Mean Alanine Aminotransferase Research Articles

Is a Preservation Solution for Living Donor Liver Transplantation Needed? Adding a New Chapter in LDLT!

Background.Preservation solutions are required for organ viability in deceased donor liver transplantation (LT). However, their role in live donor LT (LDLT) has not been standardized.Methods.Eighty adult recipients who underwent right lobe LDLT at the Department of Liver Transplantation Surgery, Gambat, Pakistan, were studied. Based on shorter cold ischemia time and no back table reconstruction work, recipients were assigned to receive “no preservation solution” (cases/non–histidine-tryptophan-ketoglutarate group; n = 40) or “HTK group” (controls; n = 40). Early allograft dysfunction (bilirubin, transaminases, and international normalized ratio), postoperative complications (biliary and vascular), hospital stay, and 1-y survival were reported. The direct cost was also reported.Results.Demographics and clinical characteristics were comparable in the 2 groups. Comparing cases versus controls, mean bilirubin, alanine aminotransferase, aspartate aminotransferase, and international normalized ratio on postoperative day 7 were similar in the 2 groups. Five (12.5%) cases and 4 (10%) controls developed early allograft dysfunction (P = 0.72). Post-LT complications (biliary leak 2.5% in cases versus 0 in control), strictures (15% in cases versus 17.5% in controls), hepatic artery thrombosis (2.5% versus 00%)‚ and portal vein thrombosis (0 versus 2.5%) were comparable. Mean hospital stay (10.80 + 2.36 and 11.78 + 2.91 d) and 30 d mortality (2.5% versus 5%) were also comparable. Finally, 1-y survival based on Kaplan-Meier analysis was comparable in both groups (ie, 92.5%; non-HTK group versus 90%; HTK group) (P = 0.71). The direct cost of using a non-HTK–based approach was less than the HTK solution.Conclusion.In a selected cohort of right lobe LDLT recipients, preservation solutions can be avoided safely with comparable outcomes.

Hepatotoxicity with High-Dose Green Tea Extract: Effect of Catechol-O-Methyltransferase and Uridine 5’-Diphospho-glucuronosyltransferase 1A4 Genotypes

The predominant catechin in green tea, epigallocatechin gallate (EGCG), may be hepatotoxic in high doses. Our objective was to investigate the influence of catechol-O-methyltransferase (COMT) and uridine 5’-diphospho-glucuronosyltransferase 1A4 (UGT1A4) genotypes on changes in liver injury biomarkers in response to long-term, high-dose green tea extract (GTE) supplementation among postmenopausal women. A secondary analysis was conducted using data from the Minnesota Green Tea Trial (N = 1,075), in which participants were randomized to consume high-dose GTE (843 mg/day EGCG) or placebo capsules for 12 months. Analysis of covariance adjusting for potential confounders was performed to examine changes in aspartate aminotransferase (AST), alanine aminotransferase (ALT), AST: ALT ratio, and alkaline phosphatase from baseline to months 3, 6, 9, and 12 across COMT and UGT1A4 genotypes. Mean age and BMI within the GTE group (n = 400) were 59.8 yrs and 25.1 kg/m2, respectively, and 98% of subjects were white. From baseline to month 3, mean AST: ALT ratio change was +1.0% in the COMT (rs4680) A/G genotype versus −4.8% in the A/A genotype (p = 0.03). From baseline to months 6 and 9, respectively, mean ALT change was +78.1% and +82.1% in the UGT1A4 (rs6755571) A/C genotype versus +28.0% and +30.1% in the C/C genotype (p < 0.001 and p = 0.004, respectively). The UGT1A4 (rs6755571) A/C genotype may be an important risk factor for clinically-relevant serum transaminase elevations with 6-9 months of high-dose GTE supplementation among postmenopausal women. Understanding the genetic underpinnings of GTE-related hepatotoxicity may allow for a genetically-informed paradigm for therapeutic use of GTE.

Long-term trends of alanine aminotransferase levels among persons living with human immunodeficiency virus/hepatitis B virus with and without hepatitis delta coinfection

BackgroundHepatitis delta virus (HDV) infection accelerates the progression of liver disease in persons living with HIV and hepatitis B virus (HBV) coinfection. We explored the association between HDV infection and alanine aminotransferase (ALT) elevation during tenofovir-containing antiretroviral treatment among persons living with HIV/HBV.Materials and methodsWe included persons living with HIV/HBV with and without HDV starting tenofovir-containing antiretroviral therapy (ART) in three European cohorts with at least 18 months of follow-up. We defined HDV infection as a positive anti-HDV antibody test. We assessed risk factors for ALT elevation ≥ 1.25x upper limit of normal after 5 years of tenofovir-treatment using multivariate logistic regression models. The difference in ALT trends between individuals with and without HDV was evaluated using linear mixed effects models.Results61/518 (11.8%) participants had an HDV infection. Among individuals with HDV, 63.9% had ALT elevation after 2 years and 55.6% after 5 years of tenofovir, whereas the estimates were 34.1% after two and 27.0% after 5 years in those without HDV. HDV coinfection (adjusted odds ratio 2.8, 95% confidence interval 1.4–5.8) and obesity at baseline (adjusted odds ratio 3.2, 95% confidence interval 1.2–8.0) were associated with ALT elevation after 5 years of tenofovir therapy. Mean ALT levels were consistently higher during follow-up in participants with HDV compared to those without HDV.ConclusionPersistent ALT elevation is common in persons living with HIV/HBV in Europe despite adequate HBV therapy. HDV coinfection and obesity are independent risk factors for persistent ALT elevation during long-term tenofovir treatment.

Cytomegalovirus Hepatitis in Allograft Livers May Show Histologic Features of Acute Cellular Rejection.

Cytomegalovirus (CMV) hepatitis in allograft livers is an important infectious complication, with histology that historically has been described to overlap with that of acute cellular rejection (ACR), a diagnosis that compels a different treatment regimen. To update the clinicopathologic features of CMV hepatitis and explore its clinical and histologic relationship with ACR. A retrospective analysis of 26 patients with a diagnosis of CMV hepatitis across 4 institutions was performed, including clinical, histologic, and immunohistochemical features. Patients were predominantly CMV donor positive/recipient negative (D+/R-; n = 9 of 15) and received a diagnosis of CMV hepatitis at a mean age of 52 years (SD, 17 years), at a mean interval of 184 days (SD, 165 days) from transplantation. Mean CMV viral load at diagnosis was 241 000 IU/mL (SD, 516 000 IU/mL), and liver biochemical enzymes were elevated (mean alanine aminotransferase, 212 U/L [SD, 180 U/L]; mean aspartate aminotransferase, 188 U/L [SD, 151 U/L]; mean alkaline phosphatase, 222 U/L [SD, 153 U/L]). Ten cases did not show histologic features of ACR, and 16 cases demonstrated features of ACR (including marked bile duct injury and endotheliitis). Viral cytopathic change was found in all cases. All patients were treated with a combination of antiviral therapy and CMV intravenous immunoglobulin, with near resolution of biochemical enzymes in all patients with undetectable serum CMV viral titers. CMV hepatitis and ACR are complex processes with interlinking mechanisms that are important to distinguish. A subset of transplantation patients with CMV hepatitis show histologic changes that mimic ACR but were treated successfully with antiviral therapy alone.

Effect of postoperative administration of nafamostat mesilate on posthepatectomy liver failure

To investigate whether the administration of nafamostat mesilate (NM) reduces the risk of posthepatectomy liver failure (PHLF) in patients undergoing hepatectomy for hepatocellular carcinoma (HCC). We retrospectively reviewed the 1114 patients who underwent hepatectomy for HCC between 2004 and 2020. NM was selectively administered to patients undergoing major hepatectomy with an estimated blood loss of >500mL. NM group was administered via intravenous of 20mg of NM from immediately after surgery until postoperative day 4. We performed 1:1 propensity score matching and included 56 patients in each group. PHLF was defined according to the International Study Group of Liver Surgery (ISGLS). The incidence of PHLF was lower in the NM group than control group (P=0.018). The mean peak total bilirubin (P=0.006), aspartate transaminase (P=0.018), and alanine aminotransferase (P=0.018) levels postoperatively were significantly lower in the NM group. The mean hospital stays (P=0.012) and major complication rate (P=0.023) were also significantly lower in the NM group. Prophylactic administration of NM reduced the risks of complication and decreased the frequency of PHLF after hepatectomy. A further prospective study is needed to verify our findings.

&lt;i&gt;De novo&lt;/i&gt; hepatitis B virus infection after liver transplantation

De novo hepatitis B virus (HBV) infection developing after liver transplantation (LTx) is the development of infection in a patient with liver disease etiologically unrelated to HBV infection and who had no preoperative HBV markers. Objective: to analyze the clinical features and characteristics of de novo HBV infection and evaluate the efficacy of nucleos(t)ide analogue therapy in liver transplant recipients. Materials and methods. The study involved 247 adult patients who underwent deceased donor LTx from 2016 to 2022 at Shumakov National Medical Research Center of Transplantology and Artificial Organs and who had no pre-transplant HBV markers. Results. Twenty-two (7%) of 247 patients had de novo HBV markers from 5 to 69 months. At the time HBV DNA was detected, the mean alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels in the patients was 53.3 ± 36.4 IU/L and 54.5 ± 33.0 IU/L, respectively. All patients received nucleos(t)ide analogues (NAs). The therapy led to a statistically significant decrease in the mean ALT level to 31.5 ± 24.2 IU/L (p = 0.049)

Haematology and serum biochemistry of dogs naturally infected with canine parvovirus-2

Canine parvovirus is a deadly virus affecting the Canid family, causing virus-induced destruction of rapidly dividing haemopoietic precursor cells such as crypts of intestinal epithelial cells, thymus, lymph nodes, bone marrow precursor cells, blood cells and cardiac cells leading to multi-organ dysfunctions. The aim of this study was to determine the haematological, serum biochemical and electrolytic changes associated with canine parvovirus (CPV) -2 infection. An immunochromatographic test was used to differentiate the virus-positive and negative dogs using faecal samples. One hundred and sixty whole blood and serum samples were collected from apparently healthy and CPV-2-positive dogs in Plateau State, Nigeria. Haematological, serum biochemical and electrolytic analyses were done using standard methods. The data obtained were analyzed using descriptive statistics and a student t-test. Significance was accepted at probability values of p &lt; 0.05. The haematological effect of CPV-2 showed a significant (P &lt; 0.05) decrease in mean Packed Cell Volume (PCV), total red blood cell count, haemoglobin concentration, total white blood cell count, neutrophils, lymphocytes and platelet count. In addition, the CPV-2 significantly (P &lt; 0.05) increased the mean aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, urea, creatinine, triglyceride and malondialdehyde, while the mean total protein, sodium, potassium, chloride and cholesterol significantly (P &lt; 0.05) decreased in the infected dogs. From the findings, CPV infection variably and significantly affected some haematological and serum biochemical parameters of infected dogs. Therefore, clinicians should endeavour to incorporate haematinics, haptatonics and immune-modulators during the management of canine parvoviral infection as supportive drugs with fluid therapy to improve the survivability of infected animals.

Evaluation of serum uric acid and liver function tests among pregnant women with and without preeclampsia at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia.

Pre-eclampsia can be described as new-onset hypertension (blood pressure ≥140/90 mmHg) together with proteinuria (24-hr urinary protein ≥ 0.3 g) or any indication of end-organ damage after 20 weeks of gestation. Liver and kidney dysfunction, thrombocytopenia, pulmonary edema, and neurologic dysfunction are common manifestations of end-organ damage due to pre-eclampsia. Pre-eclampsia is the most common cause of liver and kidney dysfunction due to hypoxia and endothelial dysfunction. Hyperuricemia indicates kidney dysfunction and is considered a predictor of the severity of preeclampsia. Therefore, the objective of this study is to evaluate the utility of the levels of serum uric acid and liver function tests [alanine aminotransferase (ALT) and aspartate aminotransferase (AST)] as biomarkers of preeclampsia-related organ damage. An institutional-based comparative cross-sectional study design was conducted, and a total of 102 subjects (51 patients with preeclampsia and 51 normotensive pregnant women) were recruited. The parameters measured were levels of serum uric acid and liver function tests. There were statistically significant differences in the mean serum uric acid, ALT, and AST levels between preeclamptic pregnant women and normotensive pregnant women (p<0.05). There were no statistically significant differences in the mean total and direct bilirubin levels. There was also a significant difference in mean serum uric acid, alanine transaminase, and aspartate transaminase levels across different gestational age categories. Our study revealed that serum uric acid, ALT, and AST levels were higher in pre-eclamptic pregnant women compared to those of normotensive pregnant women, and the differences were statistically significant. As such, serum uric acid and liver function tests may be considered biomarkers of pre-eclampsia-related end-organ damage.

Perinatal Outcome of Intrahepatic Cholestasis of Pregnancy

Objective: To determine the perinatal outcome of intrahepatic cholestasis of pregnancy and its association with obstetric and biochemical parameters.&#x0D; Study Design: cross-sectional study.&#x0D; Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi, from Feb to Aug 2020.&#x0D; Methodology: Among 3201 obstetric patients, 50 patients of obstetric cholestasis were included in the study. Data was collected on a well-designed proforma. Patients’ characteristics such as age, parity, gestational age at diagnosis and delivery, mode of delivery and co-morbidities were taken along with biochemical markers. Two groups were made based on perinatal outcome, and associations with all variables were checked.&#x0D; Results: Obstetric cholestasis was found to be 1.6%. The mean age of subjects was 27.36. The itching was the most common presenting complaint. (74%) subjects were primigravida. The majority, 29 (58%), were diagnosed between 34-35 weeks. The mean gestational age at delivery was 37.54 ± 1.96 weeks, with 70% caesarean section. Among perinatal outcomes, 24 (48%) had fetal distress, 2 (4%) had intrauterine growth restriction, 20(40%) had meconium-stained liquor, 2 (4%) had intrauterine fetal demise, 7(14%) had low birth weight babies,16.7% had poor APGAR score and 14 needed intensive care admission. The mean alanine aminotransferase (ALT) was higher among those with the adverse perinatal outcome, with a cut-off value of alanine aminotransferase (ALT) of 93.5 by ROC analysis.&#x0D; Conclusion: Obstetric cholestasis leads to adverse outcomes. Although no definite marker can rule out the risk of intrauterine demise, increased fetomaternal surveillance with active management induction of labour protocols may reduce the incidence of........

Clinical Features of Children with COVID-19 Infection: Single-Center Experience.

Compared to adult studies, there are few epidemiological and clinical reports on coronavirus disease 2019 in children. We aimed to present the demographic, epidemiological, and clinical findings of hospitalized pediatric coronavirus disease 2019 patients. Patients aged 0-18 years who were hospitalized between March and July 2020 due to severe acute respiratory syndrome coronavirus 2 infection were evaluated retrospectively. The mean age was 90.2 ± 67.5 (7-24) months and 23 (51%) were female. Clinical presentation was asymptomatic in 15 cases (33.3%), mild/moderate in 26 cases (57.8%), and severe/critical in 4 cases (8.9%). Three (6.6%) of the patients had chronic medical conditions that placed them in the high-risk group for coronavirus disease 2019. The source of infection was household transmission in 29 cases (64.4%). The most common symptoms were cough, fever, and fatigue. Mean serum lactate, C-reactive protein (CRP), aspartate aminotransferase (AST), and alanine aminotransferase (ALT) levels were significantly higher in severe/criti- cal patients compared to the other two groups (P < .05). severe acute respiratory syndrome coronavirus 2 negativity in control swabs (n=26) occurred at a mean of 10.6 ± 2.9 days after symptom onset. Forty-three patients (95.6%) were followed in the ward and 2 (4.4%) were admitted to the intensive care unit. Children aged 0-18 years constituted a very small proportion of coronavirus disease 2019 reverse transcription-polymerase chain reaction -positive cases. Asymptomatic carriage of SARS- CoV-2 by a large proportion of children seems to be a major factor driving community spread. Some children with coronavirus disease 2019 may also present neurological findings. coronavirus disease 2019 infection is more severe in patients with comorbidities, and support therapy is important in these patients.

Autoimmune Hepatitis-Like Syndrome Following COVID-19 Vaccination: A Systematic Review of the Literature.

ObjectivesDuring the summer of 2021, case reports began to emerge documenting a small number of individuals who developed autoimmune hepatitis (AIH) following COVID-19 vaccination. These cases are rare and novel, and very little is known. In our systematic review, we analyzed every published case of AIH and reviewed their characteristic findings, treatment, and outcomes. MethodsWe searched PubMed, Embase, and Web of Science from December 1, 2019, to November 1, 2021. Two researchers independently extracted information from the articles about vaccine type, patient history, laboratory values, histology results, treatment regimens, and disease course. ResultsThirty-two patients developed AIH-like syndromes after receiving a COVID-19 vaccine. Jaundice was the most frequently reported symptom (81%), and 19% of patients were initially asymptomatic and presented with elevated liver enzymes found during routine bloodwork. Mean alanine transaminase, aspartate transaminase, and total bilirubin were 1231 U/L, 921 U/L, and 14 mg/dL, respectively. Anti-nuclear antibody was positive in 56%, and anti-smooth muscle antibody in 28% of patients. Steroids were used in 75% of patients. Improvement or complete resolution was seen in 97% of patients. One patient died despite aggressive steroid treatment.ConclusionCOVID-19 vaccine-induced AIH is an uncommon association with just 32 documented cases in the literature. Clinicians should be vigilant for AIH in patients who present with liver injury following vaccination. These new findings should under not deter individuals from getting vaccinated, as the benefits of vaccination far outweigh the risks. Fortunately, COVID-19 vaccine-induced AIH appears amendable to corticosteroid therapy and appears to have a favorable outcome.

The association of liver enzymes with systolic and diastolic blood pressure in young adults

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Science and Technology Department, Brazilian Ministry of Health. Introduction Nonalcoholic fatty liver (NAFLD) disease has been associated with metabolic syndrome and cardiovascular risk factors including cholesterol, type 2 diabetes, obesity, and hypertension. Patients with NAFLD also have increased risk of coronary artery disease and major adverse cardiovascular events. Purpose The aim of this study was to assess the associations of liver enzymes with systolic and diastolic blood pressure in 22-year-old individuals from a 1993 birth cohort in Brazil. Methods During 1993, all live born babies in the city were invited to take part in a prospective study and sub-samples of this cohort were followed-up since then. At the 22-year follow-up, the liver enzymes evaluated were aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma-glutamyl transferase (GGT). Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were obtained calculating the mean of two measurements (at the beginning and the end of the interview) using a blood pressure monitoring device. The co-variables taken into consideration were sex, fasting period, body mass index (BMI), waist circumference (WC), triglycerides, cholesterol, excessive alcohol consumption (&amp;gt;8 points in the Alcohol Use Disorders Identification Test), and physical inactivity. Adjusted linear regressions have been performed and p &amp;lt; 0.05 was considered statistically significant. Results The sample was composed of 2603 (49.6%) men and 2645 (50.4%) women of approximately 22 years old. Median (IQR) AST (U/L) was 21 (18-26), and GGT (U/L) 24 (18-33). Mean (±SD) ALT (U/L) was 19 ± 16.5, SBP (mmHg) 123.9 ± 13.8, and DBP (mmHg) 73 ± 8.7. An increase of 1 U/L in ALT concentrations corresponded to a predicted increase of 0.87 mmHg in SBP and 0.62 mmHg in DBP (Table). This was stronger for GGT, as an increase of 1 U/L in GGT concentrations corresponded to a predicted increase of 1.41 mmHg in SBP and 1.14 mmHg in DBP (Table). AST was not associated with SBP (p = 0.094) or DBP (p = 0.093) (Table). Conclusions ALT and GGT are positively associated with SBP and DBP independent of potential confounders since early adult age. As causal roles remain unclear, prospective large-scale studies are necessary to better understand this association. Abstract Figure.

The Association of Flow-Mediated Dilatation and Blood Parameters in Primary Raynaud's Phenomenon.

Introduction Raynaud's phenomenon (RP) is a multifactorial disorder. If any underlying disease cannot be determined to be responsible for RP, then it is considered to be the primary RP (pRP). We aimed to investigate the differences between laboratory markers and impaired endothelial function in pRP. Materials and Methods Forty-two pRP patients and 30 healthy individuals were included as the study and control groups, respectively. The endothelial function was evaluated with flow-mediated dilatation (FMD) of the brachial artery. The blood samples were obtained from both groups, and white blood cell (WBC), hemoglobin, platelets, mean platelet volume (MPV), creatinine, alanine aminotransferase (ALT), aspartate aminotransferase (AST), D-dimer, fibrinogen, albumin, fibrinogen-to-albumin ratio (FAR), neutrophil-to-lymphocyte ratio (NLR), D-dimer-to-albumin ratio (DDAR), and monocyte chemoattractant protein-1 (MCP-1) parameters were studied. The blood parameters and FMD values obtained were compared between groups. Results The groups were similar in regard to age, gender, and smoking history (p < 0.05). There was no difference between the two groups in regard to hemoglobin, platelet, MPV, creatinine, ALT, D-dimer, albumin, FAR, NLR, and DDAR levels (p < 0.05). AST levels were slightly higher in the pRP group (p=0.027). Markedly increased WBC, fibrinogen, MPV, and MCP-1 values were detected in the pRP group (p=0.001), as well as higher abnormal FMD responses (p=0.001). There was a direct correlation between abnormal FMD response and serum MCP-1 values in patients with pRP (R: 0.308, R2: 0.095, p: 0.044). Conclusion It seems to be that MCP-1 levels are higher in patients with pRP, and increased values of MCP-1 levels seem to be related to impaired endothelial functions.

The Effects of Helicobacter Pylori Eradication on Liver Function and Metabolic Profile in Non-diabetic Non-alcoholic Steatohepatitis: A 5-year Randomized Clinical Trial.

BACKGROUND: To evaluate the effects of Helicobacter pylori (HP) eradication on liver function tests (LFT) and fat content (LFC) in non-diabetic non-alcoholic steatohepatitis (NASH). METHODS: This randomized clinical trial included dyspeptic HP infected non-diabetic NASH participants. The intervention arm received HP eradication treatment, while the control arm did not get any HP treatment. In the meantime, the standard management of NASH was performed in both trial arms. Mean alterations in LFT were the primary outcome and the secondary outcomes included the mean changes in LFC and serum metabolic profile. The trial follow-up period was 5 years. RESULTS: 40 participants (female: 20), with a mean age of 41.58 (±12.31) years, were enrolled in the study. The HP eradication arm included 20 participants (female: 11) with a mean age of 40.25 (±10.59) years, and the control arm consisted of 20 individuals (female: 9) with a mean age of 42.90 (±13.97) years. The tests of within-subjects effects showed a significant decrease in mean serum alanine aminotransferase (ALT; P=0.007), triglyceride (TG; P=0.04), cholesterol (P=0.004), and fasting blood sugar (FBS; P<0.001), and an increase in high-density lipoprotein (HDL; P=0.04) in both research groups during the study period. The tests of between-subjects effects demonstrated a more significant decrement of FBS in HP eradicated patients than the controls (P=0.02). The reduction in waist circumference, aspartate aminotransferase (AST), ALT, alkaline phosphatase, triglyceride, cholesterol, low-density lipoprotein, insulin, and LFC were more prominent in the intervention group than the controls; however, these differences were not statistically significant. CONCLUSION: Adding HP eradication treatment to standard NASH treatment showed more therapeutic effect thanthe standard NASH treatment protocol alone regarding the decrement of FBS in participants with dyspeptic non-diabetic NASH. Considering the non-statistically significant improvement in other metabolic indices and LFT in this trial, further studies are recommended.

P305 Low ALT is more Common in Patients with IBD than Healthy Controls and is Associated with Active Disease

Abstract Background Sarcopenia is underdiagnosed in patients with Inflammatory bowel disease (IBD). Studies have shown that low alanine transaminase (ALT) levels are associated with sarcopenia. We evaluated the association of low ALT levels with the IBD diagnosis and activity. Methods Data of patients from state mandatory health maintenance organization in Israel was collected. Electronic medical records within the past two years included diagnosis, medications, blood and stool tests. Based on ICD9 coding, patients diagnosed with Ulcerative Colitis (UC) or Crohn’s disease (CD) were compared to healthy control group. Patients with ICD9 diagnosis of chronic liver disease, cirrhosis, and age &amp;lt;18 were not included. Serum ALT lower than, 15 was considered low. Results Our cohort consisted of, 348,454 patients, of them, 1780 patients with CD and, 916 with UC. Mean ALT was lower among patients with IBD than healthy controls (22.71 vs., 24.04, p-value&amp;lt;0.001). In multivariate logistic regression, controlling for age, sex, BMI, and smoking status, IBD was associated with low ALT levels (OR –, 1.25, 95% CI, 1.12–1.39, p-value&amp;lt;0.001) Of the CD patients, 392 (27.96%) were in the low ALT group. Patients in the low ALT group were younger (38.85 vs., 42.38 p- value&amp;lt;0.001), were less likely to be male (33.9% vs., 54.7%), had lower BMI (23.94 vs., 26.29 p – value&amp;lt;0.001). Fecal Calprotectin and CRP was higher in the low ALT group (601.25 vs., 282.33 p-value&amp;lt;0.001, 12.94 vs., 7.35 p value&amp;lt;0.001 respectively) while serum albumin was lower (4.12 vs., 4.28 p-value&amp;lt;0.001). Among patients with UC, 204 (30.13%), had low ALT. Patients in the low ALT group were slightly younger (46.92 vs., 49.65 p-value=0.06), less likely to be male, 22.5% vs., 52% p-value&amp;lt;0.001), had lower BMI (25 vs., 26.37 p-value=0.004). Patients with low ALT had higher CRP levels (12.92 vs., 6 p-value&amp;lt;0.001) and non-significantly higher fecal calprotectin levels (779.52 vs., 498.18 p-value, 0.16). Serum albumin was lower in the low ALT group (4.04 vs., 4.26 p value&amp;lt;0.001) In multivariate linear regression models, controlling for age, gender IBD subtype, and smoking status, low ALT was associated with elevated fecal calprotectin and CRP and lower albumin levels (p-value&amp;lt;0.001). Conclusion Patients with IBD have lower ALT levels than the general population. Among patients with IBD, low ALT is associated with active disease. Further studies are warranted to strengthen the association of low ALT with sarcopenia among patients with IBD.

Clinical Characteristics of Macrolide-Refractory Mycoplasma pneumoniae Pneumonia in Korean Children: A Multicenter Retrospective Study

Mycoplasma pneumoniae is a major causative pathogen of community-acquired pneumonia in children, and the treatment of choice is macrolides. There is an increasing trend in reports of refractory clinical responses despite macrolide treatment due to the emergence of macrolide-resistant M. pneumoniae. Early discrimination of macrolide-refractory M. pneumoniae pneumonia (MrMP) from macrolide-sensitive M. pneumoniae pneumonia (MSMP) is vital; however, testing for macrolide susceptibility at the time of admission is not feasible. This study aimed to identify the characteristics of MrMP in Korean children, in comparison with those of MSMP. In this multicenter study, board-certified pediatric pulmonologists at 22 tertiary hospitals reviewed the medical records from 2010 to 2015 of 5294 children who were hospitalized with M. pneumoniae pneumonia and administered macrolides as the initial treatment. One-way analysis of variance and the Kruskal-Wallis test were used to compare differences between groups. Of 5294 patients (mean age, 5.6 years) included in this analysis, 240 (4.5%), 925 (17.5%), and 4129 (78.0%) had MrMP, macrolide-less effective M. pneumoniae pneumonia, and MSMP, respectively. Compared with the MSMP group, the MrMP group had a longer fever duration, overall (13.0 days) and after macrolide use (8.0 days). A higher proportion of MrMP patients had respiratory distress, pleural effusion, and lobar pneumonia. The mean aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, and C-reactive protein levels were the highest in the MrMP group, along with higher incidences of extrapulmonary manifestations and atelectasis (during and post infection). Pre-existing conditions were present in 17.4% (n = 725/4159) of patients, with asthma being the most common (n = 334/4811, 6.9%). This study verified that MrMP patients show more severe initial radiographic findings and clinical courses than MSMP patients. MrMP should be promptly managed by agents other than macrolides.

The Effect of Black Cumin Seed Oil on Alanine Aminotransferase Levels which are Influenced by Nutritional Status in Active Smokers

Black cumin seed oil (BCSO) has the main compound thymoquinone which is thought to have hepatoprotective activity through an antioxidant mechanism. Exposure to cigarette smoke can cause cellular oxidative stress which is the key to the inflammatory process of liver cells and an increase in the activity of the Alanine aminotransferase (ALT) enzyme. Vitamin C and folic acid are nutrients that affect ALT levels through antioxidant activity. The main objective of this study was to see the effect of BCSO administration on ALT levels which were influenced by the intake of vitamin C and folic acid in healthy respondents who were active smokers for 30 days. This study used a single-blind Randomized Controlled Trial (RCT) method, with a total of 39 test subjects divided into four groups. Group 1 received 3x1 placebo, group 2 received BCSO 3x1, group 3 received BCSO 3x2, group 4 received BCSO 3x3. Investigation based on the ANOVA test, it turned out that there was no significant difference in the mean ALT levels in both the placebo group and the treatment group with p value = 0.452. For the p value of the intake of vitamin C and folic acid were 0.359 and 0.669, respectively. Based on the results of the study showed that the administration of BCSO for 30 days had no significant effect on the average activity of ALT in healthy active smokers and there was no significant difference in the intake of vitamin C and folic acid.

Comparative Efficacy of Two Antibiotics for the Management of Secondary Bacterial Infection in Goats Clinically Affected by Peste des Petits Ruminants

Aims: Peste des petits Ruminants (PPR) is a major viral disease that poses a challenge to small ruminant farming. Its natural occurrence has been complicated by secondary bacterial infection which has led to an increase in morbidity and mortality rates. This study reports the management outcome of natural PPR-infected goats using two types of antibiotics in Nsukka metropolis of Enugu State Nigeria.&#x0D; Methodology: Goats (N=24) were confirmed to be suffering from PPR based on clinical signs and using polymerase chain reaction (PCR). The animals were divided into two groups. Group A was treated with 20% oxytetracycline (N= 10) and group B with procaine penicillin and streptomycin combination (penstrept) (N= 14) injection. Clinical signs, recovery and survivability, temperature, haematology [Packed cell volume (PCV); haemoglobin concentration (Hbconc); red blood cell (RBC) and white blood cell (WBC) counts] and some serum biochemical profiles [alanine aminotransferase (ALT); aspartate transaminase (AST); total protein (TP); Albumin; urea; creatinine; potassium and sodium] were used to assess the efficacy of the antibiotics using standard techniques.&#x0D; Results: The mean temperature, RBC, WBC and urea values of the PPR-infected goats were above their reference ranges, mean albumin values were below the reference range while mean Hbconc, PCV, AST, ALT, TP and creatinine values were within their reference range before the commencement of treatment. Following treatment, clinical signs cleared in 20% and 35.7% of the goats treated with oxytetracycline and penstrep respectively. Death was recorded in 20% and 15% of goats treated with oxytetracycline and penstrep respectively before the end of treatment. Penstrep-treated group showed improvement in their haematological profile.&#x0D; Conclusion: Based on our findings, the use of penstrep in the management of PPR-infected goats gave a better result.

Selected Morphotic Parameters Differentiating Ulcerative Colitis from Crohn’s Disease

Abstract This paper presents a method that binds statistical and data mining techniques, which aims to support the decision-making process in selected diseases of the digestive system. Currently, there is no precise diagnosis for ulcerative colitis (UC) and Crohn’s disease (CD). Specialist physicians must exclude many other diseases occurring in the colon. The first goal of this study is a retrospective analysis of medical data of patients hospitalised in the Department of Gastroenterology and Internal Diseases, Bialystok, and finding the symptoms differentiating the two analysed diseases. The second goal is to build a system that clearly points to one of the two diseases UC or CD, which shortens the time of diagnosis and facilitates the future treatment of patients. The work focuses on building a model that can be the basis for the construction of action rules, which are one of the basic elements in the medical recommendation system. Generated action rules indicated differentiating factors, such as mean corpuscular volume, platelets (PLTs), neutrophils, monocytes, eosinophils, basophils, alanine aminotransferase (ALAT), creatinine, sodium and potassium. Other important parameters were smoking and blood in stool.

Outcome of Obstructive Jaundice Patients after Endoscopic Retrograde Cholangiopancreatography

Introduction: Obstructive jaundice is frequently encountered worldwide including Bangladesh. Therapeutic Endoscopic Retrograde Cholangiopancreatography (ERCP) is one of the procedures to manage obstructive jaundice. Objectives: To ascertain the outcome of obstructive jaundice patients who underwent ERCP. Materials and Methods: It was a hospital based cross sectional observational study, carried out in Gastroenterology Department of Combined Military Hospital (CMH) Dhaka from May 2017 to May 2019. Total 200 patients were included in the study. Verbal consents were taken from patients. Data were collected with a checklist and analyzed by using SPSS 20. Results: Total 200 patients’ mean age±SD was 56.5±14.5 years with range 21 to 92 years and majority were 41 to 60 years 80(40%) followed by 61 to 80 years 78(39%). Etiology of obstructive jaundice were, benign 137(68.5%) and malignant 63(31.5%). Among the benign: 69(34.5%) were choledocholithiasis, 45(22.5%) biliary stricture, 20(10.0%) papillary stenosis and 3(1.5%) biliary warms. Among the malignant: 24(12.0%) were distal cholangiocarcinoma, 21(10.5%) periampullary tumors, 10(5.0%) Klatskin tumor, 4(2.0%) carcinoma head of pancreas, and 4(2.0%) other malignancy. Mean serum bilirubin level 17.6 mg/dl with minimum 0.6mg/dl, maximum 41.3mg/dl; mean alkaline phosphatase (ALP) level 351.4U/L with minimum 111U/L and maximum 1262U/L; mean alanine aminotransferase (ALT) level 118.8 U/L with minimum 28 U/L, maximum 521 U/L; ERCP were successfully done in 188(94.0%) patients with single attempt 171 (85.5%), repeated sessions 17(8.5%) and 12(6.0%) patients unsuccessful ERCP; complications occurred in 17(8.5%)patients, of whom post-ERCP pancreatitis 9(4.5%) and post procedure cholangitis 4(2.0%)patients. Conclusion: Benign etiologies of obstructive jaundice were more common than malignant one. Both benign and malignant etiology of obstructive jaundice can be successfully managed with ERCP with few complications. JAFMC Bangladesh. Vol 16, No 2 (December) 2020: 27-30