ABSTRACT
Khat is consumed for recreational purposes in many countries, including Yemen, where >50% of adults chew khat leaves regularly. A wide spectrum of khat-induced liver injuries has been reported in the literature. Herein, we report two patients with khat-induced liver injury. Both patients clinically presented with acute hepatitis, one of whom showed radiological evidence of hepatic outflow obstruction. Based on the histological tests, both patients had acute hepatitis, which indicated drug-induced liver injury [DILI] on a background of chronic hepatitis and portal fibrosis; of the two, one presented with symptoms of immune-mediated liver injury
ABSTRACT
Background/aim: Liver biopsy, traditionally considered to be the reference standard for staging fibrosis, has been challenged over the past decade by the development of noninvasive methodologies. Noninvasive methods, initially studied and validated in patients with chronic hepatitis C, are now used increasingly for patients with hepatitis B. However, the usefulness of these markers in the prediction of liver fibrosis in HBeAg negative patients with normal enzymes still needs to be validated
Patients and methods: Patients with chronic hepatitis B attending the National Liver Institute Biopsy Unit from September 2010 to September 2013 were included in the present study. For patients with persistently normal alanine aminotransferase greater than 40 [69 patients], the following indirect biochemical indices were measured and compared with the biopsy result: aspartate aminotransferase to alanine aminotransferase ratio [AAR], fibrosis index based on the four factors, aspartate aminotransferase to platelet ratio index, AAR to platelet ratio index, fibroindex, and age-platelet index [API]
Results: A total of 50 patients suffered from nonsignificant fibrosis [METAVIR F0-F1] and 19 patients suffered from significant fibrosis. gamma-Globulin [P=0.001] and gamma-glutamyl transferase [P=0.007] were independent predictors of fibrosis. Analysis with receiver operating curve showed that none of the predictors had a powerful diagnostic value. API had the best sensitivity and specificity [sensitivity: 83%; specificity: 58%] for predicting liver fibrosis, followed by fibroindex [sensitivity: 75%; specificity: 54%]. Aspartate aminotransferase to platelet ratio index showed a low precision in identifying significant fibrosis, with an area under the curve of 0.6
Conclusion: None of the tested noninvasive indices could distinguish the significant liver fibrosis effectively. We suggest the use of platelets, gamma-glutamyl transferase and gamma-globulins, API, and fibroindex for monitoring disease severity and predicting prognosis. In suspicious cases, a more validated modality such as FibroScan can be performed
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To isolate the essential oils of Origanum syriacum, Thymus decussatus and Salvia multicaulis and evaluate their antioxidative and hepatoprotective activities against paracetamol induced injury in primary-cultured rat liver cells. The essential oils isolated from Origanum syriacum, Thymus decussatus and Salvia multicaulis were analysed by GC-MS. Antioxidant activities of the essential oils were determined by DPPH scavenging activity [DPPH] and Trolox equivalent antioxidant capacity [TEAC] asssays. Conditions have been investigated to devise an in-vitro colorimetric MTT assay method for the hepatoprotective activity against paracetamol induced injury in primary-cultured rat liver cells. The major component of the essential oils of Origanum syriacum, Thymus decussatus was thymol 58.6% and 21.6% respectively. While the major component of Salvia multicaulis was camphor 39.8%. The antioxidant activity showed that the volatile oil of Origanum exhibited the highest activity followed by Thymus then Salvia. As for the hepatoprotective activity, the assay revealed that the volatile oil of Salvis multicaulis showed a suitable safety margin [the toxic concentration was 125 micro g/ml, while hepatoprotective concentration was only 25micro g/ml]. The essential oils of Origanum syriacum, Thymus decussatus and Salvia multicaulis exhibited remarkable antioxidant activity and significant hepatoprotective activity
Subject(s)
Antioxidants , Protective Agents , Liver , Oils, Volatile/chemistry , Plant PreparationsABSTRACT
Endoglin [CD 105], a transforming growth factor-beta [TGF-beta 1] co-receptor, has been implicated in liver fibrogenesis and carcinogenesis. To determine CD 105 in liver tissue and serum of patients with chronic hepatitis C virus [HCV] infection and to correlate CD 105 expression to stage of fibrosis and serum markers of liver fibrosis; TGF-beta 1 and hyaluronic acid [HA]. Liver biopsies from 42 chronic HCV patients and 20 healthy subjects [donors for liver transplantation] were used for tissue quantification of CD 105 by ELISA and Western blot analysis then correlating findings with tissue TGF-beta 1. Serum CD 105 and HA from patients and control subjects were determined by ELISA. According to the stage of liver fibrosis assessed by Ishak scoring system, patients were classified into 3 groups: Group I: with mild fibrosis [stage 1-2] included 16 patients [11 males, 5 females, mean age 34.5 +/- 7.2 years], Group II: with moderate fibrosis [stage 3-4] included 15 patients [12 males, 3 females, mean age 36.5 +/- 4.1 years] and Group III: with severe fibrosis [stage 5-6] included 11 patients [8 males, 3 females, mean age 41.5 +/- 5.6 years]. Patients with severe fibrosis revealed significantly higher intrahepatic expression of CD 105 and TGF-13 1 than those patients with moderate fibrosis [p<0.05, p<0.001], mild fibrosis [p<0.01, p<0.001] and normal liver [p<0.001, p<0.001]. Serum levels of CDI 05 were 7.9 +/- 1.4 ng/mL, 5.4 +/- 0.54 ng/mL and 3.6 +/- 0.52 ng/mL for patients with severe, moderate and mild fibrosis respectively with a significant difference [p<0.001]. Interestingly, serum CD1O5 showed a positive correlation with severity of fibrosis and serum HA concentrations. At a cut off 3.12 ng/mL, CD 105 gave a sensitivity of 70%, specificity of 89% with area under curve [AUC] of 0.781 for diagnosis of liver fibrosis and at cut off 43.2 ng/mL. HA had a sensitivity of 80%, specificity of 96% and AUC of 0.903. Data from this study provide evidence for a new clinical application of endoglin [CD 105] as a complementary biomarker in diagnosis and prognosis of liver fibrosis as well as a possible therapeutic role of endoglin antagonist in the management of cirrhosis