsalicylic acid (ASA) for amelioration of lower limb ischemia in type 2 diabetes. Prospective, randomized positive-controlled open clinical trial. Eighty-nine patients with type 2 diabetes mellitus and symptoms of lower limb ischemia (perceptions of coldness of the lower limbs, numbness, intermittent claudication, or pain at rest) present for 6 months or more that had not significantly changed within the past 3 months participated in the study. All subjects had an initial transcutaneous oxygen pressure (TcpO2) of less than 40 mm Hg in the foot when measured in the supine position. Subjects included 46 males and 43 females; their ages ranged from 35 to 80 years. Participants were randomly allocated to 2 groups, one was treated with cilostazol 100 mg taken twice daily (n = 48), and a second group took 100 mg of ASA daily (n = 41) for 8 weeks. Clinical assessment included measurement of transcutaneous oxygenation, and symptoms associated with lower limb ischemia. Blood analyses included a full blood panel, coagulation screen, renal function tests, hepatic function tests, and lipid profiles. All tests were performed at baseline and repeated at 8 weeks. Age, duration of diabetes, diabetic complications, lower limb ischemic symptoms, TcpO2, and smoking status did not differ between the 2 groups. In contrast, TcpO2 significantly improved from 37.1 ± 11.9 mm Hg to 42.0 ± 9.7 mm Hg in the cilostazol-treated group (P < .05), whereas no significant change was observed in the ASA-treated group (P > .05). Ischemic symptoms such as intermittent claudication (P = .009), perception of limb coldness (P = .008), and pain at rest (P = .017) showed greater improvement in the cilostazol-treated group when compared to subjects treated with ASA. Approximately 10% of patients treated with cilostazol experienced adverse side effects (palpitations, headache, diarrhea). Cilostazol was not found to have significant detrimental effects in hematologic or biochemical indices, including renal, hepatic, and blood coagulant function tests. We found that 8 weeks of treatment with cilostazol 100 mg daily was safe and well tolerated for the treatment of type 2 diabetes with lower limb ischemic disease.

Antihyperglycemic and antidiabetic effects of Ethyl (S)-2-(1-cyclohexylsulfamide carbamoyloxy) propanoate in streptozotocin-induced diabetic Wistar rats

In this study, we examined the antihyperglycemic and antidiabetic effects of a novel synthesized molecule, the Ethyl (S)-2-(1-cyclohexylsulfamide carbamoyloxy) propanoate (ESP1b), in streptozotocin (STZ)-induced diabetic Wistar rats. Experimental diabetes mellitus was produced by a single intraperitoneal injection of STZ (55mg/kg b.w.). Seven day post-injection, animals have received ESP1b orally at the doses of 5, 10 and 20mg/kg b.w. daily for 28 days. This resulted in a clear decline, in a dose dependent manner, of blood glucose levels during the oral glucose tolerance test (OGTT) and the four weeks of treatment period. ESP1b at 20mg/kg b.w. has alleviated body weight loss, improved plasma insulin concentration and at the same time markedly decreased the values of glycosylated hemoglobin, lipoproteins and atherogenic ratios. Additionally, ESP1b notably restored renal as well as hepatic functions tests. Histopathological examinations of pancreatic tissue also confirmed the previous biochemical findings. Considering the obtained results, it may be concluded that ESP1b possess a potent antihyperglycemic activity in STZ-diabetic rats possibly related to an insulin-secretagogue effect, which may be responsible for the moderate decrease in blood glucose concentration observed in normal rats administrated with this tested compound.

New advances in the diagnosis of canine and feline liver and pancreatic disease

The diagnosis of liver and pancreatic disorders in dogs and cats present their own set of challenges. However, as new diagnostic tests are developed and the optimal ways in which to use existing tests are determined, the ability of the veterinary profession to make these diagnoses continues to improve. Histopathological assessment is considered to be the reference standard for the diagnosis of many hepatic and pancreatic diseases, but it has some inherent limitations.New classes of diagnostic tests for liver disease that are currently being studied include direct and indirect serum markers of hepatic fibrosis, such as hyaluronic acid; novel markers of hepatocellular injury, such as circulating microRNAs; and quantitative tests of hepatic microsomal function. Assays for pancreas-specific lipase have greatly improved the ability of practitioners to diagnose pancreatitis in dogs and cats. However, further research is needed to fully understand the characteristics of these assays, especially in patients with concurrent non-pancreatic disease. The more common use and refinement of CT and MRI to assess the hepatobiliary system and pancreas of dogs and cats also have huge potential to improve diagnostic capabilities.

Fontan-associated liver disease: Spectrum of US findings

PurposeTo describe ultrasonography (US) findings of Fontan-associated liver disease (FALD) and to determine whether screening US examinations can identify FALD before biochemical hepatic dysfunction. MethodsThis retrospective study included 55 patients who underwent Fontan procedure over a 20-year period. Hepatobiliary US findings (n=55), CT or MRI findings (n=19), biochemical hepatic function tests (n=49), and histopathological results (n=4) were analyzed. Images were reviewed focusing on the hepatic parenchymal changes, presence of focal lesions, and signs of portal hypertension. ResultsHepatic parenchymal changes (either heterogeneous echotexture or surface nodularity) evident on US were present in 67% (37/55) and showed positive correlation with the Fontan duration. Hyper-echoic lesions were noted in 35% (19/55) and showed a predilection for multiplicity, small size, right lobe location, and irregular margin on high-frequency transducer. These lesions were not demonstrated by CT or MRI or by low-frequency transducer. Histopathological results of targeted biopsy for hyper-echoic lesions revealed lesser degree of patchy sinusoidal and portal fibrosis than seen in cases with surface nodularity. Abnormal parenchymal enhancement was commonly seen with CT or MRI in 63% (12/19) and hypervascular nodules in 21% (4/19). Most patients (82%, 40/49) showed normal biochemical hepatic function tests, despite the presence of hepatic parenchymal changes on imaging. ConclusionThe common US findings of FALD included heterogeneous parenchymal echotexture, surface nodularity, and hyper-echoic lesions. We suggest that hyper-echoic lesions without surface nodularity detected by high-frequency transducer may represent the early stage of fibrosis. US examination may be useful for identifying the progression of FALD before biochemical hepatic dysfunction.

Hepatic Ultrasonography for Surveillance in Patients With Uveal Melanoma.

There is a lack of information regarding the role of systemic surveillance in patients with primary uveal melanoma. To evaluate the utility of serial hepatic ultrasonography (USG) for detection of asymptomatic liver metastases in patients undergoing surveillance after primary treatment of uveal melanoma. Retrospective cohort study reviewing data from patients with primary uveal melanoma treated between October 2003 and October 2012 at a multispecialty tertiary care center. Patients were managed using a standardized protocol. Initial staging was done with contrast-enhanced computed tomography of the chest, abdomen, and pelvis. This was followed by periodic surveillance with hepatic USG and liver function tests scheduled every 6 months for the first 5 years and annually thereafter. Abnormal surveillance hepatic USG findings were categorized as (1) cyst or hemangioma, (2) indeterminate lesion, (3) suspicious for metastasis, or (4) consistent with metastasis. If indicated, hepatic USG abnormalities were confirmed by additional imaging modalities (confirmatory scans) such as computed tomography or magnetic resonance imaging. Liver biopsy was performed only if the confirmatory scan was positive. Sensitivity, specificity, and positive predictive value of hepatic USG for detecting asymptomatic liver metastases. In 263 patients (121 men, 142 women; mean [SD] age at diagnosis, 61.1 [13.9] years), a total of 1390 hepatic USGs were performed, with a mean of 5.3 per patient (range, 1-17 per patient). Overall, 86 hepatic USGs of 71 patients (27%) were reported as abnormal. Of the 13 lesions identified as a cyst/hemangioma and 17 as indeterminate, 1 was found to be metastatic in each group (8% and 6%, respectively). Of 36 patients with findings suspicious for metastasis, 23 (64%) had metastasis confirmed. All 5 patients (100%) with findings consistent with metastasis had biopsy-proven metastasis. The sensitivity, specificity, and positive predictive value of hepatic USG for findings that were indeterminate or suspicious for metastasis were 96% (95% CI, 80%-99%), 88% (95% CI, 83%-91%), and 45% (95% CI, 33%-59%), respectively. Specificity of the confirmatory scan was greater than that of hepatic USG (93% [95% CI, 89%-96%] vs 88% [95% CI, 83%-91%], respectively; P < .001). Only 4 of 30 patients (13%) with metastasis had abnormal findings on simultaneous liver function tests. A stepwise surveillance protocol based on serial hepatic USGs followed by confirmatory scans offers high likelihood of detecting asymptomatic metastases in patients with primary uveal melanoma.

CNS Manifestations in Orientia tsutsugamushi Disease (Scrub Typhus) in North India

To present the clinical, lab profile and outcome of a series of six children who had features of meningoencephalitis (median age of 10.5y) diagnosed as confirmed scrub typhus (ST) by using a lgM ELISA commercial kit (InBiOS International Inc. USA). This was a prospective observational study conducted at a tertiary care hospital, over a period of 7mo through April 2014. All the patients with undifferentiated febrile illness (aged 1-18y) with fever of 5-21d duration were evaluated. After thorough physical examination they were subjected to blood investigations such as complete blood count (CBC), blood culture, hepatic and kidney function tests, serum electrolytes, cerebrospinal fluid (CSF) analysis and IgM ELISA for scrub typhus, coagulogram and chest radiograph, wherever indicated. During this period, of the total 81 confirmed cases based on a positive scrub IgM ELISA and/or eschar, 6 (7.4%), had neurological involvement in the form of presence of neck stiffness, altered sensorium and/or seizures and the CSF findings were suggestive of meningoencephalitis and all had evidence of multiple organ dysfunction syndrome (MODS) needing intensive care. The CECT could be performed in four patients only showing evidence of effacement of sulci and evidence of brain edema. This communication highlights that variable central nervous system (CNS) involvement is not uncommon in patients with scrub typhus with high mortality. CSF and neuro-radiology findings are nonspecific as these are also observed in patients with aseptic meningitis or encephalitis. Early suspection and institution of appropriate therapy without delay will lead to substantial reduction in the morbidity and mortality.

Hepatoprotective Activity of Herbal Composition SAL, a Standardize Blend Comprised of Schisandra chinensis, Artemisia capillaris, and Aloe barbadensis.

Some botanicals have been reported to possess antioxidative activities acting as scavengers of free radicals rendering their usage in herbal medicine. Here we describe the potential use of “SAL,” a standardized blend comprised of three extracts from Schisandra chinensis, Artemisia capillaris, and Aloe barbadensis, in mitigating chemically induced acute liver toxicities. Acetaminophen and carbon tetrachloride induced acute liver toxicity models in mice were utilized. Hepatic functional tests from serum collected at T24 and hepatic glutathione and superoxide dismutases from liver homogenates were evaluated. Histopathology analysis and merit of blending 3 standardized extracts were also confirmed. Statistically significant and dose-correlated inhibitions in serum ALT ranging from 52.5% (p = 0.004) to 34.6% (p = 0.05) in the APAP and 46.3% (p < 0.001) to 29.9% (p = 0.02) in the CCl4 models were observed for SAL administered at doses of 400–250 mg/kg. Moreover, SAL resulted in up to 60.6% and 80.2% reductions in serums AST and bile acid, respectively. The composition replenished depleted hepatic glutathione in association with an increase of hepatic superoxide dismutase. Unexpected synergistic protection from liver damage was also observed. Therefore, the composition SAL could be potentially utilized as an effective hepatic-detoxification agent for the protection from liver damage.

Consumption of Buglossoides arvensis seed oil is safe and increases tissue long-chain n-3 fatty acid content more than flax seed oil - results of a phase I randomised clinical trial.

Enrichment of tissues with ≥20-carbon n-3 PUFA like EPA is associated with positive cardiovascular outcomes. Stearidonic acid (SDA; 18 : 4n-3) and α-linolenic acid (ALA; 18 : 3n-3) are plant-derived dietary n-3 PUFA; however, direct comparisons of their impact on tissue n-3 PUFA content are lacking. Ahiflower(®) oil extracted from Buglossoides arvensis seeds is the richest known non-genetically modified source of dietary SDA. To investigate the safety and efficacy of dietary Ahiflower oil, a parallel-group, randomised, double-blind, comparator-controlled phase I clinical trial was performed. Diets of healthy subjects (n 40) were supplemented for 28d with 9·1g/d of Ahiflower (46% ALA, 20% SDA) or flax seed oil (59% ALA). Blood and urine chemistries, blood lipid profiles, hepatic and renal function tests and haematology were measured as safety parameters. The fatty acid composition of fasting plasma, erythrocytes, polymorphonuclear cells and mononuclear cells were measured at baseline and after 14 and 28d of supplementation. No clinically significant changes in safety parameters were measured in either group. Tissue ALA and EPA content increased in both groups compared with baseline, but EPA accrual in plasma and in all cell types was greater in the Ahiflower group (time×treatment interactions, P≤0·01). Plasma and mononuclear cell eicosatetraenoic acid (20 : 4n-3) and docosapentaenoic acid (22 : 5n-3) content also increased significantly in the Ahiflower group compared with the flax group. In conclusion, the consumption of Ahiflower oil is safe and is more effective for the enrichment of tissues with 20- and 22-carbon n-3 PUFA than flax seed oil.

Safety of different acupuncture manipulations for posterior circulation ischemia with vertigo.

Acupuncture at Fengchi (GB20) in the posterior neck improves vertigo. However, subarachnoid hemorrhage and spinal epidural hematoma have been reported to occur after acupuncture in the posterior neck. Therefore, in the present study, we assessed the safety of acupuncture at Fengchi. Laboratory tests and adverse event reports were used to evaluate the safety of different acupuncture manipulations for the treatment of posterior circulation ischemia with vertigo. A total of 136 patients were randomly assigned to four groups. Verum acupuncture was conducted with different needle insertion directions (contralateral paropia or prominentia laryngea) and different needle twisting frequencies (60 or 120 times/minute) at Fengchi and matching acupoints (for example, Zhongwan [CV12], Qihai [CV6], Zusanli [ST36], and Fenglong [ST40]). The patients received 14 treatments over 3-4 weeks. Routine blood analysis, hepatic and renal function tests, urine and feces tests and electrocardiography were performed before the first treatment session and after the final session. Adverse events were recorded after every session. Of the 136 patients, 120 completed the study. There were no significant differences between pretreatment and posttreatment test results in any of the groups. Only five patients suffered from minor adverse events (needling pain, slight hematoma and transient chest tightness). No serious adverse events were found. Our results indicate that a 14-session course of needling at Fengchi is relatively safe for treating posterior circulation ischemia with vertigo.

Acute onset mania with cycling between excitement and stupor.

Byline: Mohapatra. Debadatta, Sahoo. Ashrumochan, Chittaranjan. Andrade Sir, Mania is commonly characterized by motor activation that can sometimes peak in extreme excitement and depression by retardation that can sometimes peak in a state of stupor. Paradoxically, stupor may (rarely) complicate mania; although this was recognized by Kraepelin over a century ago,[sup][1] down the decades, cases of manic stupor have seldom been described in literature.[sup][2],[3] We present herein two patients who experienced stupor associated with mania; our cases are interesting in that the onset of excitement and the switch to stupor was abrupt in both cases; one patient, additionally, showed cycling between excitement and stupor. Case Reports Case 1 A, 22-year-old farmer, had a 6-day history of irritable mood, loud and excessive talk, excessive and unnecessary spending, excessive working in the fields without experiencing fatigue, increase in appetite, and decrease in sleep. He boasted of divine powers and the ability to change the future. Aggressiveness developed, abruptly followed by reduced communication. By the 5[sup]th day, he stopped talking, stared mutely, refused food, and even neglected bowel and bladder needs. There was no history of head injury, fever, or any other past or present feature to suggest a medical origin of these symptoms. General medical examination and laboratory investigations, including hemogram, serum electrolytes, and hepatic and renal function tests, were all within normal limits. The patient was mute and immobile. He maintained eye contact without blinking. Other catatonic signs at different points in time included negativism, posturing, grimacing, verbigeration, rigidity, automatic obedience, and stereotypy. He required nasogastric feeding and urinary catheterization. The Bush–Francis (BF) Catatonia Rating Scale score was 22. The dominant clinical picture was one of stupor. Parenteral lorazepam at 8 mg/day for 3 days elicited no improvement. Thrice weekly, bilateral electroconvulsive therapy (ECT) was initiated. There was progressive improvement from the first ECT with resolution of catatonia by the third treatment; manic symptoms, however, reemerged. On inquiry, he reported that during the period of stupor, he was blissful, disinterested in worldly matters, and in close contact with God. He described experiences related to Hindu mythology. His Young Mania Rating Scale (YMRS) score was 31. Valproate and quetiapine were initiated, and ECT was continued to a total of six treatments. He was discharged in almost complete remission after a hospital stay of 16 days. Case 2 B, a 31-year-old peon, had a 5-day history of grandiosity with claims such as that he could become the Prime Minister and change the world. He was irritable, talked excessively, participated intensely in activities, and slept little. After 3 days of such behavior, there was an 18–20 h period of mutism, laughing without reason, and food refusal; manic symptoms subsequently reemerged in greater force. …

MULTIPLE HEPATIC ABSCESSES FROM A RUPTURED GALLBLADDER EMPYEMA - A CASE REPORT AND REVIEW OF THE LITERATURE

An unusual complication of gallbladder empyema is its rupture into the liver forming giant multiloculated pyogenic abscesses. This condition is rapidly fatal in diabetic and immunocompromised patients. We present a 79-year-old African American woman resident in New York City with a medical history of diabetes mellitus who presented at the ED with constitutional symptoms and right upper quadrant pain of a few days duration. She was tender and had a positive murphy’s sign on clinical examination coupled with tachycardia and a low-grade fever. Laboratory findings of leukocytosis, and metabolic acidosis, lactic academia and elevated ketones with moderately deranged hepatic function tests and negative tumor markers. Management consisted of broad spectrum antibiotics and an urgent open cholecystectomy and drainage of multiple multi-loculated hepatic abscesses. A repeat ultrasonogram showed a remnant collection which was drained by interventional radiology and drains left in-situ. She was discharged after four weeks of parenteral antibiotics with repeat sonogram showing complete resolution of hepatic abscess.

Combined liver mobilization and retraction: A novel technique to obtain the optimal surgical field during laparoscopic total gastrectomy.

During laparoscopic gastrectomy, it is important to establish a good operative field and ensure an adequate working space. The combined liver mobilization and retraction method is used to get a safe and optimal view. We retrospectively analyzed 32 consecutive patients who underwent laparoscopic total gastrectomy for gastric cancer. The patients were divided into two groups: the mobilization (+) group (n = 12) and the mobilization (-) group (n = 20). Hepatic function tests were performed in all patients. Mobilization provided a satisfactory view of the working field, especially the gastroesophageal junction and the angle of His during laparoscopic total gastrectomy, and no complications were observed during liver retraction. On postoperative hepatic function testing, there was no significant difference between the two groups on any day. Combined liver mobilization and retraction may be helpful in laparoscopic total gastrectomy.

Assessment of relation between neutrophil lympocyte, platelet lympocyte ratios and epicardial fat thickness in patients with ankylosing spondylitis.

To investigate whether there is a relation between neutrophillymphocyte (N/L) and platelet- lymphocyte (P/L) ratios and epicardial adipose tissue (EAT) thickness in patients with ankylosing spondylitis (AS). Thirty patients diagnosed with ankylosing spondylitis and 25 healthy people (controls) were included in the study. Age, gender, body mass index (BMI), height, hemogram, sedimentation, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, CRP, hepatic and renal function tests, lipid profile of the all patients were recorded. Data related to duration of the disease, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI) values of the cases in the patient group were obtained. A cardiologist measured EAT thickness by ECHO in both patient and control groups. In the patient group, mean BASDAI and BASFI scores were 2.48±2.21 and 1.5±2.07, respectively. Age, gender, BMI values did not show statistically significant difference between the patient and the control groups. N/L and P/L ratios did not change significantly in the patient group having higher EAT, BASFI values and taking anti-TNF compared to the control group. In patients with AS, EAT measurements, which are related to inflammatory response increase, can be used for monitoring of the risk of development of cardiac disease. We could not find the relation between EAT and N/L, P/L ratios in terms of evaluation of inflammatory response.

Cerium oxide nanoparticles reduce steatosis, portal hypertension and display anti-inflammatory properties in rats with liver fibrosis

Cerium oxide nanoparticles (CeO2NPs) have proven to behave as free radical scavengers and/or anti-inflammatory agents. The aim of the study was to determine whether CeO2NPs display hepatoprotective properties in experimental chronic liver disease. Systemic and hepatic effects of nanoparticles were assessed in CCl4-treated rats receiving CeO2NPs or vehicle twice weekly for two weeks and CCl4 treatment was continued for 8 additional weeks. Thereafter, mean arterial pressure and portal pressure (PP) were assessed and serum samples obtained to measure standard hepatic and renal function tests. Organ and subcellular distribution of NPs were assessed using mass spectrometry (ICP-MS) and transmission electron microscopy. Liver samples were obtained to evaluate steatosis, α-SMA expression, macrophage infiltration, apoptosis and mRNA expression of oxidative stress, inflammatory or vasoactive related genes. Most CeO2NPs were located in the liver and it reduced hepatic steatosis, ameliorated systemic inflammatory biomarkers and improved PP without affecting mean arterial pressure. In addition, a marked reduction in mRNA expression of inflammatory cytokines (TNFα, IL1β, COX-2, iNOS), ET-1 and messengers related to oxidative (Epx, Ncf1, Ncf2) or endoplasmic reticulum (Atf3, Hspa5) stress signaling pathways was observed in the liver of rats receiving CeO2NPs. This was associated with reduced macrophage infiltration and reduced abundance of caspase-3, α-SMA and inflammatory cytokines. CeO2NPs administration to CCl4-treated rats protects against chronic liver injury by reducing liver steatosis and portal hypertension and markedly attenuating the intensity of the inflammatory response, thereby suggesting that CeO2NPs may be of therapeutic value in chronic liver disease.

The First Case Report of Hepatitis B Virus (HBV) Reactivation in an Inactive Carrier of Chronic HBV After the Initiation of Treatment for Tuberculosis

Introduction: The HBV is a DNA virus that causes inflammation of the liver whether the infection is acute or chronic. After the initial phase of acute infection with HBV, resolution occurs in about 15% of patients, while chronic HBV infection is seen in about 85% of patients. Despite serological recovery, HBV DNA persists in the hepatocyte through integration into the host genome; therefore clinicians need to be aware of the risk of HBV reactivation in patients receiving chemotherapy and other immunosuppressive medications. Case Presentation: A 32-year-old female with a history of chronic HBV in the inactive carrier state and tuberculous lymphadenitis presented to the emergency department with generalized weakness, nausea, vomiting and jaundice for two weeks. She had recently been started on Ethambutol, Levofloxacin and Capreomycin by her private medical doctor for tuberculosis treatment. She denied use of any other medications or herbal supplements. She denied alcohol or illicit drug use. Her family history was unremarkable for liver disease. Physical examination was notable for scleral icterus but otherwise unremarkable. HIV test was negative. Her hepatic function tests returned as follows; aspartate transaminase 1397 U/L, alanine transaminase 1234 U/L, gamma-glutamyl transpeptidase 107 IU/L, total bilirubin 2.3 mg/dL, and direct bilirubin 0.6 mg/dL. Liver enzymes were normal four months prior to admission. Due to concern for drug-induced liver injury her anti-tuberculosis medications were discontinued. An abdominal ultrasound revealed mild increased liver echogenicity. Hepatitis C Virus antibody was non-reactive. HBsAg was reactive, anti-HBs was non-reactive, and anti-HBc was reactive and IgM anti-HBc nonreactive. HBV DNA level was greater than 1,000,000,000 IU/mLconsistent with a diagnosis of reactivation of HBV. The patient was started on tenofovir 300 mg PO daily. Ultimately the patient was discharged home. Follow up one month later revealed normalizing liver enzymes and an HBV DNA level of 471 IU/mL. Conclusion: Reactivation of HBV after starting chemotherapy or immunosuppressive medications is well described. Our case report is the first to describe HBV reactivation after starting anti-tuberculosis medications. Screening for HBV infection should be considered prior to initiating anti-tuberculosis therapy due to concern for reactivation of HBV, which can be severe and potentially fatal.

128 Utility of Hepatic Function Testing in Emergency Department Patients With Abdominal or Epigastric/Right Upper Quadrant Pain

128 Utility of Hepatic Function Testing in Emergency Department Patients With Abdominal or Epigastric/Right Upper Quadrant Pain

Prevalence of Metabolic Syndrome in Obese Prepubertal and Pubertal Children

Aim: Obesity associated with metabolic syndrome is characterized by glucose intolerance, insulin resistance, type 2 diabetes mellitus, dyslipidemia and other hormonal disorders in childhood. Unfortunately, if the preventive measures are not taken in time they become obese in the adult age. The prevalence of metabolic syndrome in the pediatric age group is still not well known in our country. The purpose of our study is to evaluate the prevalence of metabolic syndrome and other metabolic characteristics in the obese prepubertal and pubertal children. Material and methods : We studied 70 obese children and adolescents. Each child was subjected to detailed examination including anthropometric measures, blood testing (biochemistry, blood fasting glucose, renal and hepatic function tests, lipids, electrolytes, hormonal testing including free T3, free T4, TSH, thyroid autoantibodies, fasting insulin levels and oral glucose tolerance test). The criteria of metabolic syndrome were defined according to modified WHO criteria. Homeostasis model assessment of insulin resistance (HOMA-IR) parameters were used as index of insulin resistance. Results: Metabolic syndrome was found in 18.8% of cases. Metabolic syndrome was found in a significantly higher rate in the pubertal prepubertal group (P > 0.05). The data related with glucose homeostasis; fasting hyperinsulinemia, impaired glucose tolerance were 33.3% and 5.5% in the prepubertal group, where it was 64.7% and 23.5% in the pubertal group, respectively. Hypertension was observed in four pubertal cases (11.7%). Dyslipidemia were identified in 41.6% and 41.1% in prepubertal and pubertal groups, respectively, with no significant differences (P < 0.05). Conclusion: Metabolic syndrome prevalence especially abnormal glucose homoeostasis among the obese pediatric age group was quite high. We suggested that, early diagnosis, regularly follow-up and if needed, treatment will prevent beta-cell destruction and development of type 2 diabetes mellitus in these cases. Key words: Childhood obesity, obesity prevalence, metabolic syndrome, diabetes mellitus

Malignant Cerebral Venous Sinus Thrombosis in Polycythemia.

Malignant Cerebral Venous Sinus Thrombosis in Polycythemia.

Serum levels of ET-1, M30, and angiopoietins-1 and -2 in HELLP syndrome and preeclampsia compared to controls.

We aimed to compare the serum levels of ET-1, M30, and Angs-1 and -2 in patients with preeclampsia or HELLP syndrome, and normal controls. In this cross-sectional study of 74 pregnant women, serum levels of ET-1, M30, and Angs-1 and -2 were measured in preeclamptic patients with or without HELLP syndrome. 74 pregnant women; 37 had healthy pregnancies, 25 had preeclampsia (PE), and 12 had HELLP syndrome. The age, body mass index, gravidity, and parity of patients with normal pregnancy, PE, and HELLP syndrome were comparable (p>0.05). In HELLP syndrome, compared to healthy or preeclamptic pregnancies, platelet count was lower (p<0.05) and the values of hepatic function tests were higher (p<0.05). In HELLP syndrome, ET-1, M30, and Ang-2 were higher compared to healthy or preeclamptic pregnancies (p<0.05); however, they increased in preeclamptic pregnancies compared to healthy pregnancies though not significant (p>0.05). In PE or HELLP syndrome, Ang-1 was higher compared to a healthy pregnancy (p<0.05); however, in HELLP syndrome, it was also higher than in PE though not significant (p>0.05). We found no significant correlation among these biomarkers and hematological and biochemical parameters (p>0.05). For the diagnosis of HELLP syndrome, increased levels of ET-1, M30, and Angs-1 and -2 appear as promising biomarkers after determination of their standardized threshold levels after further studies. As an apoptosis-related biomarker, serum M30 level has a merit to be the most promising test for prediction or differential diagnosis of HELLP syndrome in PE patients.

Review of a challenging clinical issue: Intrahepatic cholestasis of pregnancy.

Intrahepatic cholestasis of pregnancy (ICP) is a reversible pregnancy-specific cholestatic condition characterized by pruritus, elevated liver enzymes, and increased serum bile acids. It commences usually in the late second or third trimester, and quickly resolves after delivery. The incidence is higher in South American and Scandinavian countries (9.2%-15.6% and 1.5%, respectively) than in Europe (0.1%-0.2%). The etiology is multifactorial where genetic, endocrine, and environmental factors interact. Maternal outcome is usually benign, whereas fetal complications such as preterm labor, meconium staining, fetal distress, and sudden intrauterine fetal demise not infrequently lead to considerable perinatal morbidity and mortality. Ursodeoxycholic acid is shown to be the most efficient therapeutic agent with proven safety and efficacy. Management of ICP consists of careful monitoring of maternal hepatic function tests and serum bile acid levels in addition to the assessment of fetal well-being and timely delivery after completion of fetal pulmonary maturity. This review focuses on the current concepts about ICP based on recent literature data and presents an update regarding the diagnosis and management of this challenging issue.