Higher ALT Research Articles

Predictors of Hepatic Fibrosis in Type 2 Diabetes Patients with Metabolic-Dysfunction-Associated Steatotic Liver Disease.

Approximately 25% of the world's population and more than 60% of patients with type 2 diabetes (T2D) have metabolic-dysfunction-associated steatotic liver disease (MASLD). The association between these pathologies is an important cause of morbidity and mortality in Brazil and worldwide due to the high frequency of advanced fibrosis and cirrhosis. The objective of this study was to determine the epidemiologic and clinical-laboratory profile of patients with T2D and MASLD treated at an endocrinology reference service in a state in northeastern Brazil, and to investigate the association of liver fibrosis with anthropometric and laboratory measurements. A cross-sectional study was performed in a specialized outpatient clinic with 240 patients evaluated from July 2022 to February 2024, using a questionnaire, physical examination, laboratory tests, and liver elastography with FibroScan®. Estimates showed that women (adjusted OR = 2.69, 95% CI = 1.35-5.35, p = 0.005), obesity (adjusted OR = 2.23, 95% CI = 1.22-4.07, p = 0.009), high GGT (adjusted OR = 3.78, 95% CI = 2.01-7.14, p < 0. 001), high AST (adjusted OR = 6.07, 95% CI = 2.27-16.2, p < 0.001), and high ALT (adjusted OR = 3.83, 95% CI = 1.80-8.11, p < 0.001) were associated with the risk of liver fibrosis even after adjusted analysis. The study findings suggested that female sex and BMI were associated with an increased risk of liver fibrosis, highlighting the importance of comprehensive evaluation of these patients. In addition, FIB-4 and MAF-5 provided a good estimate of liver fibrosis in our population and may serve as a useful tool in a public health setting with limited resources.

Effect of obesity and NAFLD on leukocyte telomere length and hTERT gene MNS16A VNTR variant

It is known that telomere length (TL) (evaluated with T/S ratio) is shortened in the presence of obesity. In this study, we aimed to investigate how obesity in adolescents and non-alcoholic liver disease (NAFLD) within the obese group affect TL and the clinical significance of the human telomerase reverse transcriptase (hTERT) gene MNS16A VNTR variant in terms of NAFLD. Adolescents with exogenous obesity and healthy controls (aged 10–19 years) who applied to our adolescent outpatient clinic between May-October 2023 were included in this study. We performed upper abdominal ultrasonography to investigate the presence of NAFLD in adolescents with obesity and divided into two groups: those without hepatosteatosis (obese NAFLD (-)) and those with hepatosteatosis (obese NAFLD (+)). We recorded body weight, height, waist circumference, and blood pressure measurements and measured the T/S ratio (telomere sequence copy number/gene single copy number) by the Quantitative Polymerase Chain Reaction method. The groups were compared using frequentist and Bayesian methods. Eighty-three obese adolescents [63 NAFLD(+) 20 NAFLD(-)] and 69 lean controls were included in the study. Pairwise comparisons revealed that T/S ratio was significantly lower in the obese NAFLD (-) group than the obese NAFLD (+) and the control group (p = 0.025, p = 0.007, respectively). T/S ratio was lower in the LL allele group than in the other alleles (p = 0.022) and slightly higher in the obese group with metabolic syndrome compared to the obese group without metabolic syndrome (p = 0.072). hTERT-MNS16A-VNTR gene variant LL allele had a negative correlation with T/S ratio among the obese adolescent group. Patients with LL alleles had higher ALT, GGT, HOMA-IR, and ALT/AST. Diastolic blood pressure had a significant correlation with the T/S ratio. The T/S ratio was shorter in the obese adolescent group compared to healthy ones but was higher in the NAFLD (+) obese compared to the NAFLD (-) obese. ALT level and ALT/AST ratio were higher, T/S ratio was lower in the hTERT MNS16A VNTR variant LL allele group among obese adolescents. In addition, there was a significant correlation between the T/S ratio and diastolic blood pressure in obese adolescents.

Comparison of NAFLD, MAFLD, and MASLD Prevalence and Clinical Characteristics in Asia Adults

The principal limitations of the termnon-alcoholic fatty liver disease (NAFLD) are the reliance on exclusionary confounder terms and the use of potentially stigmatizing language. Within three years, NAFLD went through two name changes, from NAFLD to metabolic-dysfunction-associated fatty liver disease (MAFLD) to metabolic dysfunction-associated steatotic liver disease (MASLD). However, there is no Asian consensus statement on the renaming of MASLD, and evidence onthe epidemiology and characteristics in the Asia population under different diagnostic criteria remainlimited. This study aimed to fill these gaps by analyzing the prevalence and characteristics of MASLD, NAFLD, and MAFLD in an Asian population. A retrospective, cross-sectional study was conducted in regional China with participants from the health management database in 2017-2022. Demographic and laboratory metabolic profile and body composition data were obtained. Hepatic steatosis were diagnosed by ultrasound. The likelihood of having fibrosis was assessed using the NAFLD fibrosis score (NFS). Recently proposed criteria for metabolic dysfunction-associated steatotic liver disease (MASLD) were applied. A total of 20,226 subjects were included for final analysis. 7465 (36.91%) participants were categorized as MASLD patients, 10,726 (53.03%) participants were MAFLD, and 7333 (36.26%) participants were NAFLD. Compared with MAFLD, body composition of MASLD and NAFLD patients were obviously different. MASLD patients were older, had a higher body mass index and percentage of male gender, and had a higher ALT, diastolic blood pressure, triglyceride, and waist circumference but lower High-Density Lipoprotein Cholesterol (HDL-C) than non-MASLD patients. Using binary regression analysis, we found for the first time that putative bone mass (OR=4.62, 95CI% 3.12-6.83) is associated with the risk of developing MASLD. The area under the receiver operating curve (AUC) for predicting cardiovascular outcomes (CV) was 0.644 for MAFLD and 0.701 for MASLD. MASLD (36.91%) prevalence was closed to NAFLD (36.26%) and lower than MAFLD (53.03%). Presumed bone mass might be the predictor of disease progression in MASLD patients. MASLD better identifies patients likely to have a higher risk of metabolic disorders or CV events.

7944 Elevated Serum Alkaline Phosphatase without other Abnormalities of Liver Associated Enzymes as an early Indicator of Glucose Intolerance: A Case Series

Abstract Disclosure: B.K. Bowens: None. C. Godar: None. D. LaChance: None. T.D. Hoang: None. M.K. Shakir: None. Glucose intolerance (GI) is defined as dysglycemia and includes impaired fasting glucose, impaired glucose tolerance, and prediabetes. Early detection of GI could lead to appropriate treatment and delay the progression to diabetes mellitus. The cases below detail two patients with elevated serum alkaline phosphatase (ALP) without other liver-associated enzyme abnormalities as an early indicator of GI. Case 1: A 54-year-old woman with a history of multinodular goiter status post thyroidectomy (2020), adrenal incidentaloma (2016), and asthma was incidentally found to have an elevated HbA1C (A1C) of 6.3% on screening labs in 2015. At that time, her ALP was 73 IU/L (ref 44−121). Her ALP levels slowly rose from 88 to 152 IU/L by September 2020. Work up did not reveal any etiological factors for the elevated ALP. One month later, HbA1C was found to be 7.6%. Metformin was initiated with improvement in A1C to 6.3% with an ALP of 130 IU/L. However, metformin was discontinued due to intolerance. In April 2023, her A1C was 9.3% with an ALP of 134 IU/L. A1C rose to 12.8% in Jun 2023 at which time she was started on insulin glargine, insulin aspart, sitagliptin, and was restarted on metformin. Her A1C decreased to 8.6% in August 2023 with normalization of ALP to 88 IU/L. Case 2: A 53-year-old woman with a history of hypertension, hyperlipidemia, obstructive sleep apnea, and non-ischemic cardiomyopathy in 2004 was found to have an elevated A1C of 5.8% on her screening labs in Jun 2019. Her ALP was notably in the high-normal range until Oct 2021 when it was found to be 138 IU/L. Her most recent A1C was 5.9% with an ALP of 142 IU/L. The patient was started on semaglutide (WegovyTM) briefly but was unable to tolerate the side effects. She was then started on metformin 500mg BID and dulaglutide with normalized ALP level. Discussion: Emerging evidence has shown that serum ALP activity is modestly increased in cardiometabolic diseases such as type 2 diabetes, dyslipidemia, hypertension, and peripheral arterial disease. These are increasingly being considered as inflammatory disorders and it has been shown that serum ALP level was positively and independently associated with metabolic syndrome both in men and women. It is possible that ALP could be an indicator of non-alcoholic fatty liver disease (NAFLD) which is associated with GI. Typically, NAFLD presents with higher ALT and GGT, however, occasionally isolated enzyme elevations or no elevated enzymes at all may occur. Conclusion: These cases suggest that an isolated elevation in ALP could be indicative of GI. Patients incidentally found to have an elevated ALP should be worked up further for possible evidence of GI. Early detection of GI could delay progression to diabetes and decrease morbidity. Presentation: 6/1/2024

Three consecutive cases of acute liver failure in young women due to acetaminophen overdose: insights into Japanese social issues and transplantation landscape.

Acetaminophen (APAP) is an over-the-counter (OTC) drug known worldwide for its safety and efficacy. However, in Japan, OTC drug overdose has become a prominent social problem in recent years due to stricter regulations for other drugs, especially among young people, and APAP is an increasing cause of acute liver injury due to overdose. This report describes three consecutive cases of acute liver failure in young women (22, 22 and 19years old) due to APAP overdose in December 2023. Despite severe liver injury, indicated by high ALT levels and coagulopathy, these cases recovered without requiring liver transplantation. This report discusses three cases of acute liver failure in young Japanese women following APAP overdose, reflecting a national increase in such cases due to increased misuse of OTC drugs and societal factors. Key findings include the need for early treatment with N-acetylcysteine (NAC) and the importance of mental health assessment in the management of overdose patients. The cases underscore the need for prompt team-based care to prevent serious outcomes and highlight the complexity of liver transplantation decisions in Japan, highlighting the need for comprehensive strategies to address the escalating problem of APAP overdose.

Diagnostic Performance of the Monocyte/High-Density Lipoprotein Cholesterol (HDL-C) Ratio for Pediatric Metabolic Associated Fatty Liver Disease in Children and Adolescents with Obesity

Background: The escalating prevalence of childhood obesity has rendered pediatric metabolic-associated fatty liver disease (MAFLD) one of the foremost health concerns. Objectives: This investigation aims to examine the relationship between MAFLD and the monocyte-to-high-density lipoprotein cholesterol ratio (MHR) in children and adolescents with obesity. Methods: In this retrospective study, we conducted a comparative analysis of MHR values for MAFLD and non-MAFLD cases in children and adolescents with obesity, aged 6 - 18, from 1 October, 2022 to 30 September 2023. To determine the prognostic value of MHR in relation to MAFLD, we implemented ROC analysis. Additionally, logistic regression analysis was utilized to examine the association between each variable and MAFLD. Results: A total of 211 children diagnosed with obesity (67 boys and 144 girls) were included in the study, comprising 121 MAFLD patients and 90 simple obesity controls. The monocyte/HDL-C ratio was significantly higher in the MAFLD group compared to the simple obesity group (0.56 ± 0.19 vs. 0.46 ± 0.14, P &lt; 0.001). There was a positive correlation between MHR and fasting insulin, HOMA-IR, TG/HDL-C, TyG, triglyceride levels, and the grade of hepatosteatosis (P = 0.011, r = 0.184; P = 0.029, r = 0.159; P &lt; 0.001, r = 0.374; P = 0.005, r = 0.203; P &lt; 0.001, r = 0.257; P &lt; 0.001, r = 0.272, respectively). The ROC curve analysis revealed that the cut-off value for MHR to predict MAFLD was 0.43 (× 109/mmol), with a sensitivity of 75.45% and a specificity of 46.34%. The area under the curve for MHR in distinguishing children with MAFLD from those without was 0.656 (P = 0.002). Logistic regression analysis indicated that male gender (OR: 3.825; P = 0.001), high ALT (OR: 1.035; P = 0.025), and high MHR (OR: 16.166; P = 0.025) had significant positive associations with the presence of MAFLD. Conclusions: We established a correlation between MHR and MAFLD in children and adolescents with obesity. High MHR was significantly related to the risk of MAFLD. The monocyte/HDL-C ratio, a noninvasive marker, may be used as an inflammatory biomarker in predicting MAFLD.

Development and validation of pFIB scores for exclusion of significant liver fibrosis in pediatric MASLD.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent pediatric liver disease, yet accurate risk scores for referral of children/adolescents with suspected clinically significant liver fibrosis are currently lacking. Clinical and biochemical variables were collected in a prospective cohort of 327 children and adolescents with severe obesity, in whom liver fibrosis was evaluated by transient elastography. Logistic regression was performed to establish continuous (pFIB-c) and simplified (pFIB-6) diagnostic scores that accurately exclude significant (≥F2) fibrosis. Performance for each was compared to established non-invasive fibrosis scores. These scores were validated in elastography (n=504) and multiple biopsy-proven MASLD (n=261) cohorts. Patient sex, ethnicity, weight z-score, HOMA-IR index, ALT, and presence of hypertension were included in the scores. The pFIB-c and pFIB-6 exhibited good discriminatory capacity (c-statistic of 0.839 and 0.826), outperforming existing indices. Negative predictive values (NPV) were >90% for both scores in the derivation and elastography validation cohorts. Performance in the histological cohorts varied (AUROCs for the pFIB-c between 0.710 and 0.770), as the scores were less accurate when applied to populations in tertiary referral centers characterized by a high prevalence of significant fibrosis and high ALT levels. Analyzing several cohorts totaling approximately 1100 children and adolescents, we developed novel risk scores incorporating readily available clinical variables. In accordance with the aim of excluding pediatric MASLD-associated fibrosis, the scores performed better in non-selected cohorts of children and adolescents living with obesity than in patients referred to tertiary liver units.

Final results of a phase II study of lenalidomide-elotuzumab as maintenance therapy post-autologous stem cell transplant (AuSCT) in patients (Pts) with multiple myeloma (MM).

7509 Background: Randomized controlled trials oflenalidomide (LEN) maintenance after AuSCT have shown a progression free survival (PFS) benefit in pts with MM. We report final results of a phase 2 trial evaluating the efficacy and safety of adding elotuzumab (ELO) to LEN as maintenance therapy post- AuSCT. Methods: On 28-day cycles, patients received ELO 10mg/kg iv weekly for cycles 1-2.Between 4/15/2015-1/27/2016, 27 pts received ELO 10mg/kg q2 weeks for cycles 3-6 and 20mg/kg monthly for cycles 7+. From 1/28/2016 forward, 74 pts received ELO 20 mg/kg monthly from cycle 3+. LEN was dosed at 10 mg/day for cycles 1-3 and increased to 15 mg/day at physician discretion starting with cycle 4 in the absence of non-hematologic (HEME) toxicity &gt; grade 1, ANC &lt; 1000/mL and platelet count &lt; 100K/ml. For the 1st 8 weeks, pts &lt;75 yrs received 28 mg of dexamethasone (DEX) 3-24 hours pre-infusion and pts ≥75yrs received 8 mg; pts received 4-10 mg iv DEX pre-infusion for all cycles. Zoster and thromboembolic prophylaxis were prescribed as per standard recommendations. The primary endpoint was PFS, defined as time from AuSCT to progressive disease (PD) or death (whichever occurred first), or censored at last contact date. Secondary objectives were best response, overall survival (OS), incidence of second primary malignancies (SPMs) and adverse event (AE) profile. Enrollment was completed on 6/5/2019. Eligible pts received ≤2 induction lines of therapy (LOT) and were 60-210 days post-AuSCT. Results: Pts (n=100) were treated for a median of 40 cycles (2-109). With a median follow up of 74.3 mos, 78% of pts (n=79) remain alive. Median PFS was 75.4 months. Median OS has not been reached; 5-year OS rate was 86.7%. At study entry, rate of ≥VGPR was 77.3% and ≥CR was 37.7%. On study, this improved to 91.1% ≥VGPR and 69.3% ≥CR. Of pts in ≥VGPR and tested for minimal residual disease (10-5 sensitivity by flow cytometry), 37/44 were negative. High-risk cytogenetics (n=44; p&lt;0.0001), International Staging System (ISS) Stage III (n=10/95, p=0.049) and Revised-ISS Stage III (n = 3/89; p= 0.026) predicted shorter median PFS (39.2, 53.2 and 32.2 mos. respectively). Median PFS on next LOT was 21.8 mos. Grade 3-4 HEME AEs (n=102) were: neutropenia 35%, thrombocytopenia 7%, and anemia 10% . Grade 3-4 non-HEME AEs in &gt;3 pts were: respiratory infections 23%, hypophosphatemia 19%, diarrhea 13% , fatigue 11% , peripheral neuropathy 7%, other infections 6%, myalgias 4%, and high ALT 4%. Incidence of HEME, non-invasive and solid tumor SPMs was 8%, 8% and 7%. Median time to HEME SPM diagnosis was 45.5 mos. Conclusions: ELO-LEN is a well-tolerated maintenance therapy on which 53% of patients had improved quality of response. Median PFS and 5-year OS compare favorably with results from CALGB 100104 and IFM 2005-02 trials of lenalidomide alone. SPM incidence is similar to rates reported in these trials. Clinical trial information: NCT02420860 .

Medium-short chain fatty acids cannot spare the essential fatty acids of low marine diets in golden pompano (Trachinotus ovatus)

Based on the essential fatty acids (EFA) precision nutrition, a blend oil (BO) of fish oil and terrestrial oils was developed, and applied successfully to the low marine diets of golden pompano (Trachinotus ovatus). To evaluate whether medium- and short-chain fatty acids (MCFA and SCFA), efficient energy supplements for animals, can spare the dietary EFA, four iso-proteic (48%) and iso-lipidic (11%) low fishmeal (FM) diets (D1-D4, contained 6% FM) were formulated and fed T. ovatus juveniles (initial weight ∼8.50 g) for 9 weeks in sea cages. Control diets (D1) contained 8% BO, while the BO of diets D2-D4 were replaced 50% with coconut oil, coconut oil + sodium butyrate, and coconut oil + n-3 LC-PUFA enriched oil, respectively. The results showed that compared to the D1 group, the growth performance of D2 and D3 were significantly lower, while a comparable growth was detected in the D4 group. The muscle and hepatic n-3 PUFA levels in the D2 and D3 groups were significantly low, and these fatty acid contents were modified in the D4 group. Meanwhile, the muscle textural firmness of the D2-D4 groups was decreased. Regarding the health index of fish, compared to the D1 group, high serum triglyceride (TG) contents and low HDL/LDL ratio were detected in the D2-D4 groups, and high ACP, AST, and ALT activities were observed in these groups. Meanwhile, high HSI and low hepatic enzymatic activities of CAT and ALT were measured in the D2-D3 groups. Additionally, the mRNA levels of hepatic fatty acid synthesis-related genes (fas, acc, and pparγ) were significantly increased in D2-D4 groups, and the expression levels of lipid catabolism genes (cpt-1 and lpl) showed an upward trend. Moreover, the D2 group exhibited the lowest intestinal wall thickness, the mRNA levels of intestine anti-inflammatory cytokines (il-10) were up-regulated in the D2-D4 groups, and the highest mRNA levels of pro-inflammatory cytokines (il-8) were detected in the D2 group. In conclusion, the EFA deficiency leads to a decline in the growth and muscle quality of T. ovatus fed low marine diets, which cannot be mitigated by the addition of medium-short chain fatty acids. The results indicated that MCFA and SCFA cannot spare the EFA of low marine diets in T. ovatus.

Association Between Insulin Resistance Indices and Liver Function Parameters Among Women With Polycystic Ovary Syndrome.

This study aimed to investigate whether polycystic ovary syndrome (PCOS) status changes the association between insulin resistance (IR) indices and liver function parameters among women. This is a cross-sectional, population-based study. We selected 1101 subjects aged ≥20 years from participants of Tehran Lipid and Glucose Study (TLGS). All of them had known the status of PCOS, and all variables were related to the IR indices and liver function parameters. The main outcome measures were TG/HDL-C and triglyceride-glucose (TyG) and liver function parameters (hepatic steatosis index [HSI], alanine transaminase [ALT] and aspartate transaminase [AST]). In the present study, there was no significant difference between the PCOS and the non-PCOS regarding the presence of liver function abnormalities. A model adjusted by age and BMI showed that the upper tertile of TyG index was positively associated with high AST (OR = 3.04 [95% CI: 1.20-7.68], p < 0.05), high ALT (4.76 [3.07-7.36], p < 0.05) and high HSI (8.44 [1.82-39.17], p < 0.05). Although the history of diabetes had a positive impact on elevated AST (1.66 [1.15, 2.40], p < 0.05), the third tertile of TG/HDL-C was associated with increased odds of elevated ALT (3.35 [2.21-5.06]) and HSI (6.55 [1.17-36.46]), whereas the second tertile of TG/HDL-C (OR = 2.65, CI 95%: 1.74-4.03) was also positively associated with elevated ALT. PCOS had no significant association with elevated liver function tests. The highest tertile of TyG index and the TG/HDL-C ratio as a surrogate of IR might play a role in detecting abnormalities of liver function parameters among women. However, PCOS status cannot change the association between IR and liver dysfunction.

Clinical Management practice and Therapeutic Outcomes of Chronic Liver Disease patients in the Conflicted area of North Ethiopia

Background: In the 21st century, low- and middle income, war prone and drought-prone areas in developing nations have seen a fast rise in the prevalence of chronic liver disease (CLD). An estimated 240 million people worldwide are infected with HIV, and 780,000 deaths are attributed to it each year, according to the World Health Organization (WHO). Objective: We want to assess the efficacy of in-hospital care for CLD patients by verifying and evaluating current management practices. Method: A retrospective descriptive study of patients with chronic liver disease who were followed up on at Debre Berhan Hospital between July 2018 and January 2021 was conducted. Results: Out of a total of 209 patients tested, 127 (or 60.74%) were males aged 41.44±12.89 of years. Ascites complications were presented in over 44% of cases. Using the laboratory data, 65 patients (31.10%) and 71 patients (33.97%) were found to have abnormally high AST and ALT values on LFTs testing. AUROC analysis was carried out with a 95% CI for Child-Pugh of 0.61 (0.53-0.75, P=0.14), MELD 0.75 (0.63-0.72, P=0.26), and ALBI 0.53 (0.31-0.54, P=0.29). Conclusion: Based on the predictive data, 87 (41.63%) patients were successfully treated and released, whereas 57(27.27%) were recommended for further care, and 47 died due to co-morbid conditions. Although, the study period coincides with the COVID-19 pandemic, more analysis of the obtained data is necessary.

The biochemical effect correlated with pulmonary dysfunction and complications in obese patients

Objective: Obesity, an epidemic metabolic disorder, is associated with various biochemical, inflammatory, oxidative and immunological pathways. We aimed to investigate the biochemical effect correlated with pulmonary dysfunction and complications in overweight and obese patients. Material and Methods: We aimed to evaluate retrospectively the effect of biochemical parameters on pulmonary dysfunction and complications in 79 overweight and obese patients. The correlative effect of biochemical values, including CRP, and spirometric measurements, such as forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1), on pulmonary dysfunction and complications in 79 overweight and obese patients seen in the outpatient clinic were evaluated. Body mass index (BMI), FEV1 and FVC, and total biochemistry values, including creatinine, AST, ALT and CRP values were correlated among each other. Results: Low FVC levels, leukocytosis, high AST and ALT levels, and comorbidities of obesity are significantly associated with high BMI values by univariate analysis in these patients. Higher AST levels are significantly correlated with higher leucocyte counts, and both AST and ALT levels are significantly correlated with platelet counts. Conclusion: We investigated the effect of biochemical parameters on pulmonary dysfunction and complications in obese patients. Obesity can be helpful to categorize high-risk patients with low FVC levels in the context of respiratory diseases and high AST and ALT levels for other comorbidities as steatohepatitis, diabetes mellitus and coronary artery disease. This study sheds light on future research on obese patients for prognosis of these diseases, because of their biochemical profile correlation with pulmonary dysfunction and complications.

High normal alanine aminotransferase is an indicator for better response to antiviral therapy in chronic hepatitis B.

Evidence shows people living with CHB even with a normal ALT (40U/L as threshold) suffer histological disease and there is still little research to evaluate the potential benefit of antiviral benefits in them. We retrospectively examined 1352 patients who underwent liver biopsy from 2017 to 2021 and then obtained their 1-year follow-up data to analyze. ALT levels were categorized into high and low, with thresholds set at >29 for males and >15 for females through Youden's Index. The high normal ALT group showed significant histological disease at baseline (56.43% vs 43.82%, p< 0.001), and better HBV DNA clearance from treatment using PSM (p=0.005). Similar results were obtained using 2016 AASLD high normals (male >30, female >19). Further multivariate logistic analysis showed that high normal ALT (both criterias) was an independent predictor of treatment (OR 1.993, 95% CI 1.115-3.560, p=0.020; OR 2.000, 95% CI 1.055-3.793, p=0.034) Both of the models had higher AUC compared with current scoring system, and there was no obvious difference between the two models (AUC:0.8840 vs 0.8835). Male >30 or female >19 and Male >29 or female>15 are suggested to be better thresholds for normal ALT. Having a high normal ALT in CHB provides a potential benefit in antiviral therapy.

Assessment of the Relationship Between Liver Enzymes and Cardiovascular Disease: A Study in Bangladeshi Adults.

Elevated liver enzyme levels are suggested to be associated with an increased risk of cardiovascular disease (CVD). However, few studies have explored the relationship between liver enzymes and myocardial infarction (MI). This study aimed to evaluate the potential association of elevated liver enzymes with MI within a population group in Bangladesh. In this cross-sectional study, 348 participants were enrolled, 189 with MI in the CVD group and 159 in the control group. Serum levels of liver enzymes (AST, ALT and GGT) and other biochemical parameters were measured using standard methods. Multivariate logistic regression models were applied to determine the associations between elevated liver enzymes and CVD. In the CVD group, 51.6%, 30.9% and 67.7% of individuals had elevated serum AST, ALT and GGT levels, respectively. On the contrary, the control group had 17.0%, 15.1% and 35.2% of individuals with high serum AST, ALT and GGT levels, respectively. Overall, 71.8% of the subjects in the CVD group and 44.7% of the subjects in the control group had at least one or more elevated liver enzymes (p < 0.001). The mean level of all three liver enzymes was significantly higher in the CVD group than in the control group (p < 0.001). In both the CVD and control groups, males had higher levels of liver enzymes than females. In the regression models, the serum levels of AST, ALT and GGT showed a positive and independent association with the prevalence of CVD (p < 0.001). However, GGT showed the strongest association among the three enzymes. This study shows a high prevalence of liver enzyme abnormalities in individuals with CVD. Serum levels of AST, ALT and GGT were independently associated with the prevalence of CVD. This suggests that measuring liver enzyme levels could be a useful marker in predicting CVD at an early stage.

Effect of Concurrent Metabolic Dysfunction-Associated Steatotic Liver Disease on Serial Non-invasive Fibrosis Markers in Chronic Hepatitis B.

Concurrent hepatic steatosis has diverse effects on chronic hepatitis B (CHB), however the combined effects of metabolic dysfunction-associated steatotic liver disease (MASLD) and CHB on liver fibrosis progression remains unclear. The primary aim of this study was to utilize serial fibrosis measurements to compare the dynamic change in fibrosis in CHB patients with/without concurrent MASLD. The secondary aim was to investigate factors associated with steatosis development and regression in CHB patients. This was a retrospective cohort study of all non-cirrhotic CHB patients identified from 1/1/2011 to 31/12/2016. Hepatic steatosis was diagnosed by ultrasound. Fibrosis markers included liver stiffness (LSM) by transient elastography, APRI and FIB-4. General linear mixed effects modelling was used to fit polynomial and linear estimates. Of 810 CHB patients (n = 2,373 LSM measurements; median age 44.4y; 48% male; 24% HBeAg positive), 14% had concurrent MASLD. LSM was higher at baseline but decreased in MASLD patients over time, while LSM remained stable in non-MASLD patients, such that all patients had similar LSM beyond 4-5 years. MASLD patients had lower APRI compared to non-MASLD patients, which was predominately due to a higher platelet count and higher ALT over time. There was substantial discordance between LSM, APRI and FIB-4. Baseline BMI was the only factor that predicted steatosis development and regression. We found no evidence of an association between concurrent MASLD and fibrosis progression amongst CHB patients without baseline advanced liver disease. APRI and FIB-4 may have reduced accuracy in MASLD patients.

Diagnostic precision of Truenat® technique and co-relation of ALT levels with HBV-DNA viral load among HBsAg positive patients at a tertiary care hospital in Eastern Uttar Pradesh.

In India, it is estimated that there are 40 million people suffering from Hepatitis B virus (HBV). Quantification of the viral burden is an important laboratory tool in the management. However, widespread use of different HBV-DNA assays is still affected by the high cost and variable diagnostic precision. The present study was conducted to evaluate the diagnostic precision and co-relation of ALT levels with HBV-DNA by Truenat®-PCR. In this prospective cross-sectional study a total of 567 serums were collected from patients by rapid HBsAg, and processed for liver function tests (LFT). The viral HBV-DNA amplification detection was carried out through by Truenat®-PCR test. Out of 567 samples, 452 samples were found to be positive by both rapid and Truenat®-PCR and 106 were negative for HBV-DNA followed by 9 invalid. High ALT level found in 73% of positive patients who had HBV-DNA level (>100000 copies/ml) which is significantly higher in 447 patients as compared to those have below ≤100000 copies/ml. Truenat®-PCR technique is a highly sensitive and can be performed with low resources for effective control of HBV infection. Evaluation of HBV-DNA levels and serum ALT levels showed a significant proportion of patient harbored ongoing viral replication and disease progression.

Assessment of Clinico-physiological and Haemato-biochemical Profiles in Hampshire Crossed Pigs

This study investigated clinico-physiological and haemato-biochemical parameters in 18 healthy Hampshire-crossed pigs, classified into three age groups: Group-I (grower), Group-II (finisher), and Group-III (pregnant). Carried out at the 30 Sow Teaching Unit, the Departments of Livestock Production and Management and Veterinary Biochemistry, College of Veterinary Science, Assam Agricultural University, Khanapara, the study aimed to discern age-related variations in pig health. Clinico-physiological assessments encompassed body temperature, heart rate, pulse rate, respiration rate, mucous membrane appearance, feeding behavior, and pen-mate behavior. Group-I exhibited higher clinico-physiological values, with significant variations in the respiration rate (p&lt;0.05) and highly significant variations in heart rate and pulse rate (p&lt;0.01) compared to Groups II and III. The haematological parameters, including hemoglobin, PCV, TLC, and TEC, were evaluated. Group-II exhibited higher hemoglobin and total erythrocyte count, while Group-I had a higher packed cell volume. Total leucocyte count variation was non-significant, but packed cell volume significantly varied (p&lt;0.05), and hemoglobin and total erythrocyte count highly significantly varied (p&lt;0.01). Biochemically, Group-I demonstrated elevated markers; Group-II had higher ALT; and Group-III exhibited increased total protein, BUN, and creatinine levels. While blood glucose, total protein, and AST showed non-significant variations, ALT, creatinine, and cortisol exhibited significant differences (p&lt;0.05), and ALP, LDH, and BUN displayed highly significant variations (p&lt;0.01). This study provides comprehensive insights into age-associated physiological, haematological and biochemical variations in pigs, contributing valuable information for effective pig health management practices.

The experience of using a mineral chelate additive for growing juveniles of the African sharptooth catfish (Clarias Gariepinus) in a recirculating aquaculture system.

Growing fish in a recirculating aquaculture system (RAS) involves various stress factors that directly affect their physiological condition. This study aimed to investigate the effect of a chelated organic-mineral additive including Fe, Mn, Cu, Zn, Co, Se and I; on the rearing performance of juvenilecatfish (Clariasgariepinus) under RAS conditions. Four groups of fish (n=50) were formed: a control group (receiving standard feed) and three experimental groups (receiving standard feed with biogenic elements chelate compounds in different concentrations). At the end of the experiment (30 days), the physiological condition of the fish was evaluated by the growth rate, internal organs condition, blood serum biochemical indices and histological examination of the middle intestine. The survival rate of fish in the experimental groups was 96-98%. According to the results, the absolute increase was 14,30% in group III, 11,13% in group II and 6,71% in group I, compared to the control. However, the use of chelated compounds in high concentrations can cause necrosis and erosion of the apical part of the villi (groups II and III). Blood biochemical analysis of fish (group II and III) receiving medium and high concentrations of chelated compounds showed high ALT activity, which was 23,02% (p<0,05) and 45,19% (p<0,05) higher compared to control, respectively. Mineral-chelate compounds, of the studied composition, at a concentration of 0,5 g/kg positively affect the histological structure of the midgut of Clarias gariepinus. This dosage of the investigated feed additive can be recommended for the practical application of rearing Clariasgariepinus in closed water installations.

Non-Invasive Prediction Scores for Hepatitis B Virus- and Hepatitis D Virus-Infected Patients-A Cohort from the North-Eastern Part of Romania.

Approximately 62-72 million people are infected worldwide with HDV. Patients with chronic hepatitis D (CHD) have a higher risk of developing cirrhosis or hepatocellular carcinoma (HCC) and an increased mortality rate compared to those with chronic hepatitis B (CHB). The stage of liver fibrosis or the risk of developing HCC can also be estimated by non-invasive scores, which are cost effective, easier to apply, and reproducible. In this study, we aimed to evaluate the predictive value of four non-invasive scores (FIB-4, APRI, AST/ALT ratio, and aMAP) in assessing severe fibrosis/cirrhosis and the presence of HCC in patients with HBV/HDV superinfection, as compared with HBV mono-infection. Our 8-year retrospective analysis revealed that HDV-infected patients had a 2-3 times higher risk of developing cirrhosis and HCC than HBV-mono-infected subjects. High AST and ALT baseline levels qualified as independent predictors for cirrhosis development in both groups. The following fibrosis scores, FIB-4, APRI score, and AAR, were significantly increased when cirrhosis was present at baseline and showed a good prediction for developing cirrhosis in the CHD group. The aMAP score, a risk predictor for HCC, showed significantly higher values in patients with HCC in both groups. Nonetheless, non-invasive scores should always be considered for monitoring patients with CHB and CHD, but only when associated with other diagnosis methods.

Biological effects of molybdenum(IV) sulfide nanoparticles and microparticles in the rat after repeated intratracheal administration.

In this study, molybdenum(IV) sulfide (MoS2 ) nanoparticles (97 ± 32 nm) and microparticles (1.92 ± 0.64 μm) stabilized with poly (vinylpolypyrrolidone) (PVP) were administered intratracheally to male and female rats (dose of 1.5 or 5mg/kg bw), every 14 days for 90 days (seven administrations in total). Blood parameters were assessed during and at the end of the study (hematology, biochemistry including glucose, albumins, uric acid, urea, high density lipoprotein HDL, total cholesterol, triglycerides, aspartate transaminase, and alanine transaminase ALT). Bronchoalveolar lavage fluid (BALF) analyses included cell viability, biochemistry (total protein concentration, lactate dehydrogenase, and glutathione peroxidase activity), and cytokine levels (tumor necrosis factor α, TNF-α, macrophage inflammatory protein 2-alpha, MIP-2, and cytokine-induced neutrophil chemoattractant-2, CINC-2). Tissues were subjected to routine histopathological and electron microscopy (STEM) examinations. No overt signs of chronic toxicity were observed. Differential cell counts in BALF revealed no significant differences between the animal groups. An increase in MIP-2 and a decrease in TNF-α were observed in BALF in the exposed males. The histopathological changes in the lung evaluated according to a developed classification system (based on severity of inflammation, range 0-4, with 4 indicating the most severe changes) showed average histopathological score of 1.33 for animals exposed to nanoparticles and microparticles at the lower dose, 1.72 after exposure to nanoparticles at the higher dose, and 2.83 for animals exposed to microparticles at the higher dose. In summary, it was shown that nanosized and microsized MoS2 can trigger dose-dependent inflammatory reactions in the lungs of rats after multiple intratracheal instillation irrespective of the animal sex. Some evidence indicates a higher lung pro-inflammatory potential of the microform.