Levels Of Liver Function Tests Research Articles

Crimean-Congo Hemorrhagic Fever Mimicking Multisystem Inflammatory Syndrome in Children Associated With COVID-19: A Diagnostic Challenge

To the Editors: Crimean-Congo hemorrhagic fever (CCHF), which is endemic in our country, is a zoonotic disease characterized by fever and hemorrhage that may be severe and even fatal. The primary transmission route to humans is tick bite; however, other forms of transmission are also reported including direct contact with blood or other bodily fluids of infected animals, nosocomial and vertical transmission.1 The clinical diagnosis of CCHF is difficult to establish because symptoms are nonspecific in the prehemorrhagic phase of the disease and laboratory findings are similar to other childhood infectious diseases.1,2 Here, we report two cases with fever, elevated inflammatory markers, and multisystem organ involvement initially considered as multisystem inflammatory syndrome in children (MIS-C), but subsequently diagnosed with CCHF—highlighting the diagnostic challenge in distinguishing MIS-C from other infectious diseases. To our knowledge, no CCHF cases misdiagnosed as MIS-C have been reported to date. Case 1 A 9-year-old boy was referred to our clinic with a preliminary diagnosis of MIS-C because of persisting fever, abdominal pain, conjunctivitis and increasing levels of acute phase reactants despite intravenous antibiotic treatment. His mother had been diagnosed with coronavirus disease-2019 (COVID-19) 2 months prior to admission. On admission, he had tachycardia (130 beats/min), conjunctivitis and maculopapular rash. His laboratory examination revealed lymphocytopenia, thrombocytopenia and elevated levels of liver function tests, troponin, pro-brain natriuretic peptide (pro-BNP) and inflammatory markers including procalcitonin (Table 1). Although all MIS-C criteria were met, CCHF diagnosis was also suspected, despite lack of tick bite, since the patient had progressively decreasing platelet count, and had a history of living in an endemic area and his family was engaged in animal husbandry. Polymerase chain reaction (PCR) test for CCHF was positive, and the patient was treated and discharged without any complications. TABLE 1. - Clinical and Laboratory Findings of Patients Case 1 Case 2 Demographics Age, years 9 15 Gender Male Male Presenting symptoms Fever (duration) Yes (4 days) Yes (3 days) Abdominal pain Yes Yes Vomiting Yes Yes Diarrhea Yes Yes Headache No Yes Nonpurulent conjunctivitis Yes Yes Rash Maculopapular rash Malar rash Admission laboratory findings White blood cell count (×103/µL) 3.49 2.33 Absolute lymphocyte count (/µL) 730 460 Absolute neutrophil count (/µL) 2630 1410 Hemoglobin (g/dL) 14.3 15 Platelet count (/μL) 43,000 130,000 Ferritin (normal range: 6–40 ng/mL) 20,880 1940 D-dimer (normal range: 0–550 ng/mL) 18,100 2150 CRP (normal range: 0–4 mg/L) 78 37 LDH (normal range:140–260 IU/L) 787 455 Albumin level (g/dL) 2.9 4.6 AST/ALT (U/L) 120/115 98/68 Procalcitonin (< 0.5 ng/mL) 8 Not performed Troponin (< 0.05 ng/mL) 0.08 0.03 Pro-BNP (< 71 pg/mL) 160 Not performed Imaging results Abdominal ultrasound Normal Hepatosplenomegaly Echocardiogram Mitral regurgitation Normal Organ system involvement Cardiovascular ✓ No Respiratory No No Gastrointestinal ✓ ✓ Hematologic ✓ ✓ Renal No No Neurologic No No Dermatologic ✓ ✓ SARS-CoV-2 RT-PCR Negative Negative SARS-CoV-2 antibody Negative Negative History of COVID-19 exposure Yes Yes CCHF-related characteristics History of tick bite No No History of close contact with animals Yes Yes CCHF PCR Positive Positive Treatment Ribavirin Ribavirin ALT indicates alanine aminotransferase; AST, aspartate aminotransferase; BNP, brain natriuretic peptide; CCHF, Crimean-Congo hemorrhagic fever; COVID-19, coronavirus disease 19; CRP, C-reactive protein; LDH, lactate dehydrogenase; MIS-C, multisystem inflammatory syndrome; RT-PCR, reverse transcriptase polymerase chain reaction; SARS-CoV-2, severe acute respiratory system coronavirus 2. Case 2 A 15-year-old boy was referred to our hospital with a preliminary diagnosis of MIS-C because of having fever, conjunctivitis, gastrointestinal symptoms, elevated inflammatory markers and history of exposure to his father who had documented COVID-19 infection three months ago. On admission, he had fever, bilateral conjunctivitis, and malar rash. Laboratory analysis revealed lymphocytopenia and thrombocytopenia in addition to elevated inflammatory markers (Table 1). Detailed questioning revealed that he had a history of close contact with animals; however, history of tick bite was not present. On the following days, his fever persisted and platelet count continued to decrease. CCHF PCR was positive and he was treated successfully. To conclude, similar to MIS-C, clinical manifestations of CCHF include fever, headache, myalgia, rash, conjunctivitis, abdominal pain, nausea, vomiting and diarrhea.1,3 Detailed patient history and differential diagnosis are important to avoid unnecessary treatment and protect healthcare providers since infection control measures are essential in CCHF. Our two cases highlight that CCHF should be ruled out when evaluating possible MIS-C, even in the absence of tick bite history, especially in patients with progressive decline in platelet count, those living in endemic areas, and those with a history of close contact with animals.

English

The aim of this study was to evaluate the effect of Berberis vulgaris water extract (BWE) against CCl4-induced hepatotoxicity and LPS/PCM induced- hepatic inflammation in the experimental animal models. CCl4 (100 ug/kg, oral) administration for 28 days as well as the co-administration of LPS (250 ug/kg bw) and PCM (2 g/kg bw) for 28 days resulted in massive elevation in serum and hepatic prooxidants and inflammatory parameters (thiobarbituric acid reactive substances (TBARS), tissue tumor necrosis factor&ndash;alpha (TNF-&alpha;), interleukin 6 (IL-6) and IL-12 and nitric oxide (NO) with depletion in antioxidants system (superoxide dismutase (SOD) and glutathione peroxidase (GPx). These alterations were combined with elevation of serum liver function tests (alanine transaminase (ALT), aspartate transaminase (AST) and alkaline phosphatase level and (ALP). Oral administration of the BWE (100 mg/kg) for 15 days showed hepatoprotective and anti-inflammatory effects against both CCl4 and LPS/PCM as it increased the activities of antioxidants enzymes, decreased the prooxidants and inflammatory markers levels and improved the serum liver function tests levels. The obtained findings thus suggest that B. vulgaris aqueous extract has protective roles against hepatic toxicity and hepatic inflammation due to its antioxidant and anti-inflammatory properties. Key words: Carbon tetrachloride, paracetamol, lipopolysaccharide, glutathione peroxidase, alanine transferase.

MO422ACUTE KIDNEY INJURY AFTER HEART TRANSPLANTATION , INCIDENCE AND PREDICTIVE FACTORS

Abstract Background and Aims Abruptly decreased kidney function is one of the common scenarios after heart transplantation and the risk factors for renal dysfunction in this population can be various. The purpose of the present study was to determine the incidence and predictors for renal dysfunction among 126 patients in early postoperative heart transplantation period between January 2015 and November 2019. Method The study was conducted at the department of cardio-thoracic intensive care unit of an affiliated teaching hospital. 126 patients had cardiac transplantation surgery during four years. Information from these patients collected on a daily basis using standardized forms. Results Out of 126 heart transplant recipients 58.7 % (n=74) developed AKI and 10% (n=13) required renal replacement therapy after transplant. After performing univariate analysis, predictors of AKI were: age, duration of anesthesia, cold ischemia time, Voluven (Starch) dose, pre-operative BUN, creatinine and serum albumin, level of liver function tests, and Hemoglubin at three-days post-transplant and urine output of less than 200ml/ hour at six-hours post-transplant. Conclusion The findings of our study suggest that longer duration of graft ischemic time, history of previous cardiac operation and transfusion of more than four blood units can independently predict the chance of developing AKI following heart transplant. Therapies, which target these modifiable risk factors, may offer protection against this complication.

Changes in liver function test levels in HIV patients undergoing highly active antiretroviral therapy (HAART). Longitudinal study in Lima, Peru

Introduction: Estimating and monitoring changes in liver function tests is necessary to prevent the occurrence of chronic liver disease in HIV patients undergoing highly active antiretroviral therapy (HAART). Objective: To determine the variation liver profile test levels in HIV patients undergoing HAART. Materials and methods: Retrospective longitudinal study conducted in 100 HIV patients treated at the Hospital Nacional Hipólito Unanue, Lima, Peru, between 2015 and 2017. Patients in all stages of clinical infection under HAART and with liver function panel results for alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), and total protein (TP) were included. Three follow-up liver function tests (every 3 months) were performed while undergoing HAART and participants were categorized as having normal or elevated levels for all liver markers. Differences between the samples analyzed were determined using the paired-samples T test, with a 95% confidence interval and a significance level of p&lt;0.05. Results: Participants’ mean age was 33±9.56 years and 67% were male. Mean serum AST, ALT and ALP values decreased between the first and the third measurement (p=0.021, p=0.076 and p=0.002, respectively). No significant differences in GGT and TP levels were observed between the three measurements, nor between patients with normal and elevated AST, ALT, ALP and TP values, but significant differences were observed for GGT (p=0.010). Conclusions: Variations in liver marker levels were observed in all participants, with a decreasing trend in AST, ALT and ALP between the early and late stages of HAART, implying that this therapy could play a role in liver tissue damage.

Cytokine storm in severe COVID-19 pneumonia.

In this study, laboratorial parameters of hospitalized novel coronavirus (COVID‐19) patients, who were complicated with severe pneumonia, were compared with the findings of cytokine storm developing in macrophage activation syndrome (MAS)/secondary hemophagocytic lymphohistiocytosis (sHLH). Severe pneumonia occurred as a result of cytokine storm in some patients who needed intensive care unit (ICU), and it is aimed to determine the precursive parameters in this situation. Also in this study, the aim is to identify laboratory criteria that predict worsening disease and ICU intensification, as well as the development of cytokine storm. This article comprises a retrospective cohort study of patients admitted to a single institution with COVID‐19 pneumonia. This study includes 150 confirmed COVID‐19 patients with severe pneumonia. When they were considered as severe pneumonia patients, the clinic and laboratory parameters of this group are compared with H‐score criteria. Patients are divided into two subgroups; patients with worsened symptoms who were transferred into tertiary ICU, and patients with stable symptoms followed in the clinic. For the patients with confirmed COVID‐19 infection, after they become complicated with severe pneumonia, lymphocytopenia (55.3%), anemia (12.0%), thrombocytopenia (19.3%), hyperferritinemia (72.5%), hyperfibrinogenemia (63.7%) and elevated lactate dehydrogenase (LDH) (90.8%), aspartate aminotransaminase (AST) (31.3%), alanine aminotransaminase (ALT) (20.7%) are detected. There were no significant changes in other parameters. Blood parameters between the pre‐ICU period and the ICU period (in which their situation had been worsened and acute respiratory distress syndrome [ARDS] was developed) were also compared. In the latter group lymphocyte levels were found significantly reduced (p = 0.01), and LDH, highly sensitive troponin (hs‐troponin), procalcitonin, and triglyceride levels were significantly increased (p < 0.05). In addition, there was no change in hemoglobin, leukocyte, platelet, ferritin, and liver function test levels, including patients who developed ARDS, similar to the cytokine storm developed in MAS/sHLH. COVID‐19 pneumonia has similar findings as hyperinflammatory syndromes but does not seem to have typical features as in cytokine storm developed in MAS/sHLH. In the severe patient group who has started to develop ARDS signs, a decrease in lymphocyte level in addition to the elevated LDH, hs‐troponin, procalcitonin, and triglyceride levels can be a predictor in progression to ICU admission and could help in the planning of anti‐cytokine therapy.

Lysyl oxidase like protein-2 (LOXL-2); a novel marker for prediction of intrahepatic cholestasis of pregnancy

Objective Lysyl oxidase like protein 2 (LOXL-2) is an enzyme that is involved in the development of hepatic fibrosis and bile duct epithelial injury in hepatic cholestasis. Our aim was to investigate maternal serum levels of LOXL-2 and their relationship with fasting total bile acid (FTBA) levels in patients with intrahepatic cholestasis of pregnancy (ICP). Materials and methods Thirty-five pregnant women with ICP and 35 healthy women with uncomplicated pregnancies as the control group, were included in this cross-sectional study. Maternal serum LOXL-2, FTBA and other liver function test levels were compared between the two groups. The predictive cutoff value for LOXL-2 level in ICP was specified. Results Serum LOXL-2 levels were found to be higher in the ICP group compared to the control group (225.699 ± 142.453 vs. 127.731 ± 63.419 pg/mL, p = .001). There was a significant positive correlation between serum LOXL-2 levels and FTBA levels (r = 0.330, p = .003). The optimal cutoff point for LOXL-2 for identifying increased risk of ICP was found to be ≥102 pg/mL, for which the sensitivity and specificity were 96.87% and 48.57%, respectively (p < .001). Conclusions Maternal serum LOXL-2 levels were significantly higher in women with ICP. LOXL-2 may be both an initiating factor in the pathophysiology of ICP and a marker in the prediction. It may also be a target in terms of preventing strategies in ICP.

A study of serum levels of prostate specific antigen, prostate acid phosphatase in prostate cancer patients and its complications on liver

Background: The prostate cancer (PC) is most leading disorders in human beings particularly in males. Prostate specific antigen (PSA) and prostate acid phosphatase (PAP) are tumor markers useful for early detection and diagnosis of PC. In prostate cancer patients more prone to liver and bone cancer metastasis because in these patients elevated levels of serum liver function tests (LFT) and these liver enzymes more specific for early detection of pathological changes in liver and bones.Methods: This is the case control study was carried out the association of serum levels of PSA/PAP inpatients with prostate cancer and healthy controls. Total 120 subjects included in this study in that 60 PC patients and 60 controls was included and blood was collected. The serum PSA levels are estimated by ELISA, PAP estimated by Kinetic method and LFT Was analyzed by commercial kits. Results: The present study evaluates the serum levels of LFT, PSA and PAP in patients with prostate cancer and compared with the healthy controls. The statistically significant difference between the PSA, PAP and LFT levels in patients with PC when compared to controls. The positive correlation in between PSA, PAP with LFT (p=0.001).Conclusions: This study suggesting that the serum PSA, PAP levels sensitive parameters for early detection of prostatic cancer and also for these patients’ frequent measurements of serum liver function tests, useful for early detection of significant pathological changes occurs in the liver and bone cancers metastasis from prostate.

Association of serum amylase and lipase levels in newly diagnosed type 2 diabetes mellitus

Background: Type 2 diabetes mellitus is a chronic metabolic disorder due to insulin resistance caused by destruction of beta cells of pancreas. Insulin resistance in newly diagnosed type 2 diabetes mellitus patients leads to hyperglycemia. Serum amylase and lipase levels is an exocrine enzyme produced by acinar cells of pancreas. Altered levels of serum amylase and lipase leads to endocrine disorders, metabolic syndrome and diabetes mellitus.Methods: This is a case-control study conducted in Akash Institute of Medical Sciences, A total 100 subjects (50 cases and 50 controls). All the subjects included after informed consent, blood samples are collected from the all the subjects. The serum amylase and was estimated by using enzymatic commercial available kits and fasting blood sugar (FBS), post-parandial blood sugar (PPBS), renal function test (RFT) and liver function test (LFT) was also estimated by laboratory standard methods.Results: This study evaluated the FBS, PPBS, RFT, LFT, Amylase and Lipase levels in patients with newly diagnosed type 2 diabetes mellitus patients and compare them with healthy controls. The serum amylase and lipase levels more significantly elevated in newly diagnosed type 2 diabetes mellitus patients and compared with the healthy controls. The study also found that significantly elevated levels of FBS, PPBS, RFT and LFT in newly diagnosed type 2 diabetes mellitus patients and compared with the healthy controls, The statistically significant levels of serum amylase and lipase levels in patients with newly diagnosed type 2 diabetes mellitus when compared with the controls (p=0.0001).Conclusions: The study suggesting that to estimation of serum amylase and lipase levels in newly diagnosed type 2 diabetes mellitus patients useful for early detection of diabetes mellitus and its complications. Because elevated levels of serum amylase and lipase in patients with newly diagnosed type 2 diabetes mellitus, these levels are positively correlated with the FBS and PPBS.

Heat precondition is a potential strategy to combat hepatic injury triggered by severe heat stress

AimEnvironmental heat stress alters physiological and biochemical functions which leads to multiorgan dysfunction including severe hepatic injury in animals. We hypothesize that heat preconditioning can be potential intervention in combating heat illnesses. Main methodsSprague Dawley rats were exposed to moderate heat stress, severe heat stress and heat preconditioning in heat simulation chamber. Mean arterial pressure, heart rate, skin and core temperature were monitored in pre and post heat exposed animals. After stress exposure, blood for hemodynamic and liver tissue for liver function tests, oxidative stress, inflammatory variables and structural studies were collected from rats. Hepatic mitochondria were isolated to study the key structural alterations and functional changes by transmission electron microscopy. Key findingsThe effect of heat precondition shows improvement in time to attain the core temperature, weight loss, blood pressure and heart rate in rats. Results exhibited decreased levels of liver function tests, elevated levels of free radicals and inflammatory cytokines in heat exposed liver as compared with heat preconditioned animals. Expression levels of mitochondrial heat shock protein 60, superoxide dismutase 1 and uncoupling protein 1 along with activity of electron transport chain complexes I-V were examined and found to be increased in heat preconditioned as compared to heat stressed animals. Morphological studies of liver parenchyma demonstrated reduction in structural deterioration of hepatic lobules and restoration of mitochondrial structural integrity in heat preconditioned rats. SignificancePresent study suggests that heat preconditioning intervention plays a crucial role in protection against heat induced hepatic injury in animals.

A Cohort Study of Liver Involvement in Patients With Adult-Onset Still's Disease: Prevalence, Characteristics and Impact on Prognosis.

Objective: Adult-onset Still's disease (AOSD) is a systemic disorder commonly accompanied by liver involvement. This study aims to illustrate the detailed information of liver abnormalities in patients with AOSD and evaluate the impact on the prognosis.Methods: A total number of 128 hospitalized patients, who met the Yamaguchi criteria of AOSD in the Department of Rheumatology and Immunology, Ruijin Hospital from July 2016 to August 2019 were consecutively enrolled and followed up. The demographic characteristics, clinical features, laboratory tests, treatments and prognosis were recorded. Correlations of liver function tests (LFTs) with disease activity and laboratory parameters were analyzed by the Spearman test. Risk factors of the refractory AOSD were evaluated by multivariate logistic regression analysis.Results: Liver involvement was presented in 104 (81.3%) patients with AOSD. We observed that 34 (32.7%) patients were with mild elevation, 32 (30.8%) patients were with moderate elevation, and 38 (36.5%) patients were with severe elevation. The majority of elevated ALT, AST and ALP decreased to normal within the range of 2 months, except for GGT. Furthermore, the LFTs were found significantly correlated with disease activity. Besides, we found patients with higher levels of LFTs tended to require more intensive treatments and suffered from poorer prognosis. Multivariate logistic regression analysis showed ALP ≥ 141 IU/L and GGT ≥ 132 IU/L are independent risk factors of refractory AOSD.Conclusion: Liver involvement is common in patients with AOSD, the levels of LFTs are associated with disease activity and related to the treatment strategies and prognosis.

Possibilities for correcting hepatotoxic reactions during therapy in patients with COVID-19 (case report)

In 2020, a pandemic of the new coronavirus infection (COVID-19) began. Treatment of this infection is limited by the lack of effective etiological treatment, which requires the selection of empirical and symptomatic therapy. The obtained some effectiveness of the use of antimalarial drugs, antiretroviral drugs in combination with antibacterial therapy made it possible to recommend it for use in the treatment regimen for patients with COVID-19. However, these drugs provoke the development of undesirable side reactions that require correction to continue treatment. Considering the need to use complex therapy in the treatment of patients with COVID-19 and the direct effect of the virus on liver cells, the likelihood of developing hepatotoxicity is quite high. The described cases of liver damage are characterized by impaired functional activity, an increase in the level of liver function tests, the development of small-drop fatty infiltration and a mild inflammatory reaction in the liver lobules. The development of these complications requires the hepatoprotective drugs, which increase the liver’s resistance to the damaging effects of various pathogens and help restore the functional activity of hepatocytes. According to the conducted studies, hepatotropic drug inosine+ + meglumine + methionine + nicotinamide + succinic acid and reamberin contribute to the normalization of lipid metabolism, a decrease in the level of enzyme markers of liver damage. The article presents the complex treatment with lopinavir + ritonavir. Thanks to hepatoprotective therapy, a week later, a decrease in ALT, alpha-amylase, blood counts to normal values was achieved.

Protective effect of Toxocara vitulorum extract against alpha-naphthylisothiocyanate-induced cholangitis in rat

BackgroundCholestasis is the major cause of bile acid accumulation leading to liver damage. Chronic infection of worms can modulate the immune response towards T helper (Th)2-related cytokines. The present study aims to evaluate the protective impact of an ascarid nematode Toxocara vitulorum extract (TvE) against alpha-naphthylisothiocyanate (ANIT)-induced cholangitis male wistar rat model compared to ursodeoxycholic acid (UDCA) as a standard drug.ResultsPretreatment with TvE and/or UDCA induced a marked reduction in the levels of liver function tests and malondialdehyde, while antioxidant markers were increased compared to cholestatic rats. Pretreatment with either TvE or combination before cholangitis induction attenuated the predominant Th1-related cytokines (IFN-γ and TNF-α) to Th2 (IL-13 and IL-10). TvE administration promoted higher expression levels of Bcl-2 protein and lower levels of caspase-3 compared to cholestatic rats.ConclusionsTreatment with TvE has improved the liver functions and elevated the levels of oxidative stress markers. The upregulation of Th2-related cytokines and suppression of apoptosis through caspase-3 might be considered as a potential mechanism of TvE. Thereby, this natural extract revealed an opportunity for use in treatment of cholangitis disease.

Abstract 14229: Hepatobiliary Markers in Minority Heart Failure Patients; Echocardiography and Clinical Outcomes

Introduction: AHA sponsored guidelines and studies have focused on cardiac disease and particular heart failure (HF) profiles among minorities like African, Hispanic, and Asian Americans. Previous studies on liver function tests (LFT) in HF patients, like aspartate and alanine aminotransferase (AST, ALT), alkaline phosphatase (ALP), and bilirubin (Bili), have underrepresented minority groups in study cohorts. We investigated the relationship between LFT levels with echocardiographic (ECHO) findings and readmission outcomes among minority patients at the Heart Health Center (HHC) of NYC Health + Hospitals, Kings County, in Brooklyn, New York. Hypothesis: In minority HF patients, LFT levels are associated with ECHO parameters, and LFT abnormalities are associated with increased risk of admission. Methods: Retrospective review was performed of patients in the HF clinic at the HHC, and during acute HF exacerbation admission from November 2017 - November 2018, with hospitalization monitored through November 2019. Baseline and admission LFT levels were obtained. While abnormal AST, ALP, and Bili levels were classified by the hospital’s laboratory range, abnormal ALT levels were classified based on national gastroenterology guidelines. Regression analysis was used to examine the relationship between LFT levels during acute HF exacerbation and ECHO parameters. Odds ratio (OR) and confidence interval (CI) were used for analysis of readmission outcomes. Results: Among 586 HF patients, there was an increased risk of hospitalization with baseline elevations in AST (OR 2.30, CI 1.24 - 4.25, p = 0.008) and ALP (OR 1.99, CI 1.10 - 3.64, p = 0.023). In those hospitalized with acute HF (n = 147), Bili was positively correlated with mitral valve (MV) EA ratio (r = 0.28, p = 0.002) and tricuspid regurgitation max velocity (r = 0.21, p = 0.004). ALT positively correlated with mean MV e’ velocity (r = 0.23, p = 0.009) and negatively correlated with aortic valve (AV) mean velocity (r = -0.24, p = 0.001). Conclusions: Understanding the association of ECHO findings and risk of hospitalization in minority patients with baseline and acute HF LFT levels has crucial implications for the identification of high risk patients and for the development of patient centered HF care strategies.

Elevated aspartate aminotransferase and alanine aminotransferase in the torsion of ovarian mature cystic teratoma: normalised after operation for torsion

The aim of the study was to report the elevated liver function test levels in torsion of ovarian mature cystic teratoma (MCT). A retrospective review was performed of 116 patients with MCT who underwent surgery in our hospital between 2010 and 2017. Eleven of 116 patients were with torsion of MCT. Of the 11 torsion of MCT cases, 6 of those showed abnormal elevated levels of aspartate transaminase (AST)/alanine aminotransferase (ALT). After operation, AST/ALT levels recovered to normal ranges. Elevated liver function levels require attention to complications associated with anaesthesia and emergency operation. However, the current report shows that emergency surgery should not be delayed to assess other causes of elevated liver function tests. Impact statement What is already known on this subject? Abnormal liver function tests require attention to complications associated with emergency surgery. What do the results of this study add: Our study shows that some patients with torsion of MCT returned to normal levels of AST/ALT after surgery without any medications to improve liver function. What are the implications of these findings for clinical practice and/or further research? This study would offer that in some cases with torsion of MCT, emergency surgery should not be delayed and the assessment of other possible causes of these elevations postponed to postoperative period. Additional studies are required to assess the correlation between elevated AST/ALT levels and torsion of MCT.

Prophylactic Chemotherapy with Methotrexate Leucovorin in High-Risk Hydatidiform Mole.

Aim:Gestational Trophoblastic Neoplasia (GTN) is used to describe a group of malignant gestational tumors originating from the placenta. The chance of having malignant GTN is high in a high-risk molar pregnancy. The main aim of this study is to investigate the effectiveness of using prophylactic chemotherapy in high-risk molar pregnancy to prevent malignant GTN. Method:In this case-control retrospective study, all patients with high-risk mole referred to Firoozgar and Akbarabadi Hospitals affiliated with Iran University of Medical Sciences (IUMS) from 2003 to 2013 were divided into two groups of recipient and non-recipient of methotrexate prophylactic chemotherapy.Demographic information including age, parity, weight, serum βHCG before and after the intervention, level of liver function tests (LFT) and GTN were analyzed. Results:There were 102 patients with a mean age of 27.13 years (SD= 0.37), and 51 patients (50 %) received prophylactic Methotrexate (MTX), and others were the non-receivers. Finally, 23 patients (22.5%) were inflicted with GTN, and 79 (77.5 %) did not. The average time of βHCG spontaneous remission between the groups were 2.5 (SD=1.33) and 3.2 (SD=1.21), for the recipient and non-recipient, respectively, which showed a significant difference (p). Conclusion:This study concludes that prophylactic chemotherapy with MTX and leucovorin may be capable of reducing GTN, which supports the prescription of MTX in high-risk mole, especially in countries with limited resources. The toxicity of methotrexate can be reduced with the addition of leucovorin.

No evidence for association between cutaneous lichen planus and hepatitis B and C virus infection in south Poland - a case-control study.

The incidence of hepatitis C virus (HCV) infection among patients with lichen planus (LP) varies considerably. Currently, there is more evidence for the association between hepatitic C and oral LP (OLP) than cutaneous LP (CLP). There is also lack of data on the Polish population. The study aimed at assessing the prevalence of HCV infection and liver test abnormalities among patients with CLP in south Poland. Eighty-four patients with CLP and 130 patients with other dermatoses (controls) were included in this retrospective case-control study. Medical records were reviewed for the presence of anti-HCV antibodies and hepatitis B surface antigen (HBsAg) and serum levels of liver function tests: aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma-glumatyltranspeptidase (GGT). Anti-HCV antibodies were not found in any of the patients in the study or control group. HBsAg was detected in one (1.19%) patient with CLP and none of the controls. Considering the prevalence of abnormal liver function parameters, there were no statistically significant differences in the frequencies of AST (P=0.87), ALT (P=0.9), and GGT (P=0.81) above the upper limit between patients with CLP and patients with other dermatoses. Currently, there is no evidence confirming the relationship between HCV infection and CLP in southern Poland. There is also no increased incidence of liver function abnormalities compared to patients with other dermatoses. However, there is a need for further research on larger groups of patients.

Effect of Ascorbic Acid Supplementation on Liver Function Tests in Hepatitis C Patients

An isolated liver function test is of little role in selection of liver disease because many harmful liver diseases may be correlated with normal levels of LFT’s. The outline of enzyme abnormalities in the perspective of patient’s commonly observed symptoms and laboratory data might be helpful in directing the subsequent diagnosis of liver diseases. Liver Function Tests (LFTs) are most generally used screening blood tests for assessment of different liver diseases and these tests provide a lot of evidence for disease processes whether for the purpose of investigation of supposed liver disease or help in observing the progress of disease action or simply by blood investigation. The evaluation of different liver enzymes simply gives diagnostic information on basic level whether patient’s principal disorder is actually hepatitis or cholestasis in source. However, it is necessary in various cases to evaluate LFTs with knowledge of liver functioning enzyme fractions. The objective of this study was to explore the effects of ascorbic acid supplementation on serum liver function tests in Hepatitis C patients. A total of 100 hepatitis C patients were selected randomly. 50 were given ascorbic acid supplementation for one month along with anti HCV treatment. The other 50 HCV patients took their normal anti HCV treatment without intake of ascorbic acid supplementation, and serum ascorbic acid level and liver function test parameters were observed before and after intake of ascorbic acid in both groups. The liver function parameters determined were aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), serum total bilirubin, direct bilirubin, indirect bilirubin and serum protein (total protein, albumin, globulin and A/G ratio). These parameters along with serum ascorbic acid were measured before and 30 days after vitamin C supplementation. Various abnormally elevated LFTs were also improved more rapidly when compared to other group which was not given ascorbic acid supplements for the period of one month. There was a significant change in levels of some liver function parameters before and after intake of ascorbic acid supplementation, and various abnormally elevated LFTs were also improved when compared to other group which was not given ascorbic acid supplements for the period of one month. The effect of Vitamin C supplementation was more marked on serum aminotransferase levels. After one-month use of ascorbic acid, serum alanine aminotransferase (p < 0.042) and serum aspartate aminotransferase (p < 0.000) levels were significantly decreased in hepatitis C patient group. In HCV group with ascorbic acid supplementation, serum total bilirubin (p < 0.046) and serum direct bilirubin (p < 0.048) were found to be less than the pre values when compared to HCV group without ascorbic acid supplementation. It was also observed that some of protein values were suggestively improved after intake of ascorbic acid supplementation.

한방병원에 입원한 환자 147명의 간기능 검사에 대한 후향적 관찰

The purpose of this study was to evaluate the changes of liver function test before and after treatment in patients admitted to Korean medicine hospital. We checked liver function test level (aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, total bilirubin, direct bilirubin) of 147 patient who admitted in Korean medicine hospital from July 1, 2015 to June 30, 2018. The subjects were selected those who took herbal medicine continuously during the admission period and who performed liver function test on admission and before discharge. And the subjects were excluded those who had a history of liver and biliary disease at the time of admission or who took hepatoprotectants. Aspartate aminotransferase, alanine aminotransferase and alkaline phosphatase significantly decreased compared with the values of admission(p 0.05). On admission 31 patients(21.1%) had abnormal liver function and 6 patients(4.1%) had liver injury while 19 patients(12.9%) had abnormal liver function and 6 patients(4.1%) showed liver injury before discharge. This study suggests that herbal medicine may not injure liver function.

Analysis of prescription pattern of the fentanyl citrate sublingual tablets according to liver or kidney function abnormality of cancer patients.

119 Background: Many advanced cancer patients eventually develop liver dysfunction or renal insufficiency during the course of their disease. However, there is limited evidence for optimally safe drug for pain control in these situation. To estimate the safety of fentanyl citrate sublingual tablets (FSTs) in kidney or hepatic dysfunction, we analyzed whether the total prescription dose or prescription period of FSTs is associated with their liver function test (LFT) or estimated glomerular filtration rate (eGFR). Methods: We retrospectively enrolled consecutive cancer patients who prescribed FSTs at least once from July 2015 to June 2017. Results: Total 611 patients were identified. Median age was 63.6 (18-89) years. Total dose of prescribed FSTs is vary widely among pts; mean 23330 ± 42111 mcg, median 8400 mcg. About kidney function, eGFR could be calculated in 523 patients (85.6%). In 80 pts (15.3%), eGFR is below 60 mL/min/1.73 m2. The total dose of prescribed FSTs have no significant correlation with grade of CKD. The duration of prescription of FSTs was shorter in patients with eGFR &lt; 60 in compared to those with eGFR ≥60; median 42 days versus 66 days (p &lt; 0.001). On the other hand, 535 pts (87.6%) have result of LFT prior to be prescribed FSTs. Significant LFT abnormality is found in 158 pts (29.5%). The total dose of prescribed FSTs have weak negative correlation with LFT level (p &lt; 0.001). The total dose of FSTs is significantly lower in pts with G3/4 LFT abnormality in compared to those with normal or G1/2 LFT abnormality. The duration of prescription of FSTs was significantly shorter in patients with G3/4 liver dysfunction in compared to those with normal or G1/2 liver dysfunction; median 30 days versus 83 days (p = 0.002). In the multivariate analysis, both G3/4 LFT and decreased eGFR are significant factors for shorter duration of prescription by the Cox proportional hazard model. Conclusions: When cancer patients have renal insufficiency or significant liver dysfunction, FSTs were used in a smaller dose for a shorter period of time. We need prospective study on the efficacy and safety of FSTs in cancer patients with liver dysfunction or renal insufficiency.

Biochemical effects of Cigarettes Smoking on Liver functions of Sudanese diabetics smokers

The present study was conducted in Khartoum state (Sudan) as a cross-sectional study in 200 participants (100 smokers and 100 non-smokers), to investigate the effects of Cigarettes Smoking on Liver functions of Sudanese smokers. The smokers were categorized into either current smokers (70 participants) or past smokers (30 Participants). Parameters were analyzed by using spectrophotometer. From the results, the levels of liver function tests (TB, Albumin and globulin) were significantly higher in non-smokers (6.0, 3.6 and 2.43 g/dl) as compared to current smokers (4.4, 2.4 and 1.98 g/dl) and past smokers (4.7, 2.7 and 1.93 g/dl). Meanwhile, ALT was significantly increased in current and past smokers as compared to non-smokers, where as AST was significantly higher in current smokers as compared to non-smokers, while there was no significant difference between current and past smokers as well as between past and non-smokers for this parameter. In addition, heavy and long duration of smoking were both associated with low total protein, albumin and AST levels .Also liver function tests were not significantly differing in current smoker's non-diabetics and non-smokers diabetics except total protein. From the results when, liver enzymes raised that may lead to increase proteins metabolism and increase blood glucose. These signs may place cigarettes smoking one of the top causes of hepatitis, pancreatitis, insulin resistance and finally diabetes mellitus type II. On the other hand, smoking cessation in diabetics lead to decrease the risk of hepatitis, Also regular physical activity and using medication regularly in diabetics lead to the same actions above; in addition diabetes complications were decreased.