Abnormal liver function test in patients with diabetes and hypertension on treatment at the Laquintinie and Douala General Hospitals

Comorbidity of diabetes mellitus and hypertension is common, with both diseases and their treatment being able to cause liver function abnormalities, which can lead to liver failure. This study aims to access the effect of drugs used in the management of these diseases on liver function. A cross sectional study will be conducted, followed by a case-control design. Ethical clearance will be obtained from the Faculty of Health Sciences Institutional Review Board and administrative authorization from the various hospital directorates. The sampling procedure adopted will be consecutive and shall include all consenting patients aged 21 years and above, treated for hypertension, diabetes mellitus, or both. Pregnant women, patients with liver disease, viral hepatitis, as well as those on known hepatotoxic drugs will be excluded. Clinical, lifestyle, anthropometric data as well as venous blood samples will be collected and analyzed for liver enzymes (aspartate transaminase, alanine transaminase, and gamma glutamyl transferase) total or conjugated bilirubin, hepatitis B surface antigen and hepatitis C virus antibodies. Student T-test will be used to compare means and chi-square to test for proportion. Associated factors will also be determined using odds ratios. A p-value of <0.05 will be considered significant. The prevalence of liver function abnormalities shall be determined. Determinants of liver function abnormalities shall also be identified.

Assessment of chronic kidney disease in patients with non-alcoholic fatty liver disease (NAFLD); A single center experience

Background: Non-alcoholic fatty liver disease (NAFLD) represents a considerable percentage of chronic liver diseases worldwide. The liver is not the only organ affected by NAFLD but also affects other organs such as the cardiovascular system and the kidney. In recent decades, there has been a growing body of evidence linking NAFLD to kidney function. So, the current study aims to assess the percentage of chronic kidney disease (CKD) in NAFLD patients and its link to different stages of hepatic fibrosis. Patients and Methods: A case-control study evaluated 62 non-alcoholic fatty liver disease patients and a control group of 38 volunteers with apparently healthy livers (normal echo pattern by ultrasound). All participants underwent serum creatinine measurement, albumin creatinine ratio in urine, calculation of estimated glomerular filtration rate (eGFR), abdominal ultrasound, and fibroScan examination. Results: The authors showed that the percentage of patients with chronic kidney diseases (patients with GFR less than 60 ml or micro-albuminuria) were significantly higher among NAFLD groups than in healthy controls. There was a significant positive correlation between the albumin creatinine ratio and subcutaneous fat thickness, BMI, and steatosis degrees. The estimated glomerular filtration rate (eGFR) and the age of the patients had a significant negative correlation. In comparison, the eGFR and AST levels had a significant positive correlation. Conclusions: Our results showed that NAFLD substantially raises the risk of getting CKD

Relationship between Elevated Liver enzymes and Metabolic syndrome among Egyptian adults

Background and study aim: Liver enzymes are important markers for hepatocyte damage. Metabolic syndrome (MS) is a combination of metabolic abnormalities including high blood glucose, obesity, hypertension and dyslipidemia. The incidence of MS is believed to be increasing in Egypt. The purpose of this study is to examine the relationship between elevated liver enzymes and MS among Egyptian adults. Patients and Methods: A total 138 apparently healthy subjects were randomly included (99 females and 39 males). Demographic, clinical (blood pressure, body mass index and waist circumference) and biochemical (measurements of alanine aminotransferase (ALT), aspartate amino-transferase (AST), alkaline phosphatase (ALP), lipid profile, blood glucose and viral markers) were collected from every subject. Metabolic syndrome was defined according to a well-known criteria and subjects in the final analysis were divided into group I; metabolic syndrome and group II; non-metabolic syndrome subjects. Results: In this study, 92 persons fulfilled three of the five criteria of metabolic syndrome (group I) with prevalence of 66.7% while group II (non-metabolic syndrome) represented 33.3%. Patients with MS were older and less physically active in comparison with group II. There were an association between elevations in liver enzymes (ALT, AST, ALP) and MS. ALT, AST and ALP were elevated in 42.4%, 17.2% and 20.7% of patients with MS respectively. ALT and AST showed positive correlation with elevated blood glucose and triglycerides levels while AST/ALT ratio showed negative correlation with diastolic blood pressure, triglycerides level and waist circumference. The more items of MS the patient have the higher the level of liver enzymes. Conclusion: Among Egyptian adults elevated levels of liver enzymes were associated with MS and a correlation was noticed with its components

Profils clinico-évolutifs de 45 patients opérés pour traumatisme hépatique / Clinical-evolutionary profiles of 45 patients operated for liver trauma

Introduction - La prise en charge des traumatismes hépatiques a considérablement évolué ces dernières années et les attitudes thérapeutiques sont de plus en plus conservatrices. L'objectif de notre étude était d'identifier les différents critères diagnostiques ayant posé l'indication opératoire ainsi que les aspects thérapeutiques et évolutifs des patients opérés pour lésion hépatique faisant suite à un traumatisme. Matériel et méthode - Il s'agit d'une étude descriptive rétrospective qui s'étale sur 4 années (du 01/01/2016 au 31/12/2019) qui a colligé 127 cas de traumatismes de l'abdomen (contusions et plaies pénétrantes de l'abdomen) opérés au service des urgences chirurgicales du CHU d'Oran - Algérie. Sur un total de 127 laparotomies effectuées pour traumatisme de l'abdomen, le foie était atteint dans 45 cas. Résultats - La moyenne d'âge des opérés était de 30,63 ans avec des extrêmes de 16 à 89. On note une nette prédominance masculine avec 89% des cas. Les traumatismes fermés de l'abdomen (TFA) sont retrouvés dans 64,4% des cas et les plaies pénétrantes de l'abdomen dans 35,6% des cas. L'instabilité hémodynamique d'emblée avec administration de supports hémodynamiques était présente dans 37,7 % des cas et ayant nécessité une exploration chirurgicale. Les lésions extra abdominales associées étaient fréquentes avec 26,6% de cas de traumatismes crâniens, 17,7% de cas d'hémopneumothorax, un cas d'hémo-médiastin, 11,1% de cas de traumatisme du rachis et 17,7% de cas de fractures du fémur. Discussion - La persistance de l'instabilité hémodynamique malgré les mesures de remplissage conditionne la prise de décision du traitement chirurgical. Tout retard à la réalisation de la laparotomie représente une perte de chance et impacte le taux de mortalité. Conclusion - Le pronostic des lésions hépatiques au cours des traumatismes de l'abdomen diffère selon la gravité lésionnelle et son caractère hémorragique. L'existence d'un choc hémorragique et l'association de lésions intra et/ou extra abdominales conditionnent le pronostic de ce type de traumatisme.

Introduction - The management of hepatic trauma has evolved considerably in recent years and therapeutic attitudes are becoming more and more conservative. The objective of our study was to identify the different diagnostic criteria that established the operative indication as well as the therapeutic and evolutionary aspects of patients operated on for liver injury following a trauma. Results - The average age of operated patients was 30.63 years with extremes from 16 to 89. There is a clear male predominance with 89% of cases. Closed trauma to the abdomen (ASD) was found in 64.4% of cases and penetrating wounds in the abdomen in 35.6% of cases. Hemodynamic instability from the outset with administration of hemodynamic supports was present in 37.7% of the cases and required surgical exploration. Associated extra abdominal lesions were frequent with 26.6% of cases of head trauma, 17.7% of cases of hemopneumothorax, one case of hemo-mediastinum, 11.1% of cases of trauma to the spine and 17.7 % of femur fractures. Discussion - The persistence of hemodynamic instability despite the filling measures conditions the decision to take surgical treatment. Any delay in performing the laparotomy represents a loss of luck and impacts the mortality rate. Conclusion - The prognosis for liver damage during trauma to the abdomen differs depending on the severity of the injury and its haemorrhagic nature. The existence of a hemorrhagic shock and the association of intra and / or extra abdominal lesions condition the prognosis of this type of trauma.

Estimation of the prophylactic effect of the egyptian propolis extract against aluminum silicate toxicity on some organs of albino rats growth performance and histochemical studies

Background: the liver is a critical organ because it contains most of the accumulated metals where toxic effects can expected. Also, the lung is directly affected by receiving aluminum as aluminum silicate. Exposure of aluminum leads to production of free radicals that damage living organs and tissues. Aim of the work: this study aimed to evaluate the nucleic acid content in liver, lung and cerebellum tissues intoxicated by aluminum silicate (AlS) and the possible ameliorative effect of propolis extract (PP). Material and methods: Forty male albino rats (weighting 100-120 grams) were categorized randomly into four groups, ten rats on each group (n=10). The 1st group considered as the healthy control group. The 2nd group received 200 ml PP/kg b.wt., day after day by stomach gavage. The 3rd group was injected intraperitoneally by 20 mg AlS/kg b.wt., twice weekly. The 4th group was treated with AlS in addition to PP as the same doses as in the 2nd and 3rd groups. After two months for each group. Liver, lung and cerebellum organs were harvested. Results: decreased body weight gain of rats was realized with weakly stained nucleic acids contents in liver, lung and cerebellum tissues that intoxicated by AlS. While, using the supplemented treatment (PP) at the same time with the induction of AlS compound showed an ameliorative effect on the nucleic acid contents. Conclusion: propolis has anti-oxidant by inhibiting AlS toxicity on nucleic acids in the different experimental organs of rats

Serum cholinesterase level as a biomarker in detecting liver injury in Patients with chronic hepatitis c

Background: hepatitis C virus can cause both acute and chronic hepatitis. The acute process is self-limited, rarely causes hepatic failure and usually leads to chronic infection. Chronic HCV infection often follows a progressive course over many years and can ultimately result in cirrhosis, HCC and the need for liver transplantation. Objective: the aim of this study is to evaluate serum cholinesterase (CHE) level as a biomarker for detecting liver damage in patients with chronic hepatitis C. Patients and Methods: the current study was carried out on 50 subjects selected from the outpatient's clinic of Internal Medicine Department of Sayed Galal Hospital, Al-Azhar University and admitted to the internal department. The study was performed in the period between July-2014 to July -2019. Results: Sensitivity of cholinesterase is 100%, its specificity is 100% and its accuracy is 100%, in predicting liver injury in patients with chronic hepatitis C. Cholinesterase is positively correlated with Hb, platelets and albumin. Cholinesterase is negatively correlated with ALT, AST and ALP, total & direct bilirubin, PT, INR, urea, creatinine and AFP. There is significant increase of cholinesterase among compensated compared with decompensated cirrhotic patients. There is significant decrease of cholinesterase among compensated cirrhotic patients compared with controls. There is significant decrease of cholinesterase among decompensated cirrhotic patients compared with controls. Conclusion: cholinesterase is an excellent biomarker of cirrhosis with good sensitivity and specificity. Cholinesterase shows good correlation with albumin, PT, INR and Child-Puch score. Cholinesterase distinguishes decompensated cirrhosis from compensated cirrhosis well

Serum lipid profile, liver function indices and electrolyte levels in diabetics and subjects with hepatic impairment in the University of Port Harcourt Teaching Hospital

This study investigated serum lipid profile, liver function indices and electrolyte levels in diabetics and hepatitics in the University of Port Harcourt Teaching Hospital. 210 subjects comprising 70 subjects each for diabetics, hepatitics, and control matched for age and sex were sampled for the purpose of the study based upon specified criteria. 45 each were males while 25 each were females. Mean alanine and aspartate aminotransferases (ALT and AST), alkaline phosphatase (ALP) and gamma glutamyltransferase (GGT) activities, respectively, were significantly elevated (p<0.05) in the diabetics (22 U/L, 30 U/L, 91 U/L, and 12 U/L respectively) and hepatitics (86 U/L, 161 U/L, 113 U/L, and 50 U/L respectively); mean triglycerides (TG), total cholesterol (TC) and low density lipoprotein-cholesterol (LDL-C) levels respectively, were significantly elevated (p<0.05) in the diabetics (1.8 mmol/L, 4.6 mmol/L, and 2.6 mmol/L respectively) and hepatitics (1.4 mmol/L, 3.6 mmol/L, and 1.8 mmol/L respectively) except the hepatitics mean LDL-C level, whereas mean high density lipoprotein-cholesterol (HDL-C) level was significantly reduced (p≥0.05) in the diabetics (1.2 mmol/L) and hepatitics (1.0 mmol/L). Mean sodium and potassium levels were significantly reduced (p≥0.05) in the diabetics (135 mmol/L and 3.5 mmol/L respectively). Mean sodium level was reduced in the hepatitics while mean potassium level was elevated in the hepatitics. Mean bicarbonate level was significantly elevated (p<0.05) in the diabetics (28 mmol/L) but slightly elevated in the hepatitics. Conclusively, differences in lipids, electrolyte levels and liver function indices found in diabetics and hepatitics have a great potential as a diagnostic means in clinical practice

9th Liver Interest Group Annual Meeting

On a beautiful Saturday morning, I made my way to the Radisson Blu Gautrain hotel in Sandton for the 9th annual liver interest meeting. After a quick cup of coffee to catch up with colleagues, we made our way into the modern and stylish conference centre to begin the talks of the day

The prevalence liver function and immunologic status of children with HIV and Hepatitis B virus coinfection in Enugu, Nigeria

Background: Hepatitis B Virus (HBV) co-infection is prevalent among HIV infected individuals because of shared routes and mechanisms of transmission. The multidimensional immunosuppression from HIV infection causes impaired spontaneous recovery from an acute HBV infection; predisposing to chronic infection which is worsened by younger age at infection. Co-infection increases the risk of HBV replication; hepatotoxicity and liver related deaths from Highly Active Antiretroviral Therapy (HAART). The study was undertaken to highlight the burden of co-infection among HIV positive children in Enugu; determine the associated risk factors and compare the effect of co-infection between co-infected and non-co-infected children using liver enzyme and CD4 counts. Materials and Methods: A cross sectional study was carried out among HIV positive children attending the Paediatric ARV clinic of the University of Nigeria Teaching Hospital; Ituku-Ozalla. A total of 140 HIV infected children aged 18 months to 15 years were recruited. An interviewer questionnaire was administered. Hepatitis B surface antigen (HBsAg) was determined using Determine test Kit. Baseline and recent CD4 counts/CD4% were retrieved from the patients' folders. Results: Fourteen (10%) were positive for HBsAg. The highest prevalence of HBsAg was observed among children aged 11- 15 years. The higher the socioeconomic class the less likely the HBsAg positivity. Seven (50%) of the co-infected children had elevated baseline ALT compared with 57 (45.2%) of non-co-infected children though the difference was not statistically significant (t = 0.6; P = 0.56). After the initiation of HAART; 10 (76.9%) of the co-infected and 18 (15.1%) of the non-co-infected children had elevated ALT. The baseline median CD4 count among children = 6 years was 230 cells/mm3 and 360 cells/mm3 respectively among the co-infected and nonco- infected; (P = 0.67). However; in children = 5 years; it was 25% and 15 % respectively (P =0.06). Conclusion: HBV co-infection among HIV infected children is common in our environment; and co-infection is associated with impaired immunity and probably liver enzyme derangement

Knowledge of Caregivers of Febrile Children about Fever; Paracetamol Use and Paracetamol Induced Hepatic Toxicity in Lagos Nigeria

Background: Fever is as a result of immune response to many pathogens. Paracetamol is widely and irrationally used at home for treatment of fever in children before presentation at the health facility but it is not clear whether caregivers are aware of the toxicity that can result from non-rational use of paracetamol.Objectives: The aim of this study was to evaluate the knowledge of fever; the use of paracetamol; and paracetamol induced hepatic toxicity amongst caregivers of febrile children. Methods: This was a prospective descriptive study in which we interviewed two hundred and ten caregivers who brought febrile children to Onwusikawa Children's Medical Center Okota Lagos over a period of one year (Jan 2013- Dec 2013). A pretested closed ended questionnaire was used to collect data on the use of paracetamol; knowledge about fever; and toxicity of paracetamol during routine clerking.Result: Paracetamol in both syrup and tablet formulations was administered by the study population to febrile children before presentation in hospital . Majority of the respondents (61%) knew fever as an increase in body temperature. About 8% of those interviewed gave paracetamol to their children including neonates almost on a daily basis to prevent fever or because they felt the baby especially the head was hot. Ninety five percent of all respondents were not aware that paracetamol could cause adverse effects while 98% did not know that paracetamol could cause hepatic toxicity. Conclusion: The knowledge regarding toxicity of paracetamol was poor. It is proposed that education of caregivers by health workers on dangers of paracetamol misuse should be routine. Pharmaceutical companies that manufacture paracetamol for children must provide a risk management plan

Biométrie hepato-splenique a l'imagerie ultrasonore de l'enfant noir africain: exemple du Togo

Objectif : Etablir les normes biometriques hepatosplenique a l'echographie selon l'age; la taille et le poids des enfants togolais.Materiels et methodes : Etude transversale colligeant 290 enfants des deux sexes (156 garcons et 134 filles) de 0 a 15 ans.Resultats : Les dimensions du foie et de la rate croissaient avec l'age et le poids mais cette croissance globalement n'etait pas statistiquement significative (p0;05). Ces dimensions fortement correlees a la taille; evoluaient statiquement significative (p0.05) avec elle. A partir de 11 ans; ces dimensions augmentaient tres peu et leurs normes etaient superposables a quelques millimetres pres a celles des adultes.Le grand axe du foie etait sensiblement egal a 1;5 fois la hauteur du rein droit et la longueur cranio-caudale de la rate voisine de la hauteur du rein gauche.Les limites hautes par tranche d'age; au dela desquelles une hepatomegalie ou une splenomegalie est plausible etaient consignees dans un abaque.La courbe de variation du grand axe du foie et de la rate en fonction de la taille des enfants etaient quasiment lineaire et pouvait etre exprime par une equation de droite : y

Effect of Hepatitis B Virus Co-Infection on CD4 Cell Count and Liver Function of HIV Infected Patients

Background: Human immunodeficiency virus (HIV)and Hepatitis B virus (HBV) share similar routes of transmission; making it possible for an individual to have a co-infection. HBV infection is well known to be a major cause of chronic liver diseases worldwide. The aim of this study was to determine the prevalence of HBV infection among HIV infected HAART naive patients and investigate the effect of co-infection on CD4 count and liver function. Study design: This was a hospital based descriptive cross sectional study of one hundred consecutive therapy-naive HIV-infected individuals. The CD4 count; Hepatitis B surface antigen; Serum albumin; total Protein; and liver enzymes were determined using standard techniques. Results:The prevalence of HIV and HBV co-infection was 37. The mean serum ALT and ALP were significantly higher in the co- infected patients (Pvalues 0.05). The mean CD4 count of the mono infected patients was significantly higher (p-value of 0.014). The mean serum ALT; AST and ALP of mono and co-infected patients with CD4 count200/?l were significantly higher than those with count ? 200 cells/?l. (p-value of 0.01). The mean ALT and AST of the co -infected patients and all patients with CD4 count 200 cells/?l were higher than the normal reference range. Conclusion : Approximately one third of HIV positive patients had hepatitis B virus co-infection. Coinfection and CD4 count 200 cells/?l are likely to result in abnormal ALT and AST. We recommend that co-infected patients and those with CD4 count 200 cells/?l should be given non-hepatotoxic antiretroviral drug

Liver Enzymes and Trace Elements in the Acute Phase of Sickle Cell Anaemia

BACKGROUND: Trace elements are required for the performance of numerous functions of immune cells. It is not clear whether levels of trace elements are elevated and whether there is a relationship between the levels of liver enzymes and trace elements in patients with sickle cell anaemia in crisis. OBJECTIVE: To compare the plasma levels of liver enzymes and trace elements in non sickle cell anaemia (NSCA); sickle cell anaemia subjects in the steady state (SCASS) and sickle cell anaemia patients in crisis (SCAC). METHODS: Haematological parameters; liver enzymes and trace elements were determined in 20 NSCA subjects; 20 SCASS subjects and 18 SCAC subjects. Variables studied included aspartate aminotransferase (AST) alanine aminotransaminase (ALT); alkaline phosphatase (ALP); and the trace elements copper; zinc; and manganese. RESULTS: Levels of liver enzymes were higher in the SCAC subjects than in the NSCA or SCASS subjects (p

Piroxicam-Induced Hepatic and Renal Histopathological Changes in Mice

Piroxicam is a non-steroidal anti-inflammatory drug widely used in rheumatic diseases. The aim of this study was to investigate Piroxicam-induced histopathological changes in livers and kidneys of male albino mice.Methods: Animals were classified into a control group and 4 treated groups. Piroxicam was injected intraperitoneally using 0.3 mg/kg every day for four weeks. Each week a group of mice was sacrificed. Liver and kidneys were obtained for histological and histochemical examination. Animals were classified into a control group and 4 treated groups. Piroxicam was injected intraperitoneally using 0.3 mg/kg every day for four weeks. Each week a group of mice was sacrificed. Liver and kidneys were obtained for histological and histochemical examination.Results: Liver sections appeared with inflammatory cellular infiltration; vacuolated hepatocytes; dilated sinusoids; and increased number of Kupffer cells. Kidney sections appeared with some cellular inflammations. The glomeruli were shrunk resulting in widening of the urinary space. Oedema and vacuolations were noticed in the tubular cells. There was a positive correlation between these pathological changes and the increased treatment periods. Histochemical staining revealed that glycogen and protein contents had decreased in the hepatocytes. This depletion worsened gradually in liver cells after two; three; and four weeks. Similar depletion of the glycogen content was observed in kidney tissue. However; protein content appeared to be slightly decreased in the kidney tubules and glomeruli. Incensement of coarse chromatin in the nuclei of hepatocytes; Kupffer cells and most inflammatory cells were detected by Fuelgen method. Kidney tissues appeared with a severe decrease in coarse chromatin in the nuclei.Liver sections appeared with inflammatory cellular infiltration; vacuolated hepatocytes; dilated sinusoids; and increased number of Kupffer cells. Kidney sections appeared with some cellular inflammations. The glomeruli were shrunk resulting in widening of the urinary space. Oedema and vacuolations were noticed in the tubular cells. There was a positive correlation between these pathological changes and the increased treatment periods. Histochemical staining revealed that glycogen and protein contents had decreased in the hepatocytes. This depletion worsened gradually in liver cells after two; three; and four weeks. Similar depletion of the glycogen content was observed in kidney tissue. However; protein content appeared to be slightly decreased in the kidney tubules and glomeruli. Incensement of coarse chromatin in the nuclei of hepatocytes; Kupffer cells and most inflammatory cells were detected by Fuelgen method. Kidney tissues appeared with a severe decrease in coarse chromatin in the nuclei.Conclusion: Piroxicam has a time-dependent toxic effect on both liver and kidney tissues

Giant Solitary Hepatocellular Carcinoma. A Case Report

Hepatocellular carcinoma (HCC) is the most common primary malignancy of the liver; among indigenous inhabitants of Africa and it may present as solitary or multiple lesions often running a rapidly fatal course. Presented is a case of a 25 year female in apparent general good health with a giant solitary hepatocellular carcinoma. HCC should be considered in the diagnosis of a right upper quadrant/epigastric mass even when it assumes a gigantic proportion in an apparently healthy patient