Levels Of Liver Function Tests Research Articles

أثر المواد البترولية علي وظائف الكبد لدي العاملين بمحطات تزويد الوقود بمدينة الأبيض - السودان

قد تبين حديثا أن التعرض للمواد البترولية لفترات زمنية طويلة قد تشكل خطراً صحياً على صحة الإنسان خاصة بالنسبة لوظائف الكبد، الكلى، الدورة الدموية، جهاز المناعة والجهاز التناسلي. الهدف من هذه الدراسة هو التعرف على الآثار التي تسببها المواد البترولية على وظائف الكبد خاصة بالنسبة للعاملين في محطات تزويد الوقود بعد العمل لفترة زمنية أكثر من عام. أجريت هذه الدراسة المقطعية الوصفية في الفترة ما بين أكتوبر 2015 حتى أغسطس 2016 لتقويم مستويات وظائف الكبد في بلازما الدم للعاملين في محطات تزويد الوقود بمدينة الأبيض. تم اختيار 37 عاملاً كمجموعة اختبار(تجريبية) ومقارنتهم مع 30 متطوعاً أصحاء ظاهرياً كمجموعة ضابطة، حيث تم جمع عينات الدم من كلتا المجموعتين ومن ثم تم تحديد مستويات البروتين الكلي، الزلال، اليرقان الكلي والمباشر وإنزيم الألانين أماينوترانسفيريز باستخدام جهاز قياس الأطياف الضوئية. وأظهرت نتائج الدراسة زيادة ذات دلالة إحصائية في متوسطات مستويات الزلال وإنزيم الألانين أماينوترانسفيريز في مجموعة الاختبار عند مقارنتها مع المجموعة الضابطة، ولا يوجد اختلاف ذو دلالة إحصائية في متوسطات مستويات البروتين الكلي، اليرقان الكلي واليرقان المباشر وغير المباشر في مجموعة الاختبار عند مقارنتها مع المجموعة الضابطة. وأيضا أشارت نتائج هذه الدراسة إلى عدم وجود علاقة ارتباط ذات دلالة إحصائية بين فترة التعرض للمواد البترولية بالسنوات مع مستويات الزلال، إنزيم الكبد، البروتين الكلي واليرقان المباشر وغير المباشر. وفي الختام أشارت نتائج هذه الدراسة إلى وجود ضعف في وظائف الكبد وربما يعزى ذلك لأثر التعرض إلى المواد البترولية لفترة زمنية طويلة، وبذلك نوصي بتحسين بيئة العمل والفحص الدوري لتفادي مضاعفات أمراض الكبد بالنسبة للعاملين في محطات تزويد الوقود.

Protective role of thymoquinone against paraquat-induced hepatotoxicity in mice

Paraquat is a common and effective herbicide; although its poisoning could lead to severe oxidative organ damages and its main target organs are the lungs, kidneys, heart, and liver. Thymoquinone is the active ingredient of Nigella sativa which is traditionally used in herbal medicine; recent studies have shown that thymoquinone could inhibit oxidative stress. This study explores protective effects of thymoquinone on paraquat-induced hepatotoxicity in mice. Accordingly, adult male mice were randomly divided into nine groups for three continuous days intraperitoneal injection treatment: (1) control; (2) solvent; (3) 20 mg/kg vitamin E; (4) 20 mg/kg thymoquinone; (5) 20 mg/kg paraquat and Groups 6, 7, 8, and 9 received 20 mg/kg of vitamin E and 5, 10, and 20 mg/kg of thymoquinone, respectively. The last four groups, received 20 mg/kg paraquat just 24 h after pretreatments. We assessed serum liver enzymes activities, liver histopathology changes, oxidative (lipid peroxidation) and antioxidative (ferric reducing antioxidant power) potential, superoxide dismutase (SOD) and catalase activity, and total thiol groups content after administration of the poison and treatments. Pretreatment with 10 mg/kg thymoquinone inhibited, safely, the elevations in levels of liver function tests (LFTs) and lipid peroxidation, restored the activity of SOD, and ameliorated the histopathological alterations induced by paraquat. Eventually, our results indicate that thymoquinone performs its hepatoprotective role in mice by prevention of SOD suppression mediated by paraquat.

Association of Serum 25-hydroxyvitamin D Levels and Liver Enzymes in a Nationally Representative Sample of Iranian Adolescents: The Childhood and Adolescence Surveillance and Prevention of Adult Noncommunicable Disease Study.

Background:Hypovitaminosis D is highly prevalent and has several adverse health effects. This study aims to assess the relationship of serum concentrations of 25-hydroxyvitamin D (25[OH] D) and liver enzymes in adolescents.Methods:This population-based cross-sectional survey was conducted among a nationally representative multistage sample of 1095 adolescents (52% boys), aged 10–18 years, living in different provinces of Iran. Serum 25(OH)D concentration <30 ng/mL was considered as hypovitaminosis D, and liver enzymes (alanine aminotransaminase [ALT] and aspartate aminotransaminase [AST]) of >40 U/L was considered as high level. To determine the association between serum 25(OH)D categories and elevated levels of liver enzymes, multiple regression models and linear regression analysis were applied, after adjustment for potential confounders. Odds ratios (95% confidence interval) of serum 25(OH)D and elevated liver enzymes were assessed by logistic regression analysis.Results:Higher rates of Vitamin D deficiency were documented among individuals with increased levels of liver enzymes. Compared to boys, median of 25(OH)D was lower in girls with elevated levels of liver function tests (12.75 vs. 25.60 ng/mL for ALT and 13 vs. 14.10 ng/mL for AST), with marginally significant gender differences regarding AST.Conclusions:We found a relatively high frequency of hypovitaminosis D among adolescents with abnormal liver function. Further prospective studies are needed to examine these associations from early life.

A Case Report of Suggested Liver Dysfunction by Atorvastatin Treated with Saenggangeonbi-tang

Objective: A general prejudice exists that all herbal medicines are not good for liver. We report that herbal medicine can have positive effects on the liver, based on the improved liver function test levels observed in one patient. We also suggest the effectiveness of co-administration of herbal an...

Prognostic value of pretreatment serum alanine aminotransferase/aspartate aminotransferase (ALT/AST) ratio and gamma glutamyltransferase (GGT) in patients with esophageal squamous cell carcinoma

BackgroundThe levels of liver function tests (LFTs) are often used to assess liver injury and non-liver disease-related mortality. In our study, the relationship between pretreatment serum LFTs and overall survival (OS) was evaluated in esophageal squamous cell carcinoma (ESCC) patients.MethodsOur purpose was to investigate the prognostic value of the preoperative alanine aminotransferase/aspartate aminotransferase (ALT/AST) ratio and gamma glutamyltransferase (GGT) in ESCC patients. A retrospective study was performed in 447 patients with ESCC, and follow-up period was at least 60 months until death. The prognostic significance of serum LFTs were determined by univariate and multivariate Cox hazard models.ResultsLFTs including ALT, AST, LSR, GGT, TBA and LDH were analyzed. Serum LSR (HR: 0.592, 95% CI = 0.457–0.768, p < 0.001 and GGT (HR: 1.507, 95% CI = 1.163–1.953, p = 0.002) levels were indicated as significant predictors of OS. The 5-year OS among patients with higher LSR levels was longer compared with those patients with decreased LSR levels, not only in the whole cohort but also in the subgroups stratified by pathological stage (T1–T2 subgroup, T3–T4 subgroup, N0 subgroup and M0 subgroup). We also found that patients with a higher GGT might predict worse OS than patients with a normal GGT, not only in the whole cohort but also in the subgroups stratified by pathological stage (T3–T4 subgroup and N1-N2 subgroup).ConclusionsBoth increased levels of LSR and decreased levels of GGT might predict shorter overall survival in ESCC patients. Our findings suggest that serum LSR and GGT levels could be used as a key predictor of survival in patients with ESCC.

Effects of the Obesity Therapy with Korean Herbal Medicine on Liver Function: Case Series

Many obesity patients were affected by depressed liver function including hepatosteatosis. The aim of this study was to investigate the clinical effect of the obesity therapy with Korean herbal medicine (KHM) on obese patient with abnormal liver function. This is a retrospective observational study performed on obesity patients with abnormal liver function. All subjects have taken serum liver function tests (LFTs) before treatment. Ten patients showed abnormal LFTs. They were treated with KHM at least 15 days. During this treatment, LFTs were evaluated afterwards. Body weight and body mass index of the patients were decreased during treatments. Five of 10 subjects recovered normal levels of LFTs. While other subjects remained at abnormal level but their levels were decreased. This study shows that the obesity therapy including KHM could be effective to improve liver function on obese patient. Additional large scale studies are necessary for more evidences.

Liver function in alpha-1-antitrypsin deficient individuals at 37 to 40 years of age.

Severe alpha-1-antitrypsin (AAT) deficiency (PiZZ) is a risk factor for liver disease, but the prevalence of liver cirrhosis and hepatocellular cancer in PiZZ adults is unknown. The risk of liver disease in adults with moderate AAT deficiency (PiSZ) is also unknown. A cohort of 127 PiZZ, 2 PiZnull, 54 PiSZ, and 1 PiSnull individuals were identified by the Swedish national neonatal AAT screening program between 1972 and 1974, when all 200,000 newborn infants in Sweden were screened for AAT deficiency. The cohort has been followed up since birth. Our aim was to study liver function and signs of liver disease in this cohort at 37 to 40 years of age in comparison with a matched, random sample of control subjects identified from the population registry.Eighty seven PiZZ, 32 PiSZ, and 92 control subjects (PiMM) answered a questionnaire on medication and alcohol consumption and provided blood samples. Liver stiffness was assessed by Acoustic Radiation Force Impulse (ARFI) elastography in 32 PiZZ, 15 PiSZ, and 51 PiMM subjects.The median of liver function tests and procollagen-III-peptide were within the normal range in all Pi subgroups. However, the PiZZ men had significantly higher plasma bilirubin than the PiMM men (P = 0.018). Plasma ɣ-glutamyl transferase (GGT) was significantly higher in the PiZZ men (P = 0.009) and the PiSZ men (P = 0.021) compared with the PiMM men. The median of liver stiffness was significantly higher in the PiZZ men (P = 0.037) and the PiSZ men (P = 0.032) compared with the PiMM men. The PiZZ women taking medication influencing liver enzymes had significantly higher GGT than the PiMM women on the corresponding treatment (P = 0.023).These AAT-deficient individuals identified by neonatal screening have normal plasma levels of liver function tests, and no clinical signs indicating liver disease at the age of 37 to 40 years. However, bilirubin, GGT, and liver stiffness are significantly higher in PiZZ men than PiMM men.

De Novo Donor-Specific Anti–Human Leukocyte Antigen Antibody Detection in Long-Term Adult Liver Transplantation

IntroductionInformation about the consequences of de novo donor-specific anti-human leukocyte antigen (DSA) antibody development in the long term after adult liver transplantation (LT) is scarce. We conducted a cross-sectional study in LT patients with a follow-up of at least 6 years. MethodsA total of 28 adult LT patients were included, with a median follow-up of 77 months (range, 63 to 96) and without preformed anti- human leukocyte antigen (HLA) antibodies prior to LT. The anti-HLA identification was performed with LABScreen Single Antigen, whereas the ability to fix the complement was demonstrated with C1q test (One Lambda). In both assays, a value >3.500 mean fluorescence intensity (MFI) was considered positive. The anti-HLA antibody specificities were compared with donor HLA antigens to confirm them as DSA. Hepatic fibrosis was assessed by transient elastography. ResultsIn 5 patients (17.8%), de novo DSA were detected, all them against DQ locus. In all of these cases (100%) the complement fixation was confirmed by C1q binding. The grade of hepatic fibrosis in de novo DSA patients was significantly higher compared with No-DSA patients (13.2 ± 9.2 KPa vs 7.3 ± 3.7 KPa; P = .02). It is noteworthy that in both groups of patients the levels of liver function tests (LFT) at the time of the study were normal or near the normal range with no difference between patients with or without de novo DSA. ConclusionsOur preliminary results are consistent with those previously demonstrated in pediatric LT, where de novo DSA production and humoral response could contribute to the liver fibrosis observed in the long term after LT in pediatric patients with normal or near-normal LFT.

Combined Hepatoprotective Activity of Murraya koenigii and Phyllanthus niruri Extracts Against Paracetamol Induced Hepatotoxicity in Alcoholic Rats

The present study elucidated the hepatoprotective activity of combination of alcohol water extracts (AWEs) of Murraya koenigii (AWEMK) and Phyllanthus niruri (AWEPN) leaves against paracetamol induced hepatic damage in ethanol exposed rats. Phytochemical analysis of AWEs determined the presence of flavonoids and phenols, followed by high performance liquid chromatography determination of an important antioxidant tannic acid in AWEMK and a major bioactive lignan phyllanthin in AWEPN. Gas chromatography mass spectrometric analysis revealed the presence of carbazole alkaloids in AWEMK whereas AWEPN was found rich in sterols. Prolonged consumption of ethanol has been reported to enhance the hepatic damage caused by paracetamol overdose by induction of cytochrome P450 (CYP450) and depletion of reduced glutathione (GSH) in alcohol abusers. Oral administration of alcohol (5 ml/kg/day) for three days followed by paracetamol (500 mg/kg, b.i.d.) for another 3 days produced liver damage in rats as manifested by the significant (P < 0.01) rise in levels of liver function tests and a marked increase in lipid peroxidation associated with significant reduction of the hepatic GSH and superoxide dismutase activity as compared with respective control values. Post-treatment of rats with silymarin (200 mg/kg), AWEMK (500 mg/kg), AWEPN (500 mg/kg) and combination of AWEMK and AWEPN (250 mg/kg each) for one week significantly (P < 0.01) inhibited these biochemical alterations which were confirmed by histopathological examination of the liver. Among all the treatment groups, the combination of extracts showed significant reversal of hepatic damage thus accentuating its hepatoprotective potential and immense value for use as a hepatoprotectant.

Serial Changes of Liver Function Tests before and during Methimazole Treatment in Thyrotoxic Patients

Overt hyperthyroidism and methimazole (MMI) treatment are frequently associated with abnormal liver function tests (LFTs). We describe the serial changes of LFTs in MMI-treated hyperthyroid patients. We retrospectively analyzed all 77 patients presenting with newly diagnosed overt hyperthyroidism (59 Graves diseases, 11 toxic nodular goiters, 4 toxic adenomas, 3 amiodarone-induced thyrotoxicosis) between 2012 and 2014. All patients started MMI at 10 to 60 mg/day that was gradually tapered. We measured thyroid-stimulating hormone, free thyroxine, alanine aminotransferase (ALT) and aspartate aminotrasnferase (AST) at baseline and at 6 weeks, 4.5 months and 10 months after starting the MMI treatment. The concomitant medication was stable during MMI treatment. At baseline, 25 patients (32.5%) had abnormal LFT, of which 5 had ALT or AST levels >2× the upper limit of normal (ULN). In most patients with baseline abnormal LFT, MMI treatment resulted in a normalization of serum ALT and AST. Thirteen patients with normal baseline LFT had <2× the ULN elevations of LFT sometime during treatment. There was a case of significant hepatotoxicity. During treatment, there were no significant differences in LFT levels between patients with initially normal or abnormal LFT. In a Cox proportional hazard regression model, abnormal LFT at baseline, abnormal thyroid function at the last evaluation, and MMI dose were not predictors of abnormal LFT at the final evaluation. MMI treatment can induce insignificant LFT elevation, <2× the ULN. MMI can be safely administered in hyperthyroid patients with abnormal LFT, and normalization of increased AST and ALT levels should be anticipated. ALT = alanine aminotransferase AST = aspartate aminotransferase fT4 = free thyroxine HCV = hepatitis C virus LFT = liver function test LOCF = last observation carried forward MMI = methimazole PTU = propylthiouracil TSH = thyroid-stimulating hormone ULN = upper limit of normal.

Prevalence of abnormal liver function tests in celiac disease and the effect of a gluten-free diet in the US population.

Guidelines recommend routine screening of liver function tests (LFTs) in patients diagnosed with celiac disease (CD). However, little is known about the prevalence of liver disorders in CD outside of Europe. Our aims were to estimate the prevalence of LFT abnormalities in CD and to evaluate the effect of a gluten-free diet (GFD) on LFTs. Adult patients with biopsy-proven CD were identified from a prospectively maintained database and matched with healthy controls. LFT levels for women and men were defined as abnormal based on the Third National Health and Nutrition Examination Survey (NHANES III) criteria. Data on demographics, coexisting liver diseases, and laboratory work-ups including aspartate transaminase (AST) and alanine transaminase (ALT) values at the time of diagnosis and on a GFD were recorded. Subsequently, data from this cohort were compared with data from 7,789 individuals participating in the National Health and Nutrition Examination Survey, 2009-2010. Univariate logistic regression, Wilcoxon signed-ranks, Student's t-test, χ(2), and Fischer's exact test were used for statistical analysis. In 463 CD patients with ALT or AST levels at the time of CD diagnosis, 40.6% had elevated LFTs compared with 24.2% of treated CD patients (P<0.001) and 16.6% of matched controls (P<0.001). Similarly, 36.7% of CD patients on the NHANES database had abnormal ALT values compared with 19.3% of non-celiac patients (P=0.03). Approximately, 78.6% of CD patients with elevated LFTs at diagnosis normalized LFTs on a GFD after a mean duration of 1.5±1.5 years. Forty percent of individuals will have elevated LFTs at CD diagnosis; however, the majority will normalize with standard CD therapy. LFTs should be checked in all patients with CD and coexisting liver disorder should be considered in patients whose LFTs have not improved within a year on a GFD.

Lactate dehydrogenase as an indicator of liver, muscular and cancer diseases

Objective: To determine lactate dehydrogenase (LDH) level as an indicator of liver, muscular or cancer diseases in patients of more than 40 years of age. Methods: Ninety-one patients (43 females and 48 males) had been tested for LDH and liver function tests (LFTs). Creatine kinase (CK) levels were measurement only in patients who had high levels of LDH. Results: As an indicator for liver diseases, high levels of LDH and one or more of LFTs, especially alkaline phosphatase, had been observed in 12 patients (8 females and 4 males). For muscular damage, measurement of CK in patients with elevated levels of LDH and normal levels of LFT revealed that CK values elevated in three males and one female. Whereas high LDH levels, as an indicator for cancer diseases, were found in three males and one female who had normal values of LFTs and CK. Conclusions: LDH can be regarded as a good biomarker for diagnosis of liver, muscular and cancer diseases. There is little variable between males and females in the elevated value of LDH. Patients who had high values of LDH, although they had normal levels of LFTs and CK are proposed to have unidentified cancer disease.

중년 남성 근로자의 알코올 섭취와 혈압, 혈청 지질, 간기능검사치 및 비만지표와의 관련성

중년 남성 근로자에 대한 알코올 섭취와 혈청지질, 간기능검사치 및 비만지표와의 관련성을 알아볼 목적으로 2013년 1월부터 12월까지의 기간 동안에 종합건강검진을 받았던 30∼59세의 남성 근로자 2,175명을 대상으로 이들의 1일 알코올 섭취량과 혈압, 혈청지질, 간기능검사치 및 비만지표와의 관계를 검토하였다. 연구결과, 혈압은 음주량의 증가와 함께 유의하 게 높은 값을 보였으며, LDL-콜레스테롤 및 중성지질(TG)도 음주량이 증가할수록 높아지는 경향을 보였으나 HDL-콜레스테 롤은 음주량이 증가할수록 낮아지는 경향을 보였다. AST, ALT, ALP 및 γ-GTP도 음주량이 증가할수록 높아지는 경향을 보 였으나 비만지표에서는 뚜렷한 차이가 없었다. 혈압(SBP, DBP), 혈청지질치(HDL-C, LDL-C, TG) 및 간기능검사치(AST, ALT)가 비정상으로 높아질 위험비는 소량 음주군에 비해 다량 음주군에서 유의하게 상승하였다. 위와 같은 결과는 다량의 음주는 혈압, 혈청지질 및 간기능검사치 증가와 유의한 관련성이 있었으나 비만지표와는 유의한 관련성이 인정되지 않음을 시사하고 있다.

Protective effects of L‐cysteine against LPS‐induced liver injuries.

An activation of Kupffer cells (hepatic resident macrophages) and hepatic stellate cells (HSCs) plays an important role in lipopolysaccharide (LPS)‐induced liver injury. It is known that the upregulated production of ET‐1 by Kupffer cells in response to LPS stress activates HSCs and induces subsequent pathophysiological change in the liver. Recently, it has been reported that some amino acids exhibit anti‐inflammatory effects. In a preliminary experiment, using 20 amino acids, we investigated the effect of amino acid administration on ET‐1 production in the mouse macrophage cell lines (RAW 264.7). Among the amino acids, L‐cysteine, L‐glutamine, L‐leucine, L‐alanine, and Glycine suppressed LPS‐induced ET‐1 production in a dose‐dependent fashion. The effect was strongest by an administration of L‐cysteine. L‐cysteine also suppressed a ET‐1‐induced contraction of collagen gel lattices cultured with HSCs. Moreover, an increased [Ca2+]i in response to ET‐1 administration in HSCs measured with the fluorescent dye fura‐2 was strongly attenuated with the presence of L‐cysteine in a culture medium. In an in vivo experiment, Wister rats were pre‐treated with L‐cysteine or saline and received intravenous injection of LPS. Increased levels of liver function tests following LPS was attenuated by L‐cysteine treatment. These results indicated that L‐cysteine may lead to a beneficial effect in LPS‐induced liver injury.

Liver Enzymes and Uric acid in Acute Heart Failure.

Background:Acute heart failure (AHF) is defined as the new onset or recurrence of gradual or rapidly worsening signs and symptoms of heart failure, requiring urgent or emergent therapy.Objectives:This study attempts to assess the association of liver function tests (LFT) and uric acid level with in hospital outcome and echocardiography parameters, in patients with acute decompensated heart failure.Patients and Methods:A total of 100 patients (aged 16 - 90 years, 60% men) admitted with AHF were enrolled. LFTs and uric acid levels were assessed on first day and before discharge, and patients were followed for 3 months.Results:In-hospital outcomes were considered. Mean Left Ventricular Ejection Fraction (LVEF) was 35% (20 - 45%). Mean Uric acid level was 8.4 mg/dL, significantly higher than chronic HF and normal groups (P < 0.02). Elevated liver enzymes were seen in 52% patients, mostly (87%) in transaminases. Liver enzymes were decreased in 85% patients before discharge. LFT and uric acid levels were inversely and significantly correlated with LVEF on echocardiography (P = 0.02), but not with diastolic parameters. Although there was no significant correlation between uric acid level and in-hospital mortality, risk of intubation and rehospitalization in 3 months, enzyme levels increased in these groups. Increased aspartate transaminase (AST level) was associated with inotrope infusion in AHF patients (42 vs. 82 mg/dL, P = 0.03).Conclusions:Abnormal transaminases and uric acid levels are seen in AHF patients. Increased AST levels may be a predictor of the need for inotrope during hospital course in these patients.

Prognostic significance of pretreatment serum levels of albumin, LDH and total bilirubin in patients with non-metastatic breast cancer.

Liver function tests (LFTs) have been reported as independent predictors of non-liver disease-related morbidity and mortality in general population and cancer patients. In this study, we evaluated the relationship between pretreatment serum LFTs and overall survival (OS) in non-metastatic Caucasian breast cancer patients. Seven LFTs, including albumin, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, lactate dehydrogenase (LDH), total bilirubin and total protein, were measured in pretreatment serum from 2425 female Caucasian patients with newly diagnosed, histologically confirmed non-metastatic invasive breast cancer. Multivariate Cox model was used to estimate hazard ratio (HR) and 95% confidence interval (CI) for the association of individual LFTs with 5-year OS while adjusting for age, smoking status, pathological characteristics and treatment regimen. We found that serum albumin, LDH and total bilirubin were significantly associated with 5-year OS in multivariate Cox analyses. Patients with higher albumin level exhibited 45% reduced risk of death (HR = 0.55, 95% CI: 0.40-0.75) compared with those with lower albumin level. Patients with higher total bilirubin level had a nearly 40% reduction in the risk of death (HR = 0.62, 95% CI: 0.45-0.85) and patients with higher LDH levels had a 1.42-fold increased risk of death (HR = 1.42, 95% CI: 1.08-1.88). Furthermore, cumulative analysis showed a significant dose-response trend of significantly increasing risk of death with increasing number of unfavorable LFT levels. Our result highlighted the potential of using pretreatment serum levels of albumin, LDH and total bilirubin as prognostic factors for OS in patients with non-metastatic breast cancer.

Damage induced by paracetamol compared with N-acetylcysteine

BackgroundThis study investigated the effect of thiamine pyrophosphate (TPP) on oxidative liver damage induced in rats with high-dose paracetamol. MethodsRats for this experiment were divided into the following groups: healthy control, paracetamol control, thiamine + paracetamol, TPP + paracetamol, and N-acetylcysteine + paracetamol. Oxidant and antioxidant parameters and liver function test levels were compared between the groups. ResultsThe results show that TPP and N-acetylcysteine with paracetamol equally prevented a rise in oxidants such as malondialdehyde and nitric oxide. They also prevented a decrease in enzymatic and nonenzymatic antioxidants such as glutathione, glutathione peroxidase, glutaredoxin, glutathione S-transferase, superoxide dismutase, and catalase in the rat liver. ConclusionThiamine pyrophosphate and N-acetylcysteine had a similar positive effect on oxidative damage caused by paracetamol hepatotoxicity. These findings show that TPP may be beneficial in paracetamol hepatotoxicity.

Acute Hepatitis Caused by Green Tea Infusion: A Case Report

The green tea is obtained by an unfermented process of leaves of Camellia sinensis and the main chemical components are polyphenols, particularly epigallocatechin-3-gallate and epicatechin-3-gallate that could be associated to adverse hepatic reactions. We present a case of acute hepatitis caused by the use of green tea.A 62-year-old woman was hospitalized because of the persistent high levels of liver function tests. After the hospitalization a lot of instrumental exams and blood checks were performed. The search of metallic elements in the used green tea infusions was performed using an inductively coupled-plasma mass spectrometry; high performance liquid chromatography-electro spray ionization-mass spectrometry analysis was done to characterize the metabolite profiles of the infusions of green tea. The blood check showed in particular alanine aminotransferase (780 U/L) and total bilirubin (1.15 mg/dL) levels abnormal. The abdominal echography and other blood parameters were normal, but liver biopsy described a “drug toxic damage”. Every day over the previous 9 months the patient drank two or three cups of several brands of green tea infusions and she stopped this behavior when abdominal pain was persistent. Her medical history didn’t report the use of other drugs or toxic products. After four months of stopping the use of green tea infusions, the liver function tests were normalized. The presence of metallic elements in tea infusion cannot justify the observed liver toxicity in our patient. Instead, the highest levels of epigallo catechin methyl gallate derived from epigallocatechin-3-gallate observed in one of the samples consumed by the patient, arise a possible correlation between some of the catechins in green tea and the hepatotoxic effect. It is conceivable that the mechanism of damage can be idiosyncratic-metabolic or allergic.

The Prognosis of Fulminant Hepatic Failure in Pregnant Women due to Hepatitis E

Objectives: Jaundice in pregnancy carries with it a high mortality rate. In this study, we examined the characteristics of women on survival of women with hepatitis E due to the stress of labor in terms of multiorgan failure after delivery. Design: A retrospective study of hospital records was done on women of hepatitis E from December 2010 to August 2011 at Civil Hospital, Ahmedabad, India. The women were divided into two groups: expired and survived. Results: Fatality rate during the epidemic months (March/ during nonepidemic months (June to February). The overall mortality rate of fulminant hepatic failure was 94%. The mean duration of jaundice, levels of bilirubin, serum glutamic pyruvic transaminase (SGPT), and prothrombin time (PT) were ! altered creatinine and PT [International Normalized Ratio (INR) >1.5] had a high mortality rate of 88 and 76%, respectively. All those who were conscious at the time of delivery (no hepatic encephalopathy) survived while those who were unconscious expired after delivery. All those who were intubated died. Conclusion: Hepatitis E is endemic in India and is an important indirect cause of maternal mortality. Study of the expired group helps understand the critical levels of liver function tests. This can help in appropriate counselling of patients and their relatives regarding the prognosis. Although delivery does not have any effect on survival, blood loss, infection and raised intracranial tension can cause liver hypoxia and worsen the disease state.

The Effect of Pioglitazone and Metformin on Liver Function Tests, Insulin Resistance, and Liver Fat Content in Nonalcoholic Fatty Liver Disease: A Randomized Double Blinded Clinical Trial

BackgroundNon-alcoholic fatty liver disease (NAFLD) is considered as the hepatic manifestation of insulin resistance (IR) syndrome. The effect of insulin sensitizers on liver function tests and metabolic indices in NAFLD patients is a matter of debate.ObjectivesThe aim of study was to compare the effects of two different insulin sensitizers, pioglitazone, and metformin, on liver function tests (LFT), lipid profile, homeostasis model assessment-IR (HOMA-IR) index, and liver fat content (LFC) in NAFLD patients.Materials and MethodsThis double blind clinical trial was performed on patients who were referred to a gastroenterology clinic with evidence of fatty liver in ultrasonography. After excluding other causes, participants with persistent elevated alanine aminotransferase (ALT) levels and “NAFLD liver fat score” greater than -0.64 were presumed to have NAFLD and were enrolled. They were randomly assigned to take metformin (1 g/day) or pioglitazone (30 mg/day) for four months. Fasting serum glucose (FSG), ALT, aspartate aminotransferase (AST), alkaline phosphatase (ALP), triglyceride, cholesterol (CHOL), high and low density lipoprotein (HDL, LDL), HOMA-IR, and LFC were checked at the baseline, two and four months post-treatment. LFC was measured by a validated formula.ResultsEighty patients (68 males) with mean age of 35.27 (± 7.98) were included. After 2 months, LFT was improved significantly in the pioglitazone group and did not change in the metformin group. After four months, both medications significantly decreased serum levels of LFT, FSG, CHOL, LDL, HOMA-IR, and LFC, and increased serum level of HDL. No statistically significant differences were seen between the two treatment groups with regard to the changes of laboratory parameters and LFC from baseline to four months post-treatment.ConclusionsDuring the four months, the use of metformin (1 g/day) and pioglitazone (30 mg/day) were safe and might have equally affected LFT, HOMA-IR, lipid profile, and LFC in NAFLD patients.