Safety of the yellow fever vaccine in people living with HIV: a longitudinal study exploring post-vaccination viremia and hematological and liver kinetics

ABSTRACT Background: Safety data on the yellow fever vaccine 17DD in People Living with HIV (PLWH) are limited. This study explored the occurrence of post-vaccination 17DD viremia and the kinetics of hematological and liver laboratorial parameters in PLWH and HIV-uninfected participants [HIV(-) controls]. Methods: We conducted a secondary analysis of a longitudinal interventional trial (NCT03132311) study that enrolled PLWH and HIV(-) controls to receive a single 17DD dose and were followed at 5, 30 and 365 days after vaccination in Rio de Janeiro, Brazil. 17DD viremia (obtained throughreal-time PCR and plaque forming units' assays), hematological (neutrophils, lymphocytes and platelets counts) and liver enzymes (ALT and AST) results were assessed at baseline and Days 5 and 30 post-vaccination. Logistic regression models explored factors associated with the odds of having positive 17DD viremia. Linear regression models explored variables associated with hematological and liver enzymes results at Day 5. Results: A total of 202 PLWH with CD4 > 200 cells/μL and 68 HIV(-) controls were included in the analyses. 17DD viremia was found in 20.0 % of the participants and was twice more frequent in PLWH than in HIV(-) controls (22.8% vs. 11.8 %, p-value < 0.001). Neutrophils, lymphocytes and platelets counts dropped at Day 5 and returned to baseline values at Day 30. 17DD viremia was associated with lower nadir of lymphocytes and platelets at Day 5. ALT levels did not increase post-vaccination and were not associated with 17DD viremia. Conclusions: 17DD was safe and well-tolerated in PLWH with CD4 > 200 cells/μL. Post-vaccination viremia was more frequent in PLWH than in controls. Transient and self-limited decreases in lymphocytes and neutrophils occurred early after vaccination. 17DD viremia was associated with lower lymphocytes and platelets nadir after vaccination. We did not observe elevations in ALT after 17DD vaccination.

The Effect of Postoperative Hepatic Fibrosis Factors on Morbidity in Mitral Valve Replacement Surgery: A Single Center Ten Years� Experience

Background: Previous studies have shown that hepatic fibrosis indices and rates can be used to predict cardiovascular mortality and morbidity. Our aim with this study was to investigate the effect of aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio and fibrosis?4 (FIB?4) index calculated with ALT, AST, and platelet biomarkers, which are simple, fast, and relatively inexpensive and were used in previous studies to predict cardiovascular disease prognosis, on the prediction of postoperative morbidity and early mortality after mitral valve replacement (MVR) surgery. Methods: By scanning the hospital electronic health record system, 116 patients who underwent isolated MVR or MVR + tricuspid valve intervention were identified from 178 patients who underwent MVR with the standard sternotomy procedure between 2011 and 2021. The study was completed with 81 of these patients. Patients were divided into AST/ALT <2 (Group 1) and >2 (Group 2). In addition, the same patients were divided into FIB?4 index <3.25 (Group 3) and >3.25 (Group 4), and a total of four groups were formed. Results: The mean age of Group 2 was significantly higher than Group 1 (P = 0.049). In addition, the mean age of Group 4 was significantly higher than Group 3 (P = 0.003). Postoperative complications did not differ between Groups 1 and 2 (P > 0.05). While noninvasive mechanincal ventilation (NIMV) requirements did not differ between Groups 3 and 4 (P > 0.05), MV duration and intensive care unit stay were significantly longer in Group 4 (P < 0.05). Conclusion: The AST/ALT ratio, which has been shown to be a predictor of cardiovascular mortality in various studies, was not useful in predicting mortality and morbidity in our study. However, a high FIB?4 index, another hepatic fibrosis index, was found to be associated with increased perioperative bleeding, duration of mechanical ventilation, and cardiac intensive care unit stay, which are important criteria in the prediction of morbidity in cardiovascular surgery.

Effect of Hayani Date (Phoenix dactylifera L) Peels on Blood Sugar, Blood Lipids, Liver and Kidney Functions, and Inflammation in Diabetic Rats

This study aimed to investigate the effect of Hayani date peel powder and its methanolic extract on glycemia and lipidemia in streptozotocin-induced diabetic rats as well as their effects on kidney and liver functions in addition to their anti-inflammatory activity. Twenty-four rats were used in this study, six of them served as normal control (group 1) which continued feeding on the basal diet, while the remaining 18 rats were injected with streptozotocin (50mg/kg) to induce diabetes. The diabetic rats were divided into three groups (6 rats each), one of them feeding on the basal diet only which acted as diabetic control (group 2), another group fed on the basal diet and treated orally with the peel extract in a concentration of 250 mg/kg body weight (group 3), while the third group was treated with peel powder merged in the basal diet with a concentration of 5% w/w (group 4). The results showed that the extract and the powder of the peels significantly decreased the blood glucose, glycated hemoglobin (HbAlc), total cholesterol (TC), total triglycerides (TG), low density lipoprotein cholesterol (LDL-c), very low density lipoprotein cholesterol (VLDL-c), alanine transaminase (ALT), aspartate transaminase (AST), creatinine, and uric acid as well as cyclooxygenase-2 (COX-2), prostaglandin 2 (PGE2), tumor necrosis factor alpha (TNF-?), interleukin 1B (IL-1?), and inducible nitric oxide synthase (iNOS) levels. In contrast, significant increases in serum insulin, high density lipoprotein cholesterol (HDL-c), and albumin were noticed in comparison to diabetic control. Generally, the peel extract was more effective than the peel powder. It is recommended by eating the whole fruit of date without peeling.

Rice bran oil reduces organ-specific fat deposition, attenuates hyperlipidaemia and abnormal liver function in Long Evans rats with high fat intake

@#Introduction: High-calorie diets, particularly the quality of dietary fats, are regarded as an independent risk factor for developing obesity, hyperlipidaemia, and liver diseases. The present study examined the impact of rice bran oil (RBO) on organ-specific fat deposition, lipid profile, and liver function enzymes in Long Evans rats. Methods: Long Evans rats (n=24) were fed for six weeks with a controlled high-fat diet (HFD) to induce hyperlipidaemia and abnormal liver function. Rats were then divided into two groups: one group continued feeding on HFD, and the other group was fed with a RBO diet, replacing the fat source. After six weeks of feeding, six rats from each group were sacrificed and required analytical tests were performed. The remaining obese rats (n=12) were divided into continued HFD and RBO diet, and after sacrificing, essential analytical tests were done. Results: RBO feeding to hyperlipidaemic rats for six weeks significantly reduced brown adipose tissue, abdominal adipose tissue, epididymal adipose tissue, and liver fat compared to continuing HFD group (p<0.05). Similarly, serum levels of total cholesterol, triacylglycerides, and low-density lipoprotein cholesterol were all decreased, whereas high-density lipoprotein cholesterol increased in response to RBO compared to HFD (p<0.05). Additionally, rats fed with RBO showed reduced alanine aminotransferase, aspartate aminotransferase, and gamma-glutamyl transferase levels when compared with continuing HFD-fed rats (p<0.05). Conclusion: These findings suggest that RBO supports the reduction of fat storage from major fat depots, controls lipid profile, and restores healthy liver functions in rats.

HEPATOPROTECTIVE POTENTIAL OF EUGENIA?UNIFLORA?L AGAINST GENTAMYCIN INDUCED HEPATOXICITY

Hepatotoxicity is a common drug adverse effect and gentamycin has been linked to hepatotoxic adverse reactions. Folklore and ethnobotanical studies indicate Eugenia uniflora L is used in the treatment of gastrointestinal ailments and has exhibited diverse biological activities. We investigated the hepatoprotective potential of this plant in treating gentamycin-induced hepatoxicity and compared the effect with Celebrex a COX2 selective inhibitor. Twenty-eight male adult Wistar rats average of 225g were used for the study and randomised into groups as described: normal control( normal saline), negative control: Gentamycin (40mg/kg. i.p), positive control; Gentamycin (40mg/kg. i.p) +5mg/kg Celebrex. Extract low dose: Gentamycin (40mg/kg i.p)+(50mg/kg) Eugenia uniflora L. leaves, intermediate-dose: Gentamycin (40mg/kg i.p) +100mg/kg Eugenia uniflora L leaves, high dose : Gentamycin (40mg/kg, i.p)+ (200mg/kg, ) of Eugenia uniflora L leaves. Our findings indicate that the body weight was unaffected throughout the experiment, as clearly demonstrated by the lack of significant variability (p<0.05). Hepatotoxicity was confirmed by dose-dependent alteration in Liver marker enzymes, including AST, ALT, and ALP. Eugenia uniflora L leaves were able to ameliorate the levels of these liver enzymes to a normal level. Liver tissue revealed a dose-dependent curative effect with Eugenia uniflora L compared to the COX2 inhibitor (Celebrex) treatment. Consequently, we hereby report, for the first time, that an aqueous extract of Eugenia uniflora L leaves confers hepatoprotection against gentamycin-induced hepatoxicity in Wistar rats.

Retrospective analysis of early surgical treatment of acute calculous cholecystitis with elevated liver enzymes / 国际外科学杂志

Objective:To investigate the safety and feasibility of early operation for acute calculous cholecystitis with elevated liver enzymes.Methods:The clinical data concerned about 39 patients with acute calculous cholecystitis complicated with elevated liver enzymes in The First Department of General Surgery, The First Affiliated Hospital of Anhui University of Science and Technology between January 2018 to December 2018 were analyzed retrospectively.There were 14 males and 25 females, the age was(57.59±15.30) years(range 29 to 84 years). All patients were given hepatoprotective therapy and antibiotic therapy, A total of 18 patients received early surgical treatment within 7 days (surgical group), 21 patients who received only hepatoprotective therapy and antibiotic therapy(control group). Observation indicators: (1)Total bilirubin, white blood cells and pancreatin in both groups at admission; (2)Data of liver enzyme indexes (ALT, AST, GGT) of the two groups at admission and 3 days after admission; (3)The length of hospital stay in the two groups, and gallstone-related events after discharge(the incidence of gallstone-related emergency, the rehospitalization rate). Normally distributed measurement data were expressed as mean±standard deviation( ± s), and comparison between groups were analyzed using t test; Non-normal distribution measurement data were represented by M( Q1, Q3), and comparison between groups were analyzed using Mann-Whitney U test. Comparison between groups were analyzed using chi-square test or Fisher method of count data. Results:There was no statistical difference between the two groups in terms of total bilirubin, white blood cells and pancreatin( P>0.05). There was no significant difference in liver enzyme indexes (ALT, AST, GGT) between the two groups when they were admitted to the hospital ( P>0.05) and 3 days later ( P>0.05). Before treatment, ALT、AST、GGT in surgical group were 161.00(83.75, 237.75) U/L, 63.50(49.50, 257.75) U/L, 245.50(66.75, 549.75) μmol/L, ALT, AST, GGT in control group were 187.00(64.00, 335.50) U/L, 104.00(53.50, 355.00) U/L, 299.00(136.50, 455.00) μmol/L, after 3 days antibiotic therapy and hepatoprotective therapy, ALT, AST, GGT in surgical group were 77.50(52.00, 111.00) U/L, 41.50(33.00, 53.75) U/L, 190.50(65.00, 372.00) μmol/L, ALT, AST, GGT in control group were 67.00(23.50, 129.50) U/L, 37.00(26.00, 61.50) U/L, 187.00(90.50, 337.00) μmol/L, levels of the two groups decreased significantly( P<0.05). There was no statistically significant difference in the length of hospital stay between the surgical group and the control group[(12.89±3.41) d vs (11.05±4.57) d, P>0.05]. After 12 months of follow-up, Gallstone-related events after discharge, the incidence of gallstone-related emergency in the surgical group was lower than that in the control group (5.6% vs 33.3%), the rehospitalization rate in the surgical group was significantly lower than that in the control group (5.6% vs 42.9%), there was statistically significant difference between the two groups ( P<0.05). Conclusion:Hepatoprotective therapy and antibiotic therapy and can effectively reduce the liver enzyme indexes of such patients in a short period of time, early surgical treatment after liver enzymes has decreased is a complete and safe option.

Evaluation of Hepatic Enzymes and its association with Glycemic Control among Non - Obese Type 2 Diabetes Mellitus Patients.

Background: Liver plays a key role in regulating the carbohydrate, lipid and protein metabolisms and in maintaining the blood glucose levels in the body. Oxidative stress plays an additional role in causing liver damage in diabetic patients, increasing damage to the hepatic cells further worsens the glycemic control causing hyperglycemia and complications of diabetes. Aim: To Estimate the liver enzymes in patients with Type 2 Diabetes Mellitus and its correlation with glycemic control among non-obese Type 2 Diabetes mellitus patients. Material and method: A Cross sectional analytical study conducted in a tertiary care hospital and Research center from January 2019 to July 2020 and 96 patients were included in the study. Patients were divided into 2 groups of 48 each, Group 1 consists of Type 2 Diabetes mellitus patients on oral hypoglycemic drugs and Type 2 Diabetes mellitus patients on insulin therapy in Group 2. Liver enzymes AST, ALT, GGT, ALP and HbA1C was estimated in both the groups. The data obtained was subjected to appropriate statistical analysis. Results: The participants in both the groups had BMI of <30kg/m. The mean levels with Standard error (SE) of hepatic enzymes and HbA1C in Group I and Group II was AST (26.38±2.3and 27.75±1.7), ALT (25.54±3.1and 26.38±1.97), GGT (33.60±4.5 and 27.48±2.4), ALP (101.23±4.7and 107.08±4.0) and HbA1C(9.96±0.29 and 9.26±0.24)respectively. Conclusion: Liver enzymes could be within normal limits in non-obese Type 2 Diabetes Mellitus patients on regular physical activity and treatment, USG abdomen along with Liver enzymes estimation to be considered during follow-up of non-obese Type 2 Diabetes Mellitus patients with normal serum triglyceride (TG) levels.

The effect of Toxoplasma gondii infection in women on some biochemical and hormonal parameters in Duhok province, Iraq

Background: Toxoplasma gondii is protozoal parasite that cause Toxoplasmosis, which is an important protozoal disease that infect more around billion people globally. Toxoplasmosis transmitted by two way in human; the horizontal transmission by accidental and ingestion of oocysts of Toxoplasma gondii through contaminated water or food, and the second rout is vertical transmission by placenta from mother to the baby. The aim of the current study was to detect the effect of toxoplasmosis on kidney function, liver function enzymes and gonadotropin hormones like follicle-stimulating hormone (FSH) and Luteinizing hormone (LH).Methods: A total of 101 (71 samples and 30 controls) of blood samples were collected from women, which were tested for seropositivity against anti-toxoplasma antibodies like immunoglobulin G (IgG), immunoglobulin M (IgM) by ELISA. After that the biochemical test (alanine aminotransferase-ALT, Aspartate transaminase-AST, Alkaline phosphatase-ALP, Urea and Creatinine) and hormonal assay (LH and FSH) and achieved for all samples.Results: Results revealed a slight increase in the level of both urea and creatinine in infected women compared with the control group. A Pearson’s Coefficient Correlation test was used to examine the positive correlations between ALT and Anaplastic lymphoma kinase (ALK), LH and FSH at p value (<0.001 for both). Preliminary studies indicate that the level of LH and FSH in infected women is lower compared to control healthy group. Finally, current study indicated that toxoplasmosis is effect on the levels of studied biochemical and hormonal parameters.Conclusions: Current study shows a significant increase in the levels of biochemical and hormonal parameters in women infected with toxoplasmosis.

Effect of coffee consumption on liver enzymes (alanine transaminase, aspartate transaminase and alkaline phosphatase), total and conjugated bilirubin levels among students in Nnewi

Background: Coffee has a number of bioactive compounds that have beneficial effects on human health in general and more importantly is the fact that coffee consumption has positive impact on the liver function. The present study investigated the effect of coffee consumption on liver enzymes: alanine transaminase (ALT), aspartate transaminase (AST) and alkaline phosphatase (ALP), total bilirubin (TB) and conjugated bilirubin (CB) levels among student in Nnewi.Methods: A total of twenty-five (25) apparently healthy participants aged between 18 and 30 years which were randomly recruited from College of Health Sciences’ students to serve as both test and control group. Each participant was advised to abstain from coffee and similar beverages for a period of three weeks prior to the commencement of the study. Subsequently, in addition to their normal diet, each of the subjects was given 2 gm of coffee dissolved in 150 ml of hot water in which 50 mg of non-dairy creamer was added before breakfast daily for 28 consecutive days. 6 ml each of baseline and test samples (after an overnight fast) were collected at day 0 and 29 respectively from each participant. Liver enzymes such as ALT, AST, and ALP activity as well as TB and CB levels was determined using standard laboratory methods.Results: This showed significant reductions in the mean serum AST and ALT activity, TB and unconjugated bilirubin (UB) levels with no significant alterations in the mean ALP activity and CB level in participants studied after short-term coffee consumption.Conclusions: This study revealed the hepatoprotective effect of coffee intake at short term basis.

Fetomaternal outcome in women with hemolysis, elevated liver enzymes and low platelet count syndrome: a retrospective study

Background: HELLP (hemolysis, elevated liver enzymes and low platelet count) syndrome which is a variant form of severe preeclampsia is an important cause of maternal and fetal mortality and morbidity. The importance lies in the early diagnosis and timely intervention for better fetal and maternal outcome. The objective of this study was to assess the maternal and fetal outcome in pregnancies complicated with HELLP syndrome.Methods: This is a retrospective study analyzing fetomaternal outcome in 63 women diagnosed with HELLP syndrome in the department of obstetrics and gynecology, Government Medical College, Thrissur from 1st January 2014 to 31st December 2016. Details were collected from data records library.Results: Among 7,566 deliveries, 63 women (0.83%) had HELLP syndrome. Mean age was 29.5 years. 47.6% (n=30) women developed HELLP syndrome at gestational age less than 34 weeks. Maternal complications were abruption (27.78%), acute kidney injury (16.67%), DIC (16.67%), sepsis (11.11%) and postpartum hemorrhage (11.11%). In this study, HELLP syndrome lead to one maternal death (1.58%). The perinatal mortality was 25.75%.Conclusions: HELLP syndrome is an alarming complication, which brings high maternal and perinatal morbidity and mortality.

Elevación de enzimas hepáticas inducida por COVID-19 en embarazada / Elevated liver enzimes induced by COVID-19 in pregnancy

INTRODUCCIÓN: Las alteraciones del perfil hepático durante el embarazo ocurren en 3-5% de las gestantes. Una nueva etiología que se ha presentado en el contexto de pandemia actual es el síndrome respiratorio agudo severo relacionado con el nuevo coronavirus (SARS-CoV-2). Éste es responsable de alteraciones hepáticas en 2 a 11% de la población general infectada por este virus, y de hasta un 30% en las embarazadas que se infectan con SARS-CoV-2. Con el objetivo de mostrar una presentación poco frecuente del SARS-CoV-2 se expone un caso clínico de elevación de transaminasas en embarazada inducida por este nuevo virus. CASO CLÍNICO: Paciente de 36 años, cursando embarazo de 20+6 semanas, consulta por dolor abdominal asociado a ictericia y coluria. Se solicita estudio donde destaca elevación de transaminasas. Ecografía abdominal con vía biliar fina. Se descartan diferentes etiologías de hepatitis aguda y crónica (dada la falta de antecedentes). Finalmente se solicita PCR para COVID-19 que resulta positiva. CONCLUSIÓN: Luego de un estudio exhaustivo de diferentes etiologías de elevación de transaminasas, se atribuye esta alteración enzimática a SARS-CoV-2. Se decide seguimiento ambulatorio estricto con pruebas hepáticas cada dos semanas. La paciente evoluciona estable con exámenes normales luego de un mes desde que se indica el alta hospitalaria. Después de descartar etiologías frecuentes de elevación de transaminasas durante el embarazo, sugerimos solicitar el estudio de este virus con PCR para COVID-19, ya que podría ser una presentación poco frecuente de SARS-CoV-2.

INTRODUCTION: Approximately 3-5% of women present alterations of hepatic enzymes during pregnancy. Under the new circumstances that the world is facing with the SARS-COV2 pandemic, a new etiology for hepatic enzyme alterations has risen. The severe acute respiratory syndrome that the novel coronavirus causes is responsible for hepatic enzyme alterations in 2 to 11% of the sick population that did not have a previous underlying hepatic condition. Furthermore, hepatic enzyme alterations in pregnant women infected with SARS-COV2 presents in up to 30% of the cases. An infrequent presentation of SARS-COV2 is presented as our clinical case. CLINICAL CASE: A 36-year-old patient with a 20+6 week pregnancy presents abdominal pain, jaundice and choluria. General blood workup shows elevated transaminases. The abdominal ultrasound revealed a thin bile duct. Acute and chronic hepatitis etiologies were discarded. Finally, a PCR of COVID-19 was solicited, which turned out to be positive. CONCLUSIÓN: After an exhaustive study to determine the etiology of the elevated transaminases, the hepatic alterations were attributed to SARS-COV2 infection. A conservative management was adopted, with outpatient follow-up with liver testing every two weeks. The patient progresses with a stable steady decline in hepatic enzyme levels, and one-month post hospital discharge, her transaminases had reached normal values. Based on this clinical case, after ruling out frequent etiologies for elevated transaminases during pregnancy, it seems reasonable to request a PCR for COVID-19, since it could be a rare presentation of SARS-CoV-2.

Fetomaternal outcome in pregnancy with HELLP syndrome

Background: HELLP Syndrome is a serious complication of pregnancy induced hypertensive disorders. It is defined as a triad of hemolysis, elevated liver enzymes, and low platelet count (HELLP). Objectives of this study was to find out incidence of HELLP syndrome in pre-eclampsia, eclampsia and its overall incidence. To analyse the clinical profile of HELLP syndrome. To study maternal and perinatal outcome including morbidity and mortality.Methods: A retrospective study was conducted from July 2017 to September 2019 at a tertiary care center with inclusion criteria of abnormal peripheral blood smear, elevated liver enzymes (LDH, aspartate aminotransferase), and low platelet count.Results: HELLP syndrome was more common in younger age group (45%) and in primigravida (52.5%). Most of the patients presented at >36 weeks of gestation (40%) and most of the patients delivered by caesarean section (67.5%). Maternal complications were acute renal failure (27.5%), DIC (22.5%), maternal mortality (7.5%). Neonatal complications associated were intrauterine death (27.5%), prematurity (25%) and intrauterine growth retardation (15%).Conclusions: Thus, HELLP syndrome requires an early diagnosis and early initiation of treatment at tertiary care center with all the medical facilities available.

Alteraciones bioquímicas y ecográficas a nivel hepático en pacientes que viven con VIH/Sida

Los pacientes con Virus de inmunodeficiencia humana (VIH) pueden presentar alteraciones del funcionalismo y estructura hepática como consecuencia de la terapia antirretroviral (TARV), de otras coinfecciones o de patologías metabólicas o neoplásicas que pueden presentarse en cualquier estadio de la enfermedad. La realización de las pruebas de laboratorio y el ultrasonido abdominal son herramientas fundamentales para la detección y seguimiento de estos casos. Objetivo: Describir las alteraciones bioquímicas y ecográficas a nivel hepático en pacientes que viven con condición de VIH/Sida que reciben TARV. Metodología: Investigación clínica, descriptiva, de campo, de corte transversal, donde se incluyeron pacientes con VIH mayores de 18 años que acudieron a la consulta de Infectología del Hospital Central de Maracay en el período marzo-junio de 2017. Se excluyeron pacientes con coinfecciones y patologías metabólicas. Se registraron datos epidemiológicos, clínicos y paraclínicos. Resultados: Se incluyeron 23 pacientes que recibían TARV, predominando el sexo masculino y el rango etario de 20-29 años. 60,87 % tenían entre 1 y 3 años en TARV regular. 21,73 % de los pacientes mostraron elevación de las transaminasas tanto glutámico-pirúvica (TGP) como glutámico-oxalacética (TGO), destacándose que todos los pacientes de este grupo recibían terapia con inhibidores de la transcriptasa reversa análogo de nucleósido más inhibidores de la transcriptasa reversa no análogo de nucleósido (ITRN/ ITRNN); en cuanto a los valores de bilirrubina se evidenció que quienes recibían la combinación ITRN/Inhibidores de la proteasa (IP) presentaron elevación de los niveles de bilirrubina a predominio de la indirecta (21,7 %). Para la GGT solo un paciente presentó alteración. El hallazgo ecográfico más frecuente fue la esteatosis hepática (69,56 %), predominando la esteatosis hepática grado II. Conclusión: Es necesario en los pacientes con condición VIH la evaluación regular e integral de parámetros hepáticos, en búsqueda de efectos adversos de la terapéutica, u otras condiciones médicas y nutricionales que puedan incrementar el riesgo de patología hepática

Patients with Human Immunodeficiency Virus (HIV) may have alterations in liver function and structure because of antiretroviral therapy (ART), other coinfections or metabolic or neoplastic diseases that can occur at any stage of the disease. The performance of laboratory tests and abdominal ultrasound are essential tools for the detection and monitoring of these cases. Objective: Describe the biochemical and ultrasound alterations at a hepatic level in patients living with HIV/ AIDS who receive ART. Methodology: Clinical research, descriptive, field, cross-sectional, which included patients with HIV over 18 years who attended the consultation of Infectious Diseases at the Central Hospital of Maracay in the period March-June 2017. Patients with coinfections and metabolic pathologies were excluded. Epidemiological, clinical and paraclinical data were recorded. Results: Twenty-three patients receiving ART were included, predominantly male and with an age range of 20-29 years. 60.87 % were between 1 and 3 years on regular ART. 21.73 % of the patients showed elevation of both glutamic-pyruvic transaminase (GPT) and glutamic-oxalacetic transaminase (GOT), highlighting that all patients in this group received therapy with nucleoside analogue reverse transcriptase inhibitors plus non-nucleoside analogue reverse transcriptase inhibitors (NRTIs/NNRTIs). In terms of bilirubin values, it was shown that those receiving the combination of NRTIs/Protease Inhibitors (PI) showed an increase in bilirubin levels with a predominance of hint (21.7 %). About GGT only one patient presented alteration. The most frequent ultrasound finding was Hepatic Steatosis (69.56 %), with predominance of hepatic steatosis grade II. Conclusion: It is necessary in patients with HIV condition regular and comprehensive assessment of liver parameters, in search of adverse effects of therapy, or other medical and nutritional conditions that may increase the risk of liver disease.

Progressing haemolysis, elevated liver enzymes, low platelet count syndrome: near miss case

A 25 years old women presented in labour room with 30 weeks’ pregnancy in labour with breech with previous two caesarean section and scar tenderness with foetal bradycardia (FHR 90) and jaundice. After caesarean section in emergency hour she started bleeding in abdominal drain while uterus was well contracted. On investigation and examination diagnosed as HELLP syndrome, managed promptly by medical teams of three departments (obstetrician, anaesthesia and medicine).

Study of thrombocytopenia in pregnancy: clinical presentation and outcome at tertiary care rural institute

Background: Platelet count below 1.5 lakh/cumm is called as thrombocytopenia. After anaemia it is the second most common haematological disorder in pregnancy. It affects nearly 6 to 15%; on an average 10% of all pregnancies. Gestational thrombocytopenia is a clinically benign thrombocytopenic disorder usually occurring in late pregnancy. It resolves spontaneously after delivery.Methods: It is a hospital based prospective observational study over a period of 1 year. All pregnant women who attended OPD at the department of obstetrics and gynecology, UPUMS, Saifai for antenatal checkup were included for the study and blood sample was withdrawn.Results: Out of 263 cases enrolled for study, 90 women were found to have thrombocytopenia, and 173 had normal platelet count. Thus, incidence of thrombocytopenia was 34%. Gestational thrombocytopenia accounted for majority of cases of thrombocytopenia in pregnancy (50%) followed by hypertensive disorders (22.4%). It was further followed by ITP (11.11%) and dengue (5.5%).Conclusions: Gestational thrombocytopenia is the most common cause of thrombocytopenia during pregnancy (50%), but other underlying causes must be considered as well. A thorough history and physical examination will rule out most causes.

A study of thrombocytopenia in pregnancy

Background: Thrombocytopenia is defined as low platelet count and if it is present during pregnancy can jeopardize the maternal and fetal outcome. Thrombocytopenia occurs in 6-15% of pregnancies. Causes of thrombocytopenia include gestational, idiopathic thrombocytopenia, preeclampsia, HELLP, DIC, malignancy and marrow failure. Aim of this study was to find out the common causes of thrombocytopenia in this hospital and management being used.Methods: Data was collected form those women who came to the antenatal clinic (booked) and labour room (unbooked) in the department of obstetrics and gynecology, GMERS Medical College and Hospital, Sola, Ahmedabad. Data of a total of 75 pregnant women were collected during the period of July 2018 to June 2019.Results: There were 66.67% cases of gestational thrombocytopenia, 13.33% related to preeclampsia, 8% in Eclamptic patients, 2.67% in HELLP and DIC, 6.67 in ITP, and lastly 2.67% in dengue cases. There were number of associated complication whether directly related (PPH) or part of the disorder. PPH was observed in 22.67% which is maximum among all complications. Other complications were part of major associated illness i.e. liver failure (6.67%), renal failure (5.3%), DIC (5.3%) and HELLP (8%).Conclusions: Mode of delivery was not influenced by platelet count, but for obstetric indications. Management of patients was as per the diagnosis. Single donor plasma is preferable to random donor plasma. PPH was the commonest complication and we should be wary of that.

Effect of laparoscopy on liver enzymes

Background: Laparoscopic procedures have gained popularity in recent days because of advantages like small incision, less postoperative pain and discomfort, short hospital stay, early ambulation and early discharge. Very few studies are available to correlate Laparoscopic Surgeries and liver enzyme elevation. This effect may be due to either CO2 pneumoperitoneum, diathermy extruding liver, injury to branch of the hepatic artery or general anesthesia. This study was done to evaluate the changes in liver enzymes pre-operatively and post-operatively following laparoscopy.Methods: This prospective study included 103 patients who underwent various laparoscopic surgeries over a period of 2 years in Bharati Hospital & Research Centre, Pune, India. Serum AST, ALT and bilirubin levels were measured preoperatively and on post-operative day 1 and post-operative day 3. Patients with coexisting liver disease, Patients on long term use of hepatotoxic drugs, patients who developed complications such as CBD injury, obstruction, infection, leakage and high grade fever during surgery and in the post-operative period were excluded.Results: All laparoscopic procedures cause a transient elevation of serum bilirubin and liver enzymes. Elevation in the liver enzymes correlated directly with the duration of pneumoperitoneum. Elevation in the serum bilirubin but doesn’t correlates with the duration of pneumoperitoneum. These elevations do not have clinical significance in patients with normal hepatic function preoperatively.Conclusions: Duration of laparoscopic procedure should be kept to minimum and undue prolongation should be avoided. Decision to convert the operation to open surgery from a laparoscopic surgery should be prompt.

A study of clinical characteristics and outcome of obstetric patients in intensive care and high dependency unit of a tertiary centre of Jharkhand, India

Background: Few women during their pregnancy, labour and postnatal period require critical care related to the pregnancy itself, aggravation of a pre-existing illness and complications of the delivery. Pregnant patients account for a small number of ICU admission - 2-10% two main indications for admission are hypertensive disorders (17.2%-46%) and massive haemorrhage (10%-32.8%). The primary objective of the present study was to review the characteristics of the obstetric patients admitted to our ICU over a 2-year period.Methods: It was a prospective study conducted over 50 patients in high dependency and intensive care unit at Alam hospital over a period of 2 years (October 2014 to October 2016).Results: During the study period a total of 50 obstetric patients were transferred to the intensive care unit (ICU). Antenatal care played significant role in the obstetric outcome. 84% of patients transferred to the ICU during the study period had inadequate or no antenatal care, while 8% were booked in their pregnancy and had adequate antenatal care. ICU interventions included mechanical ventilation used in 20(40%) patients, blood and blood product transfusion in 35(70%) patients’ inotropes in 20 patients (40%) antihypertensive therapy in 20 patients (40%), arterial embolization in 2(4%) patients. Maternal mortality was seen in 10 patients (20%).Conclusions: There is a need for training in emergency obstetrics so that the complication can be managed right at the time of occurrence.

Possible protective effect of olive leaves extract on paracetamol induced hepatotoxicity in male albino rats / Possível efeito protetor do extrato de folhas de oliveira na hepatotoxicidade induzida por paracetamol em ratos albinos machos

Paracetamol (PCM) overdose can cause hepatotoxicity with oxidative stress; the present study was carried out to establish the possible protective effect of olive leaves extract (OLE) on toxicity induced by paracetamol in adult male rats. Twenty four adult male rats were divided into four equal groups; control, olive leaves extract group, paracetamol group and olive leaves extract plus paracetamol group. Some biochemical parameters and liver histopathology were evaluated. PCM treatment significantly increased serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin, gamma-glutamyltransferase (GGT), lactate dehydrogenase (LDH), urea, creatinine and alpha-fetoprotein. Paracetamol was found to significantly increase malonaldehyde (MDA) and decrease glutathione reductase (GR) activity in tissue and significantly decrease total antioxidant capacity (TAC) and superoxide dismutase (SOD) in serum. Administration of OLE caused a significant decrease serum AST, ALT enzyme, total bilirubin, GGT, LDH, creatinine, urea, alpha-fetoprotein. Also, amelioration of oxidant ­ antioxidant status with olive leaves extract was observed in addition to a significant decrease in MDA and a significant increase in TAC in liver tissue with a significant increase in glutathione reductase (GR) and SOD in serum compared to paracetamol treated group The chemical pathological changes were in step with histopathological observation suggesting marked hepatoprotective result of olive leaves extract. It could be concluded that olive leaves extract (OLE) treatment may be effective in decreasing hepatic injury and oxidative stress induced by paracetamol overdose in male albino rats

A sobredosagem de paracetamol (PCM) pode causar hepatotoxicidade com estresse oxidativo; o presente estudo foi realizado para estabelecer o possível efeito protetor do extrato de folhas de oliveira (OLE) na toxicidade induzida pelo paracetamol em ratos machos adultos. Vinte e quatro ratos machos adultos foram divididos em quatro grupos iguais: controle, grupo extrato de folhas de oliveira, grupo paracetamol e extrato de folhas de oliveira mais grupo paracetamol. Alguns parâmetros bioquímicos e histopatologia hepática foram avaliados. O tratamento com PCM aumentou significativamente aspartato aminotransferase sérica (AST), alanina aminotransferase (ALT), bilirrubina total, gama-glutamiltransferase (GGT), lactato desidrogenase (LDH), uréia, creatinina e alfa-fetoproteína. Verificou-se que o paracetamol aumenta significativamente o malonaldeído (MDA) e diminui a atividade da glutationa redutase (GR) no tecido e diminui significativamente a capacidade antioxidante total (TAC) e a superóxido dismutase (SOD) no soro. A administração de OLE causou uma diminuição significativa de AST, enzima ALT, bilirrubina total, GGT, LDH, creatinina, uréia, alfa-fetoproteína. Também foi observada melhora do status oxidante - antioxidante com extrato de folhas de oliveira, além de uma diminuição significativa no MDA e um aumento significativo no TAC no tecido hepático, com um aumento significativo na glutationa redutase (GR) e SOD no soro em comparação ao grupo tratado com paracetamol. As alterações patológicas químicas acompanharam a observação histopatológica, sugerindo resultado hepatoprotetor acentuado do extrato de folhas de oliveira. Pode-se concluir que o tratamento com extrato de folhas de oliveira (OLE) pode ser eficaz na diminuição da lesão hepática e do estresse oxidativo induzido pela overdose de paracetamol em ratos albinos machos

Human acute Chagas disease: changes in factor VII, activated protein C and hepatic enzymes from patients of oral outbreaks in Pará State (Brazilian Amazon)

Oral transmission of Chagas disease has been increasing in Latin American countries. The present study aimed to investigate changes in hepatic function, coagulation factor levels and parasite load in human acute Chagas disease (ACD) secondary to oral Trypanosoma cruzi transmission. Clinical and epidemiological findings of 102 infected individuals attended in the State of Pará from October 2013 to February 2016 were included. The most common symptoms were fever (98%), asthenia (83.3%), face and limb edema (80.4%), headache (74.5%) and myalgia (72.5%). The hepatic enzymes alanine aminotransferase (ALT) and aspartate aminotransferase (AST) of 30 ACD patients were higher compared with controls, and this increase was independent of the treatment with benznidazole. Moreover, ACD individuals had higher plasma levels of activated protein C and lower levels of factor VII of the coagulation cascade. Patients with the highest parasite load had also the most increased transaminase levels. Also, ALT and AST were associated moderately (r = 0.429) and strongly (r = 0.595) with parasite load respectively. In conclusion, the present study raises the possibility that a disturbance in coagulation and hepatic function may be linked to human ACD.