Impaired Liver Function Tests Research Articles

Hepatotoxicity and Its Impact on Mortality in COVID-19 Patients

Objective: "COVID-19-related liver damage" can occur frequently in course of COVID-19 disease and cause significant problems. Our study aimed to investigate prevalence of liver damage due to COVID-19, its risk variables, and the effect of liver damage on course of COVID-19 and mortality. Method: One hundred patients over eighteen years of age who were hospitalized between 01.08.2021-01.03.2022 and had positive RT-PCR tests were included in our study. Impaired liver function tests were identified as having alanine aminotransferase(ALT) and aspartate aminotransferase(AST) levels exceeding upper laboratory limits. Results: The mean age of patients included in study was 57.9 ± 14.9 years, with 49% of them being male. In our study, we had an 8% death rate and 37% of patients had abnormal liver function tests. The presence of severe disease(p<0.001), anorexia symptoms(p=0.027), and abdominal pain(p=0.010) were significant for mortality. A prolonged hospital stay was significantly associated with death(p=0.029), with the mean length of hospital stay being 11.8 ± 4.6 days. Favipiravir use for longer than five days was associated with a substantial risk of liver damage(p=0.044) and mortality(p=0.020), while use of antibiotics in carbapenem group was associated with a significant risk of death(p=0.001). Conclusions: It is noteworthy that a considerable proportion of COVID-19 patients may exhibit increased liver tests, which could serve as a significant predictor and risk factor, particularly with regard to mortality. In order to properly monitor and manage COVID-19 patients, particularly those who are at risk, comprehensive measurements, including liver tests, should be carried out on a regular basis.

Severity of gallstone, sludge or microlithiasis induced pancreatitis - all of the same?

Severity of microlithiasis and sludge-induced pancreatitis in comparison to gallstone-induced pancreatitis has never been studied for a lack of definition. In order to understand whether bile duct obstruction or other mechanisms contribute to biliary pancreatitis severity we performed a monocentric, retrospective cohort study. In this retrospective cohort study 263 patients with acute biliary pancreatitis treated at a tertiary care center from 2005 to 2021 were stratified according to the recent consensus definition for microlithiasis and sludge. The gallstone-pancreatitis cohort was compared to microlithiasis, sludge and suspected stone passage pancreatitis cohorts in terms of pancreatitis outcome, liver function and EUS/ERCP results using one-way ANOVA and Chi2 test. Multinomial logistic regression analysis was performed to correct for bias. Microlithiasis and sludge-induced pancreatitis classified according to the revised Atlanta classification, did not present with a milder course than gallstone-induced pancreatitis (p = 0.62). Microlithiasis and sludge showed an increase in bilirubin on the day of admission to hospital, which was not significantly different from gallstone-induced pancreatitis (p = 0.36). The likelihood of detecting biliary disease on EUS resulting in bile duct clearance was highest on the day of admission and day 1, respectively. Microlithiasis and sludge induce gallstone-equivalent impaired liver function tests and induce pancreatitis with similar severity compared with gallstone-induced acute biliary pancreatitis.

Emphysematous pyelonephritis and sepsis in a diabetic female patient caused by extended-spectrum beta-lactamase-producing Escherichia coli – case report

Emphysematous pyelonephritis (EPN) is a rare, severe, spontaneous gas-forming infection of renal parenchyma and its surrounding areas. EPN was detected in diabetic patients. A 49-year-old female with type I diabetes mellitus presented with severe thrombocytopenia, acute kidney injury (AKI) and was in need of haemodialysis treatment. She had impaired liver function tests, with active urine sediment, indicating severe upper urinary tract infection with suspected sepsis. The contrast enhanced CT scan of the abdomen showed multiple areas of air density in renal parenchyma and perirenal regions, suggestive of left-side EPN. The blood and urine cultures reported growth of extended-spectrum beta-lactamase (ESBL) producing Escherichia coli. The final diagnosis of emphysematous pyelonephritis complicated with severe sepsis and AKI was established. The patient was managed conservatively with wide-spectrum antibiotics, fluid resuscitation, consistent blood sugar control, and haemodialysis treatment. Percutaneous drainage techniques (PCD) and nephrectomy were postponed because of the initial clinical response to the antibiotics treatment. However, the patient experienced sudden clinical deterioration and died only a few hours after the established diagnosis. An autopsy was not performed upon the patient’s family’s request. EPN should be highly suspected in poorly controlled diabetic patients with urinary tract infection and should be promptly recognized and aggressively treated. The patients with multiple risk factors had high mortality, even with timely diagnosis and combined (conservative and surgical) treatment.

Higher Risk of Chronic Hepatitis E Virus Infection in Patients with Human Immunodeficiency Virus-1: An Iranian Cross-sectional Study.

Occurrence of Hepatitis E Virus (HEV) infection may be common in Human Immunodeficiency Virus (HIV-1) patients and may lead to chronic infection as well as cirrhosis. We intended to determine the incidence of HEV infection among HIV-1 patients compared to individuals without HIV-1 infection. In our cross-sectional study, 87 HIV-1-positive patients were compared to 93 healthy individuals in Kerman, Iran. Plasma and peripheral blood mononuclear cells (PBMCs) were obtained from all the participants. Plasma samples were evaluated for HEV IgM and IgG using the ELISA kit. Then, reverse transcriptase-nested polymerase chain reaction (RT-nested PCR) was used in RNA extractions from PBMCs to check for the presence of HEV RNA. Among the subjects examined in our study, 61 (70.1%) and 71 (77.4%) out of patients with HIV-1 infection and healthy individuals were male, respectively. The average ages of patients with HIV-1 and the control group were 40.2 years and 39.9 years, respectively. No discernible differences were found between the two groups based on IgM and IgG seropositivity against the HEV. However, HEV-RNA was found in 8% of patients with HIV-1 and 1.1% of HIV-1-negative individuals (P=0.03). There was also an association between the HEV genome and anti-HEV and anti-HCV antibodies in HIV-1-positive patients (P=0.02 and P=0.014, respectively). HEV infection may be more common in HIV-1 patients and may develop a chronic infection in immunocompromised individuals. Molecular-based HEV diagnostic tests, including RT-PCR assays, should be performed in HIV-1 patients with unknown impaired liver function tests.

Transient sinus bradycardia caused by hepatitis A virus: a case report

BackgroundThe most common cause of acute viral hepatitis is the hepatitis A virus (HAV). Millions of people are thought to be infected each year. It is transmitted either by the fecal-oral route or by consuming contaminated food. Extrahepatic complications, notably cardiologic ones, are infrequent. This case report was presented due to the development of HAV-related bradycardia without hypotension in an unvaccinated refugee patient.Case presentationA 9-year-old male presented with the complaint of jaundice and vomiting. There was no history of fever, diarrhea, or abdominal pain. A precise knowledge of suspected food intake is lacking. There was no pathological examination finding except jaundice. Total bilirubin, direct bilirubin, aspartate aminotransferase, and alanine aminotransferase levels were high. The coagulation test was normal. Anti-HAV-IgM/IgG was positive in the patient with suspicious viral hepatitis. In the follow-up, the heart rate decreased to 43 beats/min during sleep and 46 beats/min when awake. Cardiological examination and tests were within normal limits. Hypotension was not accompanied. In the follow-up, bradycardia and impaired liver function tests regressed. The patient was discharged on the 10th day.ConclusionsCardiologic complications are rare, and patients diagnosed with acute hepatitis A should be monitored. The most effective way of protection from the hepatitis A virus is vaccination.

Prevalence of Hepatitis B and C Viral Infections in Chronic Liver Disorder

Background and aim: Hepatitis is a liver infection caused by a variety of viruses and is a major public health issue worldwide. Hepatitis B and C are common liver infections caused by HBV and HCV that spread through sexual contact, contaminated blood product and contaminated needles. The present study aimed to determine the prevalence of hepatitis B and C in chronic liver disorders. Material and Methods: This prospective study was conducted on 136 chronic liver disease patients in the Department of Gastroenterology and Hepatology, Ayub Teaching Hospital Abbottabad from August 2021 to January 2022. Patients above 18 years age and clinically diagnosed with chronic liver disorder were enrolled. Chronic liver disorders were diagnosed based on clinical history, impaired liver function tests, and ultrasound. A questionnaire was used to accumulate possible related factors with virus infections from patients. Qualitative immunochromatographic method was used for screening out the serum for the presence of anti-hepatitis C virus antibodies and hepatitis B surface antigen. SPSS version 26 was used for data analysis. Results: Out of 136 chronic liver disorders, there were 88 (64.5%) male and 48 (35.5%) females. The overall mean age was 42.6±6.82 years with an age range from 15 to 75 years. Of the 136 CLD, the single, married, divorced, and widow were 34 (25%), 80 (58.8%), 12 (8.8%), and 10 (7.4%) respectively. The urban and rural dwellers were 98 (72.1%) and 38 (27.9%) respectively. The prevalence of Hepatitis B surface antigen and anti-HCV antibody was 52 (38.2%) and 34 (25%) respectively. The incidence of dual HBV and HCV coinfection was 6 (4.4%). Conclusion: The present study found that the prevalence of HBV and HCV infections were 38.2% and 25% among chronic liver disorders. HCV infections were 2.95 times higher in health facilities where dental extractions were provided compared to those who had no dental extraction facilities. All the CLD clinically diagnosed should be tested for HBV and HCV infections. Sterilization of surgical and dental instruments in proper way must be done along with public education regarding infections and transmission modes to prevent infections spreading. Keywords: HBV, HCV, Chronic liver disorders

Porto-sinusoidal vascular disorder.

It is well established that portal hypertension can occur in the absence of cirrhosis, as reported in patients with immune disorders, infections and thrombophilia. However, similar histological abnormalities primarily affecting the hepatic sinusoidal and (peri)portal vasculature have also been observed in patients without portal hypertension. Thus, the term porto-sinusoidal vascular disorder (PSVD) has recently been introduced to describe a group of vascular diseases of the liver featuring lesions encompassing the portal venules and sinusoids, irrespective of the presence/absence of portal hypertension. Liver biopsy is fundamental for PSVD diagnosis. Specific histology findings include nodular regenerative hyperplasia, obliterative portal venopathy/portal vein stenosis and incomplete septal fibrosis/cirrhosis. Since other conditions including alcohol-related and non-alcoholic fatty liver disease, or viral hepatitis, or the presence of portal vein thrombosis may occur in patients with PSVD, their relative contribution to liver damage should be carefully assessed. In addition to histology and clinical diagnostic criteria, imaging and non-invasive tests such as liver and spleen stiffness measurements could aid in the diagnostic workup. The introduction of PSVD as a novel clinical entity will facilitate collaborative studies and investigations into the underlying molecular pathomechanisms encompassed by this term.

Pazopanib in metastatic soft tissue sarcoma (STS): Results of a multi-institutional observational study.

e23542 Background: Soft tissue sarcomas (STS) are a heterogenous group of tumors which have limited therapeutic options and poor prognosis in advanced/metastatic settings. Herein, we present the clinical outcomes of metastatic STS patients treated with pazopanib (PAZ) in real-life. Methods: We retrospectively collected data about adult patients treated with PAZ for metastatic STS in Turkey. We described the clinical characteristics and tumor responses, and estimated the progression-free survival (PFS) and overall survival (OS) using the Kaplan-Meier method. The Cox proportional hazards regression model (HR, 95%CI) was used for evaluation of prognostic factors for PFS. Results: 507 patients (median age: 52 [range: 18-87]; 56.8% female) were included in the analysis. Extremities were the most common primary tumor sites (n:202; 39.8%) followed by abdomen (n:116; 22.9%) and pelvic cavity (n:102;20.1%) where 98% of STSs arose in uterus (n:100). The leading histologic subtypes were leiomyosarcoma (n:192; 37.9%), synovial sarcoma (n:58; 11.4%) and undifferentiated pleomorphic sarcoma (n:48; 9.5%). Of the reported tumor grades (n = 350), 61.4% (n:215) were grade 3. The most common metastatic sites were lungs (52.7%) and liver (20.3%). Doxorubicin plus ifosfamide (45.9%) was the preferred front-line regimen and PAZ was the treatment of choice in second (59.8%) and third-line (61.8%) settings. The median follow-up under PAZ treatment was 5.03 (0.10-84.67) months. Objective response and disease control rates were 31.4% and 42.2%, respectively. Overall, 183 (36.1%) patients were alive at last follow up, 123 of which (67.2%) did not show progression. The median PFS and OS for the study group and the most commonly observed types of STS are shown in Table. Favorable prognostic factors for PFS were low-intermediate tumor grade (HR[95% CI] for grade I and 2 vs 3:1.371[1.016-1.849]; p = 0.039) and ECOG (Eastern Cooperative Oncology Group) score (HR[95% CI] for ECOG score < 2 vs ≥2: 2.698[1.923-3.787]; p = 0.0001). Weakness/asthenia (10.8%), impaired liver function tests (4.7%) and diarrhea (3.6%) were the most common adverse events, no grade 4 or 5 events were observed. Conclusions: This large scale real-life study confirms that PAZ, with its positive impact on clinical outcomes and acceptable tolerability and safety profile is a valuable treatment option for metastatic STS.[Table: see text]

Clinical, Laboratory, and Electrocardiographic Findings in Colchicine Toxicity: 10 Years of Experience.

Background:We aimed to investigate the clinical, laboratory, and electrocardiographic (ECG) findings of colchicine poisoning and to evaluate if there is a correlation between them and the two major outcomes of this toxicity which are respiratory/cardiovascular failure and death.Materials and MethodsMedical records of 34 colchicine-intoxicated patients that were treated in our center during the past 10 years were retrospectively evaluated. The patient's clinical presentation, vital signs, laboratory tests, ECGs, and outcomes were reviewed.ResultsAbdominal pain, and hypotension at presentation had significant correlation with mortality (p = 0.003, OR: 2.2 [4.1, 7.9], p = 0.029, OR: 13.0 [1.5, 111.8]). Mortality significantly occurred in those with sinus tachycardia, hypokalemia, metabolic acidosis, and impaired liver and kidney function tests (p-values = 0.025, 0.007, 0.04, and 0.008, respectively). All the patients had some ECG abnormalities. Most frequent ECG abnormalities were pathologic ST segment elevation and depression (70%), left atrial enlargement (48%), and sinus tachycardia (37%), PR elevation in aVR lead (37%), and T wave inversion (37%).ConclusionsColchicine toxicity is a dangerous entity regarding the cardiovascular events and requires close general and cardiac monitoring.

Surgical treatment of acute aortic dissection in a patient with SLE and prior antiphospholipid syndrome on therapy for over 30 years: a case report

BackgroundIn patients with systemic lupus erythematosus (SLE), lengthy treatment and long-term steroid use are the main risk factors for developing aortic aneurysms or aortic dissections. In patients with cardiac tamponade, hemodynamic collapse may lead to acute renal and hepatic failure.Case presentationWe report the successful treatment of a 55-year-old woman with SLE since the age of 21. She suddenly felt chest pain approximately 2 weeks before developing fever and vomiting and was admitted to our hospital. Initially, she had severe liver dysfunction and was admitted to the hepatology department, where treatment for fulminant hepatitis was initiated. However, computed tomography (CT) showed an acute aortic dissection (DeBakey type II) and severe bloody pericardial effusion. Therefore, we performed emergency pericardial drainage. Plasma exchange therapy was initiated as emergency aortic surgery was deemed impossible due to impaired liver function tests and coagulation. Ten days later, the patient developed peritonitis due to small bowel perforation, and laparotomy was performed for abscess drainage and perforation closure. She had received steroid pulse therapy at the age of 21. At 40 years of age, she developed deep vein thrombosis due to antiphospholipid antibodies and was prescribed prednisolone. She was ambulatory at 3 months after the onset of acute aortic dissection, and CT revealed a rapidly enlarging true aneurysm in the distal arch. We performed elective aortic surgery. Although there were no antiphospholipid antibodies, surgery could have led to a devastating antiphospholipid syndrome. Therefore, we decided to treat the patient with triple therapy. Methylprednisolone was intravenously administered intraoperatively and at 1 day postoperatively. The patient was discharged without complications after returning to her usual oral prednisolone regimen.ConclusionsThe patient described herein had a systemic circulatory failure due to cardiac tamponade, accompanied by liver failure. This condition is a significant cause of death in patients with aortic dissection-associated SLE and is extremely dangerous. However, multi-specialty intervention helped the patient recover, and she has been attending the outpatient clinic. Aortic surgery requiring hypothermia in SLE patients with antiphospholipid syndrome and a history of thrombocytopenia or thrombosis requires a multi-disciplinary treatment team, including cardiac surgeons and medical experts.

Voriconazole-Induced Cholestatic Hepatotoxicity in an Immune Competent Patient

Voriconazole is a frequently prescribed anti-fungal medication used in particular for invasive aspergillosis. Voriconazole-induced hepatotoxicity is a relatively rare but serious clinicopathologic entity. We report a patient presenting with impaired liver function test results pointing towards the cholestatic picture. The patient had initial blood tests to confirm cholestasis, followed by imaging modalities that did not show any obstruction along the common bile duct and/or pancreatic pathway. The patient’s voriconazole dose reduction was advised, resulting in lower levels of abnormal liver function tests.

Autoimmune hepatitis in patients aged 70 years or older: Disease characteristics, treatment response and outcome

Autoimmune hepatitis (AIH) affects both sexes and all age groups. However, very few studies have focused specifically on the characteristics and outcome of AIH in patients aged 70y or older. 25/234 patients with well-established AIH and disease onset at ≥70-y (median: 73-y) were analysed and compared to the rest patients (median: 47y). Treatment response was assessed in all patients from both groups who were eligible for treatment (n=202). Disease presentation was mainly insidious in both groups (19/25, 76% vs. 134/209, 64.1%; P=.313). At diagnosis, older patients had lower alaninoaminotrasferase (101[433] vs. 199[441] IU/L, P<.05) but were more frequently cirrhotic (12/25, 48% vs. 57/209, 27.3%; P=.03). Importantly, similar rates of on-treatment response (16/18, 89% vs. 154/184, 84%; P=.565), corticosteroid withdrawal (10/16, 62.5% vs. 113/154, 73.4%; P=.355) and complete withdrawal of immunosuppression (1/16, 6.3% vs. 40/154, 26%; P=.122) were achieved in both groups. Treatment-related adverse events were evenly observed between groups (6/18, 33% vs. 54/184, 29%; P=.724). In treated patients, the age ≥70y was only associated with the overall mortality (HR 8.3 [95% CI: 2.1-36.4], P=.003), but not with the liver-related mortality (HR 3.4 [95% CI: 0.4-30.0], P=.268). AIH should be seriously considered in patients ≥70y with unexplained impaired liver function tests as the disease is not infrequent in this group and seems to bear an increased risk for advanced disease stage at diagnosis. However, if immunosuppression is started promptly, it seems as safe and effective as in younger patients.

Effect of drinking high fluoride water on liver enzymes a comparitive cross-sectional study

ABSTRACT Objective: The aim of this study is to determine the effects of drinking water with high fluoride level on liver functions. Method: This is a descriptive comparative cross-sectional study conducted at Sammu rind village where the drinking water has increase fluoride content. The comparative area was Gadap town where the drinking water has normal fluoride level. Sampling was done randomly and sample size was calculated by WHO calculator and found to be 121 each for exposed and unexposed population. Blood samples taken for liver functions included bilirubin, AST, ALT, Alkaline phosphate, Gamma GT, total protein, albumin and globulin. SPSS version 16 was used for analysis. Mean and SD calculated for quantitative variable and the two comparative groups were cross-tabulated. To check the statistical significance t-test was applied. Results: There was no statistically significant difference with consideration to serum bilirubin, ALT, and AST. However, statistically significant difference was established with respect to alkaline phosphatase, Gamma GT total proteins and A/G ratio between two groups. Conclusion: In our study, there was no evidence of impaired liver function tests in subjects drinking water with high fluoride content.

DRESS Sendromu: Bir Olgu Sunumu

DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms) syndrome is a rare, life-threatening drug reaction characterized by acute onset of fever, skin rash, and multisystemic involvement. Although the pathophysiology is not exactly known, slow detoxification of arene oxide bioactive metabolites of drugs and viral coinfections are blamed in people with genetic predisposition. A 17-year-old male patient was admitted to our clinic with a rash covering his entire body for 5 days. The patient, who stated that he had been using carbamazepine for 4 months due to epilepsy, had fever reaching 38.5°C at the time of admission, impaired liver function tests, high CRP, leukopenia, thrombocytopenia and eosinophilia. The patient, who was hospitalized, developed sudden vision blurriness and the cranial MRI result was reported as normal. It was thought that the blurriness in the vision could be caused by drug-induced eosinophil infiltration. This case is presented as a rare case of DRESS syndrome with blurred vision. Keywords: drug-induced hypersensitivity syndrome, anticonvulsant treatment, blurred vision

Evaluating Non-Traumatic Loss of Consciousness in Children Admitted to the Emergency Room

Background Non-traumatic loss of consciousness is a nonspecific symptom resulting from a broad range of diseases in children, and its outcome depends on factors, including its primary etiologies, age, sex, and patient clinical condition at the time of admission. The purpose of this study was to evaluate the etiology and outcome of children's non-traumatic loss of consciousness and to determine predictive clinical and paraclinical features. Materials and Methods: This retrospective cross-sectional study was conducted in Imam Hossein Hospital, Isfahan, Iran. Documents of 101 children aged one month to fifteen years old who were admitted with non-traumatic loss of consciousness from March 2016 to March 2017 were reviewed. Data regarding patient’s profile, signs and symptoms, para-clinical findings, progression, and outcome were collected and analyzed using SPSS software version 23.0. Results: Results showed that the most common cause was infections (40.6%), followed by seizure (23.8%) and intoxication (19.8%). Also, infection was the main cause of mortality. The mortality rate was 18.8% and it was significantly and directly correlated with duration of hospitalization, intensive care unit (ICU) admission, and emergency interventions such as intubation or cardiopulmonary resuscitation (CPR) at the time of admission, seizure status, dehydration, irritability, poor feeding, oliguria, hypotension, non-reactive pupils, low oxygen saturation, hyporeflexia, and hypotonia. Moreover, paraclinical factors such as thrombocytopenia, neutropenia, impaired liver and kidney function tests, and high coagulation test predicated poor outcomes. Conclusion The most common cause of non-traumatic loss of consciousness and the most common cause of mortality was infection. Longer duration of hospitalization, ICU admission and interventions were associated with poor outcomes. It seems physicians should pay more attention to these predictive factors.

CoQ10 exerts hepatoprotective effect in fructose-induced fatty liver model in rats.

Excess dietary sugar is associated with deleterious metabolic effects, liver injury, and coenzyme-Q10 (CoQ10) deficiency. This study investigates the ability of CoQ10 to protect against fructose-induced hepatic damage. Rats were fed tap water or 30% fructose for 12weeks with or without CoQ10 (10mg/kg, po). An additional group of rats were allowed to feed on either water or 30% fructose for 12weeks, followed by four weeks of treatment with either the vehicle or CoQ10. Fructose-fed rats showed lower CoQ10 levels, increased systolic pressure, increased body weight, higher liquid consumption, decreased food intake and hyperglycemia. Fructose-fed rats also showed deteriorated serum and liver lipid profiles, impaired liver function tests and oxidative status, and lower expression of adiponectin receptor 1 and 2 along with higher GLUT-2 levels. Furthermore, following fructose treatment, tyrosine kinase-PI3K pathway was inhibited. Additionally, there was an increase in the levels of apoptotic markers and serum visfatin and a decrease in the levels of adiponectin and soluble receptor of the advanced glycated end product. Consequently, several histopathological changes were detected in the liver. Concurrent or three months post-exposure administration of CoQ10 in fructose rats significantly reversed or attenuated all the measured parameters and hepato-cytoarchitecture alterations. This study suggests CoQ10 supplement as a possible prophylaxis or treatment candidate for fructose-induced liver injury.

Роль тромбоцитов как одного из маркеров активности инфекционного процесса у больных хроническим гепатитом С с обострением естественного течения болезни

The purpose. To determine the role of Tr as one of the prognostic signs of the infectious process activation in case of exacerbation of the natural course of CHC at various periods of infection against the background of functional liver failure. Material and methods. 460 people (244 men and 216 women) were observed, divided into three groups depending on the number of Tr, according to the phases of disseminated intravascular coagulation syndrome (DIC): group I — hypercoagulation: Tr &gt; 350 x 109/l, n = 36; group II — phase of multidirectional shifts: Tr 350–200 x 109/l, n = 148; group III — hypocoagulation: Tr &lt; 200 x 109/l, n = 276, including patients with liver cirrhosis (n = 97) in the CHC outcome. We analyzed the number of Tr and their maximum amplitude (MA) of spontaneous aggregation in patients with an active infectious process, which is manifested clinically by indicators of liver functional tests (alanine aminotransferase, total bilirubin and its direct fraction, gamma-glutamyltranspeptidase, alkaline phosphatase, total protein, albumin) and the degree of fibrosis. Conclusion. The number and function of blood platelets in exacerbation of HCV are closely related not only to inflammation of the liver tissue, but also to the duration of infection, which is reflected in the manifestations of DIC syndrome. The longer the time of infection and the more active the infection process, the more pronounced the phase of hypocoagulation with a low Tr number, signs of cholestasis and fibrosis of the liver tissue. The relationship between the decrease in the number of platelets with impaired liver function tests and the severity of fibrosis is confirmed by the presence of correlations between them. Regardless of the phases of the DIC syndrome, an increase in the MA of spontaneous Tr aggregation is characteristic, especially expressed in the hypocoagulation phase.

Brucellosis in Southern Israel: Comparison between Children with and without Hematological Manifestations

Objectives: We characterized the epidemiological, diagnostic and clinical aspects of children <18 years presenting with brucellosis accompanied by hematologic manifestations in Southern Israel. Method and Patients: A retrospective study on children hospitalized with brucellosis and diagnosed clinically, as well as by positive blood cultures. Patients with hematologic involvement were compared with patients w/o hematologic involvement. Results: 128/252 (50.8%) children were diagnosed with brucellosis and had blood cultures positive for Brucella melitensis. Thirty-three (25.8%) had hematologic manifestations (leukopenia 32, thrombocytopenia 14, 13 both). In univariate analysis, more males were diagnosed with hematologic involvement while no differences were seen between the 2 groups in known risk factors for brucellosis like use of non-pasteurized milk, contact with livestock, brucellosis among family members, clinical signs/ symptoms and presence of negative serological tests. The most common presentations in patients with hematologic manifestations were monoarthritis, lymphadenopathy and hepatomegaly (36.7%, 17.2% and 12.5%, respectively) w/o any differences compared with patients w/o hematologic manifestations. Impaired liver function tests and recurrent disease were more frequent in patients w/o hematologic involvement vs. patients with hematologic involvement (42.5% vs. 9.2%, P=0.005 and 10.4% vs. 0%, P=0.06). High antibodies titers (1:640-1:1280) were more common in patients w/o hematologic involvement (28.4% vs. 6%, P=0.002). In 3 different multivariate statistical models, patients with hematologic manifestations were older than those w/o hematologic manifestations. Conclusions: Brucellosis accompanied by hematologic manifestations is common in children in Southern Israel. Patients with hematological involvement did not present with major different characteristics compared with patients w/o hematological involvement. We recommend testing for brucellosis in all Bedouin children with leukopenia and/or thrombocytopenia in Southern Israel.

Evaluation of preoperative liver function test efficacy in patients with symptomatic cholelithiasis.

The present study aimed at investigating the necessity of preoperative liver function tests (LFTs) in patients with uncomplicated gallstone disease before laparoscopic cholecystectomy. Significant relationship between common bile duct (CBD) stones and acute cholecystitis is reported. There are contradictory reports about the effect of CBD stones on liver function tests in patients (LFTs). In the current study, patients with symptomatic cholelithiasis who referred to hospitals during January 2015 and May 2016 were enrolled. Routine tests and ultrasonography were performed on all patients before surgery. Data were presented as means ± SD and qualitative variables as frequency (percentage) were considered. Statistical analyzes were performed with SPSS software. A consecutive series of 270 patients (58 males and 212 females) who referred for laparoscopic cholecystectomy were enrolled in this retrospective study. Pre- operative LFTs were normal in 249 patients (85%) and abnormal LFT was detected in 41 patients (15 %). This study showed that 15 % of patients with cholelithiasis without dilated CBD had impaired LFTs. Routine LFTs in preoperative evaluation of symptomatic cholelithiasis usually reveals normal findings and is not helpful in uncomplicated cholelithiasis.

Hepatoprotective effects of Moringa oleifera Lam (Moringaceae) leaf extracts in streptozotocin-induced diabetes in rats

Abstract Effects of methanolic leaf extracts of Moringa oleifera (MO) on hepatic injury in streptozotocin (STZ)-induced diabetes were investigated. Male Wister rats were divided into 6 groups (n = 7). Animals in group A were orally treated daily with 3.0 ml/kg/body weight (BW) of distilled water, while B, E and F were similarly treated with 500, 250 and 500 mg/kg/BW of MO, respectively. Groups C-F were rendered diabetic by single intraperitoneal injections of 45 mg/kg/BW of STZ. Additionally, group D was treated with subcutaneous insulin (2.0 U/kg/BW, bid). Diabetic animals exhibited significant weight loss, polydipsia, impaired glucose tolerance, fasting hypoinsulinemia and impaired liver function tests compared to controls. Treatment with MO methanolic leaf extracts significantly improved weight loss, polydipsia, glucose tolerance and also liver function tests in diabetic animals. MO has dose-dependent antidiabetic and hepatoprotective effects.