Higher AST Research Articles

P-20 METABOLIC ASSOCIATED FATTY LIVER DISEASE: FIBROSIS AND SARCOPENIA FREQUENCIES

Metabolic fatty liver (MAFLD) is a global health problem with a prevalence of about 25%. It consists in a multissystemic disease correlated with many others comorbidities. Progressive disease or steatohepatitis is associated with worst outcomes, more inflammation and fibrosis. Liver fibrosis stratifies patients with more propensity for cardiovascular deaths and cirrhosis. Nowadays, elastography is able to detect safely fibrosis. Risk factors identification which are associate with progressive disease and cirrhosis complications allow adequate treatment for MAFLD. Estimate and evaluate liver fibrosis and sarcopenia in MAFLD present in high risk patients – obesity, metabolic syndrome and diabetes 2 type diseases. Identification of risk factors for progressive disease. All patients enrolled were submitted to clinical, antropometric assessment and blood tests. The non-invasive assessment of MAFLD and fibrosis stage was performed by ultrasound, FLI-score and elastography. Sarcopenia was evaluated by Dual energy X-ray absorptiometry (DXA) – Baungarten index- and by bioimpedancy. Numerical variables were analyzed by Mann-whitney and Anova tests. Categorical variables were analysed by Fischer´s exact test. 42 patients were included until now, 87% women e 13% men; Median age was 66 (52-61) years. Three patients did not had steatosis(n=26). Eight participants (31%) had fibrosis > = 2. One patient was classified as sarcopenic, Median IMC was 31,8 Kg/m 2 (22,8-44); Coefficient attenuation parameter (CAP), ferritin and D vitamin were not different between the fibrosis and non fibrosis groups. Fibrosis was associated with higher AST, p value of 0,04; ALT and fibrosis was not correlated, p value of 0,07. All considerations must be taken with caution because of the small group of patients.The steatosis high risk study population: metabolic syndrome, obesity and diabetes type 2 patients had a higher fibrosis frequency than in general population, 31%, and no correlation with sarcopenia in this small population. The AST level was correlated with fibrosis in steatosis group patients.

Prevalence of fatty liver disease and its associated factors among Jordanian patients with type 2 diabetes mellitus: A cross-sectional study

BackgroundDiabetes mellitus (DM) is a well-known risk factor for Non-alcoholic fatty liver disease (NAFLD). Patients with type 2 DM (T2DM) who have NAFLD are at a higher risk of developing advanced stages of liver disease, including fibrosis, cirrhosis, and hepatocellular carcinoma compared to non-diabetic patients. This study aimed to estimate the prevalence of NAFLD among patients with T2DM, using hepatic ultrasonographic changes combined with derangement of hepatic transaminases level. Materials and methodsThis cross-sectional study was conducted at the National Center for Diabetes, Endocrinology and Genetics (NCDEG) in Amman, Jordan. A total of 408 patients with T2DM and 90 non-diabetic subjects were included in this study. Body mass index (BMI), waist circumference, glycosylated hemoglobin (HbA1c), lipid parameters and abdominal ultrasonography were measured. ResultsUsing the ultrasonographic criteria for the diagnosis of NAFLD, the prevalence of NAFLD was 80.4 % and 53.3 % among diabetic and non-diabetic participants, respectively. Among the diabetic participants, 25 %, 40.4 %, and 15 % had mild, moderate, and severe grades of steatosis, respectively. On the other hand, 24.4 %, 21.1 %, and 7.8 % of the non-diabetic participants had mild, moderate, and severe grades of steatosis, respectively. Diabetic patients between 25 and 45 years of age, patients with overweight or obesity, patients with increased waist circumference were significantly at higher risk of having NAFLD. High TG, lower HDL, elevated AST and ALT, and using sulfonylureas and metformin versus using metformin only were significantly associated with increased odds of having NAFLD. ConclusionsNAFLD is highly prevalent among patients with T2DM. Overweight or obesity, abnormal cholesterol levels and treatment with sulfonylureas were significantly associated with NAFLD.

Presence of fatty liver disease leads to unusual rise of liver enzymes in patients with common bile duct colic

This study compares liver enzymes, inflammatory markers and bilirubin levels in patients with and without fatty liver disease (FLD) presenting with common bile duct (CBD) obstruction. CBD colic was diagnosed based on clinical, radiological and biochemical criterion. Presence of FLD was diagnosed by ultra sound scan and the macroscopic appearance of liver during surgery. Liver enzymes, inflammatory markers and bilirubin levels were prospectively assessed and compared between the two groups. Out of 42, there were 22 (52.3%) patients with FLD. Median body mass index was 26.9 (24.1-30.8) in fatty liver group compared to 25.7 (23.5-26.2) in others. Individuals with FLD showed high aspartate transaminase (558.5 vs. 247.0, p = 0.005), alanine trasaminase (467 vs. 228.5, p = 0.005) and bilirubin (3.8 vs. 2.2, p = 0.015) levels compared to those without FLD. According to multiple linear regression models, high AST and ALT levels showed significant associations with FLD after adjusting for age, gender, body mass index, amylase and C reactive protein levels. The median enzyme level at two weeks did not show a difference among patients with and without FLD. Presence of FLD causes unusual rise of AST and ALT levels in patients with CBD stones. This rise is transient.

CLINICAL PROFILE AND INCIDENCE OF INFECTION IN SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS AT MEDICAL INPATIENT INSTALLATION, DEPARTMENT OF INTERNAL MEDICINE, DR. SOETOMO GENERAL ACADEMIC HOSPITAL, SURABAYA, INDONESIA IN 2016

Background: Systemic Lupus Erythematosus (SLE) is an autoimmune disease with unknown aetiology. SLE attacks multiple organs with diverse clinical manifestations. Most patients get immunosuppressant therapy that suppresses immune system, causing the body to be susceptible to infection. Objective: to describe clinical manifestations, laboratory abnormalities, and incidence of infections in SLE patients hospitalized at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia in 2016. Materials and Methods: Cross-sectional descriptive observational study used medical records of 273 SLE patients hospitalized at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia in 2016. Results: Clinical manifestations found in this study were malar rash 7.33%, discoid rash 2.93%, oral ulcer 8.42%, allopecia 16.48%, arthritis 26.74%, serositis 13.19%, kidney 35.9%, neurology 24.91%, anemia 73.71%, leucopenia 32.67%, lymphopenia 76.89%, and thrombocytopenia 33.86%. Laboratory abnormalities found in this study were hematology (anemia 73.71%, leucopenia 32.67%, lymphopenia 76.89%, thrombocytopenia 33.86%), kidney function (high serum creatinine levels 39.66%, high BUN levels 41.2%, hypoalbuminemia 62.6%), urine (proteinuria 68.21%, hematuria 51.79%) and liver function (high ALT levels 36.65%, high AST levels 29.86%). Infection occurred in 33.7% patients. The most common infections were pneumonia (70.65%), urinary tract infections (51.09%), and sepsis (35.87%). Conclusion: The most common clinical manifestations experienced by SLE patients are hematological disorder, kidney disorder, and arthritis. Prominent laboratory abnormalities are anemia, lymphopenia, and proteinuria. Infection is a common complication, with the most common types pneumonia, urinary tract infection, and sepsis.

Substance Use, Highly Active Antiretroviral Therapy, and Liver Enzymes: Evidence From a Cross-Sectional Study of HIV-Infected Adult Patients Without Comorbidities on HAART in the University of Port Harcourt Teaching Hospital.

This study applied a structural equation modeling (SEM) to evaluate the role of substance use (alcohol, smoking, and trado-medicine use) to changes in the liver enzymes (AST, ALT, and ALP) levels in HIV-infected adult patients on a highly active antiretroviral treatment (HAART) for not <1 year. The study was a cross-sectional, part of a randomized comparative trial (Ref: UPH/CEREMAD/REC/19), involving 129 (46 males and 83 females) HIV-infected adult patients. Liver enzyme levels were determined from analyzed blood samples using the Clinical Chemistry Analyser (VS10) manufactured by Vitro Scient, while the study determined substance use using a reliable (Cronbach alpha = 0.805) rapid-exploratory survey questionnaire. Liver enzyme values were further categorized into: normal or abnormal using normal reference ranges (ALT = 7–55 U/L, AST = 8–48 U/L, and ALP = 40–129 U/L). STATGRAPHICS V16.1.11 (StatPoint Tech., Inc.) and SPSS (IBM® Amos V21.0.0, USA) were used to analyze the data. Among the HIV-HAART patients, 27.9% were alcohol users, 20.9% smokers, and 20.1% trado-medicine users. In addition, ALP (71.3%) abnormality was higher than ALT (34.9%) and AST (28.7%). The result from the SEM provided only a partial support for our hypotheses of direct substance use effects on the liver enzyme levels and abnormalities; with a direct association of alcohol with an elevated AST (b = 0.170, p = 0.05) and smoking with a higher AST (b = 0.484, p < 0.01) and ALT (b = 0.423, p < 0.01) values. Trado-medicine use was not directly associated with enzyme elevation and abnormality. In conclusion, ALP abnormality was the most common, and there is a close association between an elevated ALT and AST, with or without an elevated ALP. The study found that HIV-HAART patients who drink or smoke will have at least one or more abnormal transaminases. The possible explanation to the increased risk among HIV-HAART patients could be associated with the metabolic pressures and supra-additive effects on the livers.

Examining Liver Function in Adults with Diabetes in the United States.

Hyperglycemia is the hallmark of various types of diabetes and considered to be a risk factor for several chronic disorders including liver function. Though liver is a dynamic organ, incessant glucotoxicity can lead to altered liver function. The goals of the present study were to examine the association between diabetes with liver functions amongst adults in the United States. We analyzed14,948 adultswith diabetes in the National Health and Nutrition Examination Survey (NHANES) conducted from 2007 to 2016.Diabetes and prediabetes were defined in accordance with theAmerican Diabetes Association 2021 guidelines. The association of demographic characteristics with glycemic levelswas analyzedusing the Chi-square test. A multivariate logistic regression model was constructed to evaluate the associations of glycemic levels with abnormal liver enzyme levels. Regression model was adjusted for age, sex, and ethnicity. The statistical analyses were performed using STATA ver. 14. A. p value of ≤0.05 or≤0.001 was considered statistically significant. A total of 14,948 adults (20 years and above) were included in this study. Sample mean age was 45.5±0.33 yrs., 54% were female, 53% were non-Hispanic White, and 60% had some college or graduate level education. In the overall sample, 19% adults were diabetic and 34% were pre-diabetic. Pre-diabetic glycemic levels were associated over one and half times higher odds of ALT (OR: 1.45, 95% CI: 1.31, 1.60, p<0.001) and over 1.3 times of higher odds AST (OR: 1.30, 95% CI: 1.14, 1.49,p<0.001). On the other hand, diabetic glycemic levels were associated with close to one and half times higher odds of ALT (OR: 1.37, 95% CI: 1.18, 1.59,p<0.001) and AST (OR: 1.48, 95% CI: 1.24, 1.76, p<0.001). On regression analysis, after adjustment, pre-diabetic and diabetic status was associated with high ALT (OR: 1.21, 95%CI: 1.11, 1.32, p<0.001), AST (OR: 1.14, 95%CI: 1.04, 1.27, p<0.05), ALP (OR: 1.40, 95%CI: 1.16, 1.68, p<0.001) and GGT (OR: 1.42, 95%CI: 1.24, 1.63, p<0.001). Our results indicated that diabetes is significantly associated with liver function. This observed association deserves further exploration to understand the longitudinal impact of diabetes on liver function.

Clinical features, management, and outcome of hemodialysis patients with SARS-CoV-2.

The aim of the study was to evaluate the clinical features of the patients on HD with COVID‐19 and determine the prognostic factors. In this single‐center prospective study, a total of 58 chronic renal failure patients on HD and diagnosed COVID‐19 infection were enrolled in the study. The patients were divided into two groups according to their need for intensive care unit referral. Demographic features of the patients, clinical manifestations, laboratory data, treatments, and clinical outcome were evaluated. The mean age of 58 HD patients was 63.2 ± 13.8 (30–93) years and female–male ratio was 0.34. SARS‐CoV2‐PCR positivity rate was 32.8%. 85.2% of patients (n = 46) had bilateral lesions and 14.8% (n = 8) had unilateral one lesion in chest CT. The most common symptoms were fatigue (in 44 patients, 80%) and dyspnea (in 31 patients, 56.4%). The most common comorbidity was HT (in 37 patients, 67.3%). The patients who need intensive care and died were older (p = 0.015). We observed lower platelet and eosinophil counts, potassium levels, higher AST, troponin and CRP levels in the group of patients who need intensive care and died than the group who survived (p = 0.043, 0.005, 0.033, 0.007, 0.001, <0.001, respectively). 15.5% of the patients (n = 9) were transferred to intensive care unit. Among them, two were discharged with cure and seven patients died. Mortality rate was 12.1%. Older age, lower platelet and eosinophil counts and higher AST, troponin and CRP levels were prognostic risk factors in our HD patients who needed intensive care.

ADAM10 and ADAM17 regulate EGFR, c-Met and TNF RI signalling in liver regeneration and fibrosis

ADAM10 and ADAM17 are proteases that affect multiple signalling pathways by releasing molecules from the cell surface. As their substrate specificities partially overlaps, we investigated their concurrent role in liver regeneration and fibrosis, using three liver-specific deficient mouse lines: ADAM10- and ADAM17-deficient lines, and a line deficient for both proteases. In the model of partial hepatectomy, double deficient mice exhibited decreased AKT phosphorylation, decreased release of EGFR activating factors and lower shedding of HGF receptor c-Met. Thus, simultaneous ablation of ADAM10 and ADAM17 resulted in inhibited EGFR signalling, while HGF/c-Met signalling pathway was enhanced. In contrast, antagonistic effects of ADAM10 and ADAM17 were observed in the model of chronic CCl4 intoxication. While ADAM10-deficient mice develop more severe fibrosis manifested by high ALT, AST, ALP and higher collagen deposition, combined deficiency of ADAM10 and ADAM17 surprisingly results in comparable degree of liver damage as in control littermates. Therefore, ADAM17 deficiency is not protective in fibrosis development per se, but can ameliorate the damaging effect of ADAM10 deficiency on liver fibrosis development. Furthermore, we show that while ablation of ADAM17 resulted in decreased shedding of TNF RI, ADAM10 deficiency leads to increased levels of soluble TNF RI in serum. In conclusion, hepatocyte-derived ADAM10 and ADAM17 are important regulators of growth receptor signalling and TNF RI release, and pathological roles of these proteases are dependent on the cellular context.

Liver disease symptoms are associated with higher risk of adverse clinical outcomes: A longitudinal study of North American adults with chronic Hepatitis B.

Symptoms of chronic hepatitis B (CHB) are not well characterized. To evaluate CHB symptoms and associations with disease activity and clinical outcomes. Longitudinal data from 1,576 participants in the Hepatitis B Research Network Cohort Study who completed symptom assessments were analyzed. A composite symptom score was calculated using a Symptom Checklist (0=none to 40=extreme). Multivariable mixed models assessed variables associated with symptom change over time. Latent class symptom trajectories were evaluated. The cumulative probability of long-term clinical outcomes (new onset cirrhosis, hepatic decompensation, hepatocellular carcinoma, liver transplantation, death) was examined by baseline symptom groups. Participants median age was 42 (range:18-80), 51% were male, 75% Asian, (68% of whom were born outside North America) with a median follow-up of 4.2 years. On average, symptoms did not significantly change over time. The multivariable model identified several variables associated with higher symptoms during follow-up: being female, non-Asian, born in the US/Canada, lower education, higher AST, lower platelets, and more comorbidities. Two patient subgroups were identified based on longitudinal symptom trajectories: a low symptom group (92%, n=1,451) with symptom scores averaging 2.4 over time and a moderate symptom group (8%, n=125) with symptom scores averaging 11.5. During follow-up, 7.3% in the moderate symptom group, but only 3.2% of the low symptom group, developed adverse outcomes (p=0.02). In this large cohort of CHB patients, symptoms were generally mild and stable over time. However, in some patients with moderate symptoms at baseline, deleterious clinical outcomes were more frequent in follow-up.

Thyroid Ultrasound Findings and Its Associated Parameters in Saudi People

Background: Thyroid abnormalities are the most common endocrine abnormalities in Saudi Arabia (KSA). Ultrasonography (USG) is the commonest method of thyroid gland imaging. Thyroid lesions prevalence depends on factors such as sex, age, iodine intake, and other metabolic parameters. Objectives: Investigating different thyroid lesions and their associated clinical parameters. Subjects and Methods: This is a cross-sectional study of adult residents who visited Internal Medicine Clinic in Riyadh, KSA. 206 participants were subjected to thyroid USG, weight and height measurement, laboratory investigations including FBG, HbA1C, ALT, AST, creatinine, uric acid, lipid profile, thyroid stimulating hormone (TSH), and FT4. Results: Thyroid nodules were found in 27.2%, 30.1% had thyroiditis, and 6.8% had pure cysts. There was a significant prevalence of thyroid ultrasound findings within different age groups, (P = 0.002). The highest BMI was found in subjects with nodular size ≤1cm. Subjects with thyroid nodules had higher level of FBG, HbA1c, ALT, AST, uric acid, total cholesterol, HDL-C, LDL-C and TSH. The most frequent thyroid status was euthyroid, followed by subclinical hypothyroidism which had higher frequency in subjects with nodular size ≤1cm (30.8%). Conclusion: Imaging, particularly USG, plays an important role in classifying thyroid gland abnormalities. We found that thyroid lesions, including nodules, pure cysts, and thyroiditis, were non-significantly positively associated with disturbed metabolic profile such as high FBS, HBA1C, ALT, AST, total cholesterol, and LDL levels. Our results for biochemical parameters do not allow inferences on whether they are independent factors associated with thyroid lesions or not.

Impact of Individual Surgeon Volume on Outcomes Following LVAD Implantation

<h3>Purpose</h3> Surgeon volume affects outcomes of complex operations. However, it is not clear if individual surgeon volume in a large volume program affects left ventricular assist device (LVAD) outcomes. <h3>Methods</h3> We reviewed primary LVAD implants at our center between 2013 and 2020. Cases were dichotomized into a high-volume group (surgeons averaging more than 10 LVAD cases per year), and a low-volume group (10 or less cases per year). Propensity score matching was performed. Survival and incidence of major adverse events were compared; predictors of survival were identified with multivariable analysis. <h3>Results</h3> There were 315 patients who met inclusion criteria- 45 implants in the low-volume group, 270 in the high-volume group. In the propensity matched cohort, there was no difference in survival to hospital discharge between the low (91.9%) and high (91.7%) volume groups (p=1). Survival at 1-year was also similar between the groups (85.4% vs 88.6%, p=0.732). There was no difference in the incidence of major adverse events between the groups. Predictors of mortality in the first year included: age (Hazards Ratio [HR] 1.061, p<0.001), prior sternotomy (HR 1.991, p=0.014), elevated INR (HR 4.748, p<0.001), higher AST (HR 1.001, p=0.001), higher bilirubin (HR 1.081, p=0.014), and pre-operative mechanical ventilation (HR 2.662, p=0.005). Individual surgeon volume was not an independent predictor of discharge or one-year survival. <h3>Conclusion</h3> There was no difference in survival or adverse events between high and low volume surgeons suggesting that, in an experienced center, low-volume VAD surgeons can achieve similar outcomes to their high-volume colleagues.

Maternal Serum Levels of Zinc, Copper, and Thiols in Preeclampsia Patients: a Case-Control Study.

Preeclampsia is one of the leading causes of maternal mortality-morbidity, and environmental factors act as the main driving force for the development of disease in genetically lean women. Trace element levels (zinc, copper) and thiol state (total, native thiol) may affect involved risk factors and play a role in the pathogenesis. The objective of our study is to assess trace element and thiol levels in patient and control groups. A total number of 88 pregnant women (in their third trimester) included 43 preeclampsia patients and 45 normotensive pregnant women as controls. The main findings of this study were the significantly elevated copper levels and decreased thiol levels (native and total thiols) in the patient group compared to controls (p < 0.05). Disulfide levels were not statistically different between the groups (p > 0.05). In patients, the predictive cutoff value of copper was 224 μg/dL and was 1.19 for the copper/native thiol ratio. Zinc levels were not statistically different between the two groups. Correlation analysis revealed no relationship between zinc-copper and zinc-total thiol levels in patients, while a positive correlation was evident in controls (zinc-copper, p < 0.05, r = 0.425, and zinc-total thiol levels, p < 0.05, r = 0.642). Patients had marginally high ALT and AST values in the normal range, and a significant difference was found between the two groups (p < 0.05). According to these results, elevated copper levels and decreased thiol levels may have a value for early prediction. The mechanisms that may be responsible for the altered element and thiol status have been discussed here in the context of oxidative stress.

Clinical Manifestations and Characterization of COVID-19 in Liver Transplant Recipients: A Systematic Review of Case Reports and Case Series.

This systematic review is conducted to explore available information on clinical presentations, laboratory finding and outcomes of SARS-COV-2 in liver transplant patients. We searched four databases for relevant terms related to COVID-19 and liver transplantation and collected both case reports and case series on liver transplantation published up to the end of September 2020. After initial screening of irrelevant articles, 25 studies were included and analyzed in this review. Among the 59 patients included, 78.3% were over 50 years old, and 71.6% were males. The majority of patients (93.3%) were hospitalized. The most common presenting symptoms were fever (72.9%) followed by dyspnea and cough (54.2%). The majority of patients revealed a high level of CRP (64.3%). Moreover, high level ALT, AST and ALP were reported in 64.3, 37.5, 30.5 and 22.2% of patients. A total, 9(15.3%), of cases died as a result of complications of COVID-19. Chest radiographs were reported in 72.9%(43/59) of cases that 94% demonstrated radiologic evidence of abnormality. The results demonstrated that the most prevalent symptoms and signs were fever, dyspnea and cough. Moreover, most patients were males and hospitalized. The rate of mortality and high level of CRP, ALT/AST and ALP is similar within the non-immune suppressed and general population. However, early detection of high level of serum CRP, ALT/AST and ALP combined with a clinical COVID-19 symptom and finding of CT scan may be used as an index for the presence and severity of the disease.

Different characteristics of infants diagnosed with congenital choledochal malformation prenatally or postnatally

The general condition, clinical and pathological characteristics, and treatment regimens of patients prenatally and postnatally diagnosed with congenital choledochal malformation (CM) were analyzed in order to investigate the clinical significance of early diagnosis, treatment, and intervention in CM. We retrospectively analyzed 33 children who were admitted to the Children’s Hospital of Soochow University between 1 March 2010 and 31 May 2019, and their diagnosis of CM was confirmed by radiological, surgical and pathological findings. All the patients were under 36 months of age. The patients were divided into prenatally diagnosed and postnatally diagnosed groups. There were 16 and 17 CM patients in the prenatally and postnatally diagnosed groups, respectively, with a preponderance of females in both groups. Compared with the prenatally diagnosed group, the postnatally diagnosed group had a higher incidence of abdominal pain and vomiting (p < 0.05) and higher AST, GGT, and TB levels (p < 0.05). Although postoperative histopathological examination showed inflammation in both groups, congestion in the cyst walls and fibrous tissue hyperplasia were more significant in the postnatally diagnosed group (p < 0.05). In addition, operation time, length of time required to resume a normal diet after surgery, and total length of hospitalization differed between the 2 groups (p < 0.05), with the prenatally diagnosed group having a relatively longer operation time and taking longer to resume a normal diet after surgery. However, the total length of hospitalization in the prenatally diagnosed group was shorter than that in the postnatally diagnosed group. Compared with prenatally diagnosed CM patients, more symptoms, greater severity of symptoms, and more time to recovery after surgery were observed in postnatally diagnosed CM patients.

126 Effect of astaxanthin supplementation on invitro embryo development and immune response of dairy cows

Astaxanthin is a carotenoid antioxidant reported to have beneficial effects on animals, including immune response and reproductive function. This study aimed to determine the effect of daily supplementation of dairy cows with astaxanthin on leukocyte population and oocyte developmental potential in summer. Lactating Holstein cows (n=45) from a compost barn in Paraná, Brazil, received 0 (control), 0.25 (low AST), or 0.5 (high AST) mg/kg per day of astaxanthin for 75 days in the summer (January to March 2020). Groups were homogeneous according to parity, days in milk, and milk yield. Blood cell count (white blood cells, lymphocyte, neutrophil, monocyte, basophil, and eosinophil) was performed on sodium citrate-treated blood samples collected every 14 days. Ovum pickup (OPU) was then conducted three times at a 20-day interval and oocytes underwent IVF to assess their developmental competence. Data were tested for normality of residues (Shapiro-Wilk test) and homogeneity of variances (F max test), and square root-transformed when premises for ANOVA were not met. One-way ANOVA (embryo development data; effect of astaxanthin) or two-way repeated-measures ANOVA (oocyte quality, and leukogram data; effect of astaxanthin, time, and interaction) followed by Tukey’s multiple comparisons test were performed using GraphPad Prism vs.7.0 (GraphPad Inc.). During the experimental period, animals were exposed to an average air temperature of 29.40±0.20°C and relative humidity of 58.00±0.80%. Physiological parameters were as follows: heart rate of 53.55±0.34 beats/min, respiratory rate of 48.39±0.31 breaths/min, body surface temperature of 32.83±0.11°C, and rectal temperature of 38.77±0.02°C. A higher white blood cell count was observed for the low AST group compared with control (P=0.0203) and high AST (P=0.0107) groups after 56 days of supplementation. For lymphocyte quantification, an effect of astaxanthin (P=0.0440) and astaxanthin×time of supplementation interaction (P=0.0239) were observed. The lower dose of astaxanthin caused an increase in lymphocyte number, which could be detected after 42 days of astaxanthin supplementation (P ≤ 0.05). No significant differences were detected for other leukocyte types. No effect of astaxanthin was observed on total number of oocytes recovered per cow except for the first OPU, in which more oocytes were retrieved from cows supplemented with 0.5 mg/kg per day of astaxanthin (9.92±1.95) compared with control (3.58±0.73; P=0.0179) and low AST (4.23±1.18; P=0.0358) groups. In addition, more viable oocytes (grades 1, 2, or 3 according to cytoplasm homogeneity and cumulus cells layers) were obtained from animals supplemented with 0.5 mg/kg per day of astaxanthin (3.17±0.39) compared with control (1.67±0.31; P=0.0050) and low AST (1.56±0.26; P=0.0022) groups. Interestingly, no differences were observed for invitro developmental potential among groups. These data suggest that a low dose of astaxanthin can affect lymphocyte mobilization, whereas a higher dose is required to improve the number of morphologically viable oocytes obtained by OPU from Holstein cows during summer.

Predictive Markers for the Early Prognosis of Dengue Severity: A Systematic Review and Meta-Analysis

Background: Predictive markers for severe dengue stand out as a solution for the proactive management of dengue. Despite the low mortality rate resulting from severe cases, dengue requires vigilant examination and round-the-clock nursing care due to an abrupt and unpredictable progression of complications, posing a burden on clinical triage and material resources. Accordingly, identifying markers that allow for predicting disease prognosis from the initial stage of diagnosis is needed. Given the betterment of laboratory techniques and pathogenesis understanding, myriad candidates have been proposed to be associated with severe dengue progression. Therefore, we aim to provide a systematic overview of the relationship between putative biomarkers and severe dengue. Methods: We performed a systematic review and meta-analysis to compare the differences in host data collected within 72 hours of fever onset amongst the different severity levels. We searched nine bibliographic databases without restrictive criteria of language or publication date. We assessed risk of bias and graded robustness of evidence using NHLBI quality assessment tools, Q-genie tool (for genetic association studies), and GRADE, respectively. We synthesized the body of evidence by narrative review and frequentist meta-analysis, which estimated the effects of the markers in either absolute or relative measures. Findings: Of 4000 records found, 40 studies were eligible for qualitative synthesis, 19 for meta-analysis. We identified 108 host markers collected within 72 hours of fever onset from 6160 laboratory-confirmed dengue, including hematopoietic parameters, biochemical substances, clinical symptoms, immune mediators, viral particles, and genes. There was substantial heterogeneity in most findings, and the analyses lacked statistical power due to a small number of participants. As an exception, there was robust evidence of a significant decrease in platelet counts (MD -40.75, 95% CI -58.61 to -22.88) as well as the increase in AST levels (SMD 0.87, 95% CI 0.36 to 1.38) in severe dengue during this timeframe. Interpretation: Dengue infected patients presenting with either low blood platelet count or high serum AST level—in the first 72 hours of fever onset—are more likely to develop severe dengue. Registration Details: This study protocol is registered in PROSPERO (CRD42018104495). Funding Information: None. Declaration of Interests: We declare no competing interests.

455. Hepatic Laboratory Abnormalities Associated with Disease Severity in Patients with COVID-19: A Pooled Analysis of 6 Retrospective Cohort Studies Including 755 Patients

BackgroundPatients with COVID-19 are at high risks of developing significant pulmonary complications. However, its possible hepatic involvement has not been researched extensively. This study amis to analyze liver abnormality associated with disease severity in patients with COVID-19.MethodsThis was a pooled analysis of 6 retrospective, cohorts studies including 755 Chinese adult patients (> 18 years) diagnosed with COVID-19, admitted from January through February 2020. These patients were classified into two groups: non- severe and severe, based on interim guidelines of World Health Organization and the National Health Commission of China. Patients would be classified into severe group if one of three following criteria were met: respiratory rate > 30 breaths/min, SpO2 < 93% on room air, or PaO2/FiO2 ≤ 300mmHg. Results were analyzed with Student’s t- test, Pearson’s Chi-Squared test and Wilcoxon rank-sum test by SAS Enterprise Guide 7.1.Table 1: Pooled Results Results755 Chinese adult patients (>18 years) with COVID-19 were included. Gender of male (OR 1.95; 95% CI 1.26–3.0; P=0.0022), and Wuhan region (OR 2.17; 95% CI 1.4–3.34; P= 0.0004) were significantly associated with the severe group compared with the non-severe group. Also the severe group had a significant lower albumin (g/dL) (3.5±1.1 vs. 4.1±1.0, P= 0.001), higher AST (U/L) (34.1±24.8 vs. 22.3±17.9, P= 0.001), and higher CRP (mg/L) (54.1±122.2 vs. 9.3±59.0, P= 0.0135) compared with the non-severe group. Surprisingly, no significant difference of age between these two groups was identified. Furthermore, no significant difference of ALT, Total bilirubin, D-dimer or INR with disease severity were identified.Table 2: Lab Results And Age With Disease Severity Table 3: Age And Location With Disease Severity Figure 1: Variables Comparison Severe vs. Non- Severe ConclusionThis study demonstrated that male gender and of Wuhan origin were significantly higher in proportion in the severe group. Of Wuhan origin as a risk factor of severe COVID-19 could be explained by limited medical resources for overwhelming COVID-19 patients in Wuhan during the period of January and February 2020. It is unclear why male was the risk factor of severe COVID-19 based on our data. Also, there were significant lower Albumin, higher AST and CRP in severe COVID-19, but their values were not too impressive. However due to limited data and studies, future studies are needed to elucidate risks factors associated with severe COVID-19.Figure 2: Locations of Patients by Cities Locations of Severe COVID-19 by Cities Disclosures All Authors: No reported disclosures

Effect of allicin on antioxidant defense system, and immune response after carbofuran exposure in Nile tilapia, Oreochromis niloticus

In this work, allicin was evaluated as an immunostimulant and antioxidant agent preventing Nile tilapia; Oreochromis niloticus against carbofuran toxicity. Fish (60 ± 8 g) were allocated to five groups; the first group (control), the second group was fed 1 g/kg allicin–supplemented diets without carbofuran intoxication, the third group exposed to 1/10 LC50 carbofuran (0.246 mg/L). While the fourth, and fifth groups were fed allicin supplemented diet at concentration of 0.5 and 1 g/kg diet, respectively, and exposed to carbofuran at the same concentration similar to the one of the third group. After 30 days, fish exposed to carbofuran showed high ALT, AST, ALP, cholesterol, glucose, cortisol, uric acid, and creatinine levels. However, serum AChE, total proteins, immunoglobulins, and lysozyme activity were markedly (P ≤ 0.05) reduced in carbofuran exposed tilapia fish. Moreover, malondialdehyde (MDA) level was significantly increased in liver, and kidneys tissues of carbofuran exposed fish. Whereas, catalase (CAT) activity, superoxide dismutase (SOD), and total antioxidant capacity (TAC) were decreased (P ≤ 0.05) significantly in both liver, and kidneys tissues after exposure to carbofuran. Interestingly, tilapia fish treated with carbofuran (0.246 mg/L) and fed (0.5 and 1 g/kg diet) allicin in both the 4th & 5th groups, respectively, decreased serum biochemical parameters; and hepatorenal (MDA) levels, as well as increased AChE, immunological profile, and oxidative stress biomarkers. The results suggested that co- administration of allicin at the high dose is more capable of improving the biochemical, and immunological parameters, and tissue antioxidant responses of carbofuran treated fish.

The Severity of Hepatitis D in Young Adults of Age 18-25 Years.

BackgroundCurrent literature on the prevalence and characteristics of hepatitis D virus (HDV) infection in young adults is limited. This study aims to determine the disease characteristics and severity in young adults.MethodsThe case records of HDV RNA positive patients of age 18-25 years were analyzed.ResultsOut of 119 patients, 105 (88%) patients were male. HBV-DNA was detectable in 83 (70%). Hepatitis B e-antigen (HBeAg) was non-reactive in 99 (83%). Cirrhosis was identified in 45 (37.8%) individuals; nine (7.5%) were classified as Child class B or Child class C. Twenty-four (20.2%) had a Model For End-Stage Liver Disease (MELD) score of ≥10, out of these 16 had a score of 15 or more. The risk of decompensation was calculated according to the Baseline-event-anticipation (BEA) score; eight (6.7%) patients were at BEA-A (mild risk), 105 (88.2%) were at BEA-B (moderate risk), and six (5.0%) were at BEA-C (severe risk). Notable findings in patients with cirrhosis included splenomegaly, low total leucocyte counts, low platelets, high bilirubin, elevated aspartate aminotransferase, gamma-glutamyl transferase and international normalization ratio, low albumin, high AST to Platelet Ratio Index (APRI), and high BEA score. The splenic size, platelet count, and albumin levels were independently associated with cirrhosis (p < 0.001, <0.001, and 0.003). A model using a combination of platelet count, albumin, and spleen size was developed to accurately predict cirrhosis in this cohort. It had an area under the receiver operating characteristics (AUROC) of 0.935.ConclusionsHDV-infected young adults, age 18-25 years, were at moderate to severe risk of disease progression. About one-third of patients had already developed cirrhosis indicating the aggressive nature of the disease.

S2457 Histoplasma Hepatitis Presenting as Mirizzi Syndrome

INTRODUCTION: Hepatitis secondary to Histoplasmosis is a pathology that is complex and difficult to diagnose. We report a case that presented as Mirizzi syndrome with respiratory dysfunction that proved to be disseminated histoplasmosis with hepatic involvement. CASE DESCRIPTION/METHODS: A 50 y/o female on adalimumab for rheumatoid arthritis presented with right-upper quadrant pain, a 5-day history of jaundice, fever and shortness of breath. Liver chemistries were elevated with alkaline phosphatase of 733 IU/L, total bilirubin of 7 mg/dl, AST 612 IU/L and ALT 202 IU/L. Abdominal ultrasonography revealed gallstones and mildly dilated common bile duct. A chest CT showed diffuse bilateral groundglass opacities. Based on the complex presentation and timing (mid March, 2020) the working diagnoses were gallstone disease with potential SARS-CoV2 infection. Endoscopic Retrograde Cholangiopancreatography exposed Mirizzi syndrome and a long-stent was placed into the bile duct. COVID-19 testing was negative. Liver enzymes showed minimal improvement and respiratory symptoms continued to worsen. Other laboratory tests as well as a detailed toxin intake (including alcohol) were negative. Due to the lack of improvement the patient underwent bronchoscopy and liver biopsy. The former showed buddying yeast in the lungs and the latter liver granulomas with PAS positive yeast consistent with Histoplasma. Liver biopsy cultures were positive for Histoplasma capsulatum. The patient was placed on Itraconazole and discharged home upon improvement. Eight weeks post discharge her liver enzymes have almost completely normalized and symptoms have resolved. DISCUSSION: Disseminated histoplasmosis affecting the liver is a relatively rare and often lethal complication of this infection. The confirmation of extra pulmonary disease is critical as the length of therapy extends from several weeks to one year. Histoplasma hepatitis has been reported in individuals undergoing immunosuppression, such as our patient, and a consistently reported characteristic has been a high AST to ALT ratio which can lead to an initial suspicion of alcoholic hepatitis. This should be kept in mind if the provided history is not compatible with toxin-related (alcohol) liver disease. Our patient also had a clinical presentation compatible with Mirizzi syndrome further obscuring the diagnosis. In this regard, alternative diagnoses should be thought if there are no dramatic improvements of liver chemistries following recanalization of the bile duct.