significance of bile acid determination in latent hyperbilirubinaemia

This work was conducted on 1540 apparently healthy personels and blood donors. Individuals with total serum bilirubin 1.4 mg/dl or more were subjected to haematological investigations to exclude haemolysis, biochemical investigations including conjugated and unconjugated bilirubin, serum transaminases [AST and ALT], alkaline, phosphatase [ALP], albumin and prothrombin time and post prandial serum bile acids as well as serological markers for viral hepatitis. Liver biopsy was performed in selected cases. Serum bilirubin was found to be elevated [1.9 mg/dl] in 56 cases [3.63%]. 39 of these cases were found to be positive for serological markers of viral hepatitis [11 HBV and 28 HCV] and 17 cases were seronegative. The latter group had no evidence of haemolysis with normal hepatic enzymes as well as normal serum bile acid level. In HBV positive cases, 4 of them had elevated hepatic enzymes and 7 had elevated serum bile acids while in HCV positive cases there were 6 cases with elevated hepatic enzymes and 23 cases had elevated serum bile acids. Abnormal histopathological changes in liver structure were reported in seropositive cases. Serum bile asid determination should join the common liver function tests, its level correlates with liver histopathological findings better than aminotransferases

Pituitary adrenal axis status in children with protein calorie malnutrition [PCM]

Thirty six children suffering from various forms of protein calorie ma1nutrition [PCM] [15 with marasmus, 9 with kwashiorkor and 12 with marasmic kwashiorkor] Their ages ranged in between 4 to 20 months, beside 10 healthy children of matched age and sex were similarly taken as a control group. The following investigations [serum Na and K. plasma ACTH, serum cortisol and aldosterone] were performed. There were: [1] Increased serum cortisol levels with loss of diurnal variation in all groups of PCM [2] Increased plasma ACTH levels in all groups of PCM. [3] Incomplete dexamethasone suppression [4] variable changes in the levels of serum aldosterone among various forms of PCM. In marasmic group mean serum aldosterone level was within normal, but the mean levels were significantly higher in both kwashiorkor and marasmic kwashiorkor groups. After nutritional rehabilitation the levels of these hormones returned to normal indicating that these changes are protective mechanisms as well as easy reversibility of the axis