Marcadores humorales y estudio ultrasonográfico en pacientes diabéticos con enfermedad hepática por acumulación de grasa / Humoral markers and ultrasonographic study in diabetic patients with liver disease due to fat accumulation

Introducción: La enfermedad hepática grasa no alcohólica se caracteriza por: una acumulación de grasa en el hígado en forma de triacilglicéridos, ausencia de inflamación, fibrosis y un consumo de menos de 30 grados de alcohol al día. Esta afección se asocia a la diabetes mellitus (sobre todo tipo 2), y se observa un creciente aumento en el número de consultas hospitalarias por esta causa. Objetivo: Determinar la relación de los marcadores humorales y el estudio ultrasonográfico en pacientes diabéticos con enfermedad hepática grasa no alcohólica. Métodos: Se realizó una investigación descriptiva y transversal en la Consulta Provincial de Hepatología del Hospital Universitario Clínico-Quirúrgico «Arnaldo Milián Castro», en el período de marzo 2019 a diciembre 2020. El universo de estudio estuvo conformado por 89 pacientes (con edades mayores o iguales a 19 años, de ambos sexos); la muestra estuvo constituida por 66 pacientes que fueron seleccionados por muestreo no probabilístico. Resultados: Predominaron los pacientes con edades entre 40 y 59 años, masculinos, de piel blanca, y procedencia urbana. El grado de esteatosis predominante fue el grado 1 (leve). Los marcadores humorales (glicemia, gamma glutamil transpeptidasa, albúmina e índice de Ritis) fueron los más afectados patológicamente. Conclusiones: Los estudios ultrasonográficos mostraron una asociación estadísticamente significativa con alteración de los marcadores humorales de lesión hepática, lo cual puede alertar de una posible evolución desfavorable de esta enfermedad.

Introduction: non-alcoholic fatty liver disease is characterized by an accumulation of fat in the liver in the form of triacylglycerides, absence of inflammation, fibrosis and a consumption of less than 30 degrees of alcohol per day. This condition is associated with diabetes mellitus (especially type 2), and there is a growing increase in the number of hospital visits for this cause. Objective: to determine the relationship between humoral markers and ultrasonographic study in diabetic patients with non-alcoholic fatty liver disease. Methods: a descriptive and cross-sectional investigation was carried out in the provincial hepatology consultation at "Arnaldo Milián Castro" Clinical and Surgical University Hospital from March 2019 to December 2020. The study universe consisted of 89 patients (older than or equal to 19 years, of both genders); the sample consisted of 66 patients who were selected by non-probabilistic sampling. Results: white male patients aged between 40 and 59 years living in urban areas predominated. The predominant degree of steatosis was grade 1 (mild). Humoral markers (glycemia, gamma- glutamyl transpeptidase, albumin and De Ritis ratio) were the most pathologically affected. Conclusions: ultrasonographic studies showed a statistically significant association with changes in humoral markers of liver injury, which may alert to a possible unfavorable evolution of this disease.

Semi-rational evolution of ω-transaminase from Aspergillus terreus for enhancing the thermostability / 生物工程学报

ω-transaminase (ω-TA) is a natural biocatalyst that has good application potential in the synthesis of chiral amines. However, the poor stability and low activity of ω-TA in the process of catalyzing unnatural substrates greatly hampers its application. To overcome these shortcomings, the thermostability of (R)-ω-TA (AtTA) from Aspergillus terreus was engineered by combining molecular dynamics simulation assisted computer-aided design with random and combinatorial mutation. An optimal mutant AtTA-E104D/A246V/R266Q (M3) with synchronously enhanced thermostability and activity was obtained. Compared with the wild- type (WT) enzyme, the half-life t1/2 (35 ℃) of M3 was prolonged by 4.8-time (from 17.8 min to 102.7 min), and the half deactivation temperature (T1050) was increased from 38.1 ℃ to 40.3 ℃. The catalytic efficiencies toward pyruvate and 1-(R)-phenylethylamine of M3 were 1.59- and 1.56-fold that of WT. Molecular dynamics simulation and molecular docking showed that the reinforced stability of α-helix caused by the increase of hydrogen bond and hydrophobic interaction in molecules was the main reason for the improvement of enzyme thermostability. The enhanced hydrogen bond of substrate with surrounding amino acid residues and the enlarged substrate binding pocket contributed to the increased catalytic efficiency of M3. Substrate spectrum analysis revealed that the catalytic performance of M3 on 11 aromatic ketones were higher than that of WT, which further showed the application potential of M3 in the synthesis of chiral amines.

Niveles tensionales en niños y adolescentes con esteatosis hepática / Tensional levels in children and adolescents with hepatic steatosis

Introducción: la enfermedad hepática no alcohólica (EHNA) constituye un desorden multifactorial cuyos elementos de riesgo se pueden aludir a la obesidad, el sedentarismo y el componente genético. Objetivo: evaluar los niveles tensionales en niños y adolescentes con esteatosis hepática por sonografía de 5-18 años en el Hospital Regional Universitario Dr. Arturo Gullón. Métodos y técnicas: se realizó un estudio descriptivo de corte transversal y fuente primaria. La muestra estuvo compuesta por de 106 participantes. Se realizó sonografía abdominal para determinar la presencia de esteatosis hepática y se midió la presión arterial sistólica abdominal para determinar la presencia de esteatosis hepática y se midió la presión arterial sistólica y diastólica, IMC, talla y pruebas de laboratorio. Para el análisis estadístico se empleó chi-cuadrado. Resultados: el sexo predominante en la tensión arterial sistólica fue el femenino con un 44.9 % en estadio prehipertensión, mientras que el masculino fue el sexo predominante en presión arterial diastólica con un 49.1 %. Se evidenció que los individuos con IMC del percentil 90 se encontraban en estadio prehipertensión en el percentil. El perfil lipídico (colesterol, HDL, LDL, triglicéridos) y las transaminasas (SGOT y SGPT) mostraron relación con niveles tensionales elevados con predominio en la TAD. Los valores elevados de glicemia presentan relación con las cifras aumentadas de la tensión arterial sistólica. Conclusión: el estudio mostró que existe una relación entre la esteatosis hepática no alcohólica y el riesgo de desarrollar hipertensión arterial. Presentando relación estadísticamente significativa entre los niveles tensionales elevados y el perfil bioquímico estudiado, así como al IMC de los pacientes evaluados en la investigación

Introduction: Nonalcoholic fatty liver disease (NAFLD) is a multifactorial disorder whose risks factors can be attributed to obesity, sedentary lifestyle and a genetic component. Objective: To evaluate blood pressure levels in children and adolescent aged 5-18 years old with hepatic steatosis using ultrasound at the Dr. Arturo Grullón Regional University Hospital. Methods and Techniques: A descriptive cross-sectional study of primary source were carried out. The sample of the study consisted in 106 participants. Abdominal ultrasono-graphy was performed to determine the presence of hepatic steatosis and systolic and diastolic blood pressure, BMI, height and laboratory tests were measured. Chi square was used in the statistical analysis of the data. Results: The predominant sex in systolic blood pressure was female with 44.9% in prehypertension stage, while male was the predominant sex in diastolic blood pressure with 49.1%. It was evidenced that individuals with BMI ≥90thpercentile were in the prehypertensive stage at the percentile. The lipid profile (cholesterol, HDL-C, LDL-C, triglycerides) and transaminases (SGOT ad SGPT) showed a relationship with high blood pressure levels with a predo-minance in DBP. Elevated glucose levels are related to an increase in systolic blood pressure. Conclusion: The study showed that there is a relationship between nonalcoholic fatty liver disease and the risk of developing high blood pressure. Presenting a statistically significant relationship between the elevated blood pres-sure levels and the biochemical profile studied, as well the BMI of the patients evaluated in this research

Normal transaminases in obese patients with metabolic associated steatohepatitis (MASH): a cohort of Peruvian patients

Introduction: Metabolic associated steatohepatitis (MASH) is one of the most frequent causes of chronic liver disease. Liver transaminases are important biomarkers to measure liver injury, however, a proportion of patients with MASH may present with normal levels of transaminases. The levels of serum transaminases may not correlate with the severity of histopathological changes. Objective: We aimed to identify the frequency of normal transaminases in obese patients with MASH, as well as to describe the clinical, biochemical and histological characteristics in this specific group of patients. Materials and methods: A retrospective cross-sectional study was conducted in the bariatric surgery service of a private clinic. Obese patients older than 18 years with a body mass index (BMI) >30Kg/m2 and 2 co-morbidities undergoing a gastric sleeve surgery were included. Measurement of biochemical routine laboratory exams was performed. Insulin resistance was calculated using the homeostasis evaluation model (HOMA-IR). All patients underwent liver biopsies prior to surgery and the diagnosis of MASH was based on the Brunt criteria. Results: 159 obese patients with MASH were included, of which 47.2% had normal transaminases and 52.8% elevated transaminases. Factors associated with alteration in transaminases were: being male OR=4.02 (95% CI: 2.037.96; p50 IU/L OR=7.50 (95% CI: 3.40-16.56; p<0.01). The values of HOMA-IR and GGT were significantly higher in the group of high transaminases (p<0.01). Differences in the degree of fibrosis were not associated with transaminases levels. Conclusion: In conclusion we found that the frequency of normal transaminases was 47.2% in obese patients with MASH. Factors associated with elevation in liver enzymes were being male, diagnosis of diabetes mellitus and elevation in GGT levels. The degree of fibrosis was not associated with elevations in liver transaminases. These findings suggest that transaminases levels alone are not accurate markers to assess liver injury, as they do not necessarily correlate with histological liver damage.

Introducción: La esteatohepatitis asociada metabólica (MASH) es una de las causas más frecuentes de enfermedad hepática crónica. Las transaminasas hepáticas son biomarcadores importantes para medir el daño hepático; sin embargo, una proporción de pacientes con MASH pueden presentar niveles normales de transaminasas. Los niveles de transaminasas séricas pueden no estar correlacionados con la gravedad de los cambios histopatológicos. Objetivo: Nuestro objetivo fue identificar la frecuencia de transaminasas normales en pacientes obesos con MASH, así como describir las características clínicas, bioquímicas e histológicas en este grupo específico de pacientes. Materiales y métodos: Se realizó un estudio transversal retrospectivo en el servicio de cirugía bariátrica de una clínica privada. Se incluyeron pacientes obesos mayores de 18 años con índice de masa corporal (IMC) >30Kg/m2 y 2 comorbilidades sometidos a cirugía de manga gástrica. Se realizó la medición de los exámenes bioquímicos de laboratorio de rutina. La resistencia a la insulina se calculó mediante el modelo de evaluación de la homeostasis (HOMA-IR). Todos los pacientes se sometieron a biopsias hepáticas antes de la cirugía y el diagnóstico de MASH se basó en los criterios de Brunt. Resultados: Se incluyeron 159 pacientes obesos con MASH, de los cuales el 47,2% tenían transaminasas normales y el 52,8% transaminasas elevadas. Los factores asociados a la alteración de las transaminasas fueron: ser hombre OR=4,02 (IC 95%: 2,03-7,96; p50 UI/L OR=7,50 (IC 95%: 3,40-16,56; p<0,01). Los valores de HOMA-IR y GGT fueron significativamente mayores en el grupo de transaminasas altas (p<0,01). Las diferencias en el grado de fibrosis no se asociaron con los niveles de transaminasas. Conclusión: Encontramos que la frecuencia de transaminasas normales fue del 47,2% en pacientes obesos con MASH. Los factores asociados con la elevación de las enzimas hepáticas fueron el sexo masculino, el diagnóstico de diabetes mellitus y la elevación de los niveles de GGT. El grado de fibrosis no se asoció con elevaciones de las transaminasas hepáticas. Estos hallazgos sugieren que los niveles de transaminasas por sí solos no son marcadores precisos para evaluar el daño hepático, ya que no necesariamente se correlacionan con el daño hepático histológico.

Short-term effects of acute fructose intake on blood antioxidant capacity and liver enzymes in healthy young adults / 中国医师进修杂志

Objective:To investigate the short-term effects of acute fructose intake on serum antioxidant capacity and liver enzymes in healthy young adults.Methods:From January to June 2019, 64 healthy young subjects were recruited, and divided into 75 g glucose group, 25 g fructose group, 50 g fructose group and 75 g fructose group by random digits table method with 16 cases each. The subjects took corresponding amounts of glucose or fructose according to grouping. The levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), glutathione peroxidase (GPX), superoxide dismutase (SOD), C-Jun amino terminal kinase (JNK), malondialdehyde (MDA) and 8-OH deoxyguanine (8-OHdG) before taking sugar and 30, 60, 120, 180 min after taking sugar, and the changes of ALT, AST and LDH at 30, 60, 120 and 180 min after taking sugar compared with that before taking sugar.Results:One case in 50 g fructose group, 2 cases in 75 g fructose group and 1 case in 75 g glucose group dropped out due to adverse reaction; finally, 15 cases in 75 g glucose group, 16 cases in 25 g fructose group, 15 cases in 50 g fructose group and 14 cases in 75 g fructose group completed the study. The increase of ALT and AST after taking sugar in 25 g fructose group, 50 g fructose group and 75 g fructose group was significantly higher than that in 75 g glucose group, and there were statistical differences ( P<0.05); there was no statistical difference in the change of LDH after taking sugar among 4 groups ( P>0.05). One hundred and eighty min after taking sugar, the receiver operating characteristic (ROC) curve analysis result showed that there were no statistical differences in the areas under curve of ALT, AST and LDH among 4 groups ( P>0.05). There was no statistical difference in SOD before taking sugar among 4 groups ( P>0.05); the SOD 60 min after taking sugar in 50 g fructose group and 75 g fructose group, and SOD 180 min after taking sugar in 25 g fructose group, 50 g fructose group and 75 g fructose group were significantly lower than those in 75 g glucose group: (4.84 ± 1.88) and (4.38 ± 1.12) μg/L vs. (6.25 ± 1.65) μg/L, (4.46 ± 1.66), (5.22 ± 1.66) and (3.99 ± 0.96) μg/L vs. (6.55 ± 1.78) μg/L, and there were statistical differences ( P<0.05). There were no statistical differences in the changes of JNK, GPX, MDA and 8-OHdG before and after taking sugar among 4 groups ( P>0.05). The ROC curve 180 min after taking sugar analysis result showed that the area under curve of SOD in 75 g fructose group was significantly lower than that in 75 g glucose group (9.06 ± 1.88 vs. 12.74 ± 3.15), and there was statistical difference ( P<0.05); there were no statistical differences in the areas under curve of GPX, JNK, MDA and 8-OHdG among 4 groups ( P>0.05). Conclusions:Acute fructose intake can lead to the decrease of antioxidant capacity, and the increasing of oxidative damage and liver enzymes in healthy adults.

A Prospective Cohort Study of Laboratory Abnormalities During Isotretinoin Treatment For Acne Vulgaris

Background@#Acne vulgaris is a chronic inflammatory condition of the pilosebaceous unit. Isotretinoin is used to treat moderate to severe acne that is resistant to antibiotics and topical agents. However, it may cause alterations in lipids and liver enzymes.@*Methods@#A total of 129 patients with acne vulgaris (moderate to severe facial acne) treated with isotretinoin were recruited between May 2020 and July 2021 from the dermatology clinics at Hospital Serdang and Hospital Kuala Lumpur. Of these, 120 patients with complete data of lipid panel (total cholesterol, low density lipoprotein cholesterol [LDL], triglycerides [TG], and high density lipoprotein cholesterol [HDL]) and hepatic panel (alanine transaminase [ALT] and aspartate transaminase [AST]) levels at baseline, and in three subsequent follow-up visits (i.e., one, three, and six months) were included in the analyses. Abnormalities were graded according to standard laboratory values and their severity according to the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE)grading system.@*Results@#Of the 120 study participants, 83% were female and 37% were male between the ages of 15 and 36 years. We observed a significant increase in median values at baseline and at the six-month follow-up for total cholesterol (p<0.0001), triglycerides (p<0.0001), LDL (p<0.0001), ALT (p<0.0001), and AST (p<0.0001). We observed a significant correlation between body mass index and the HDL (r2 =- 0.26, p=0.01) and ALT (r2 =0.383, p=7.9x10-06) levels. Based on the CTCAE grading system, almost all study participants with abnormal results had grade 1 abnormalities. Only one patient had a grade 2 abnormality in ALT, which required treatment discontinuation.@*Conclusion@#Low dose isotretinoin therapy for acne vulgaris may cause mild and non-progressive elevation of LDL, total cholesterol, and liver transaminases which do not require treatment withdrawal in most cases.

Hipertransaminasemia en coledocolitiasis / Hypertransaminasemia in choledocholithiasis

Introducción. La coledocolitiasis aguda se presenta cuando un cálculo se impacta en el conducto biliar distal. Usualmente se manifiesta con un patrón colestásico, con aumento de la AST y ALT leve o moderado. Sin embargo, se han reportado series de casos de coledocolitiasis con AST y ALT con valores >400 UI/L, lo que puede llevar al médico a considerar una hepatitis como diagnóstico presuntivo, en vez de una coledocolitiasis. Con esta revisión exploratoria se pretende explicar esta forma de presentación, y sugerir los pasos que debe dar el clínico para identificar estos casos y brindar un diagnóstico oportuno y certero. Metodología. Se realizó una revisión exploratoria utilizando los buscadores PubMed, BIREME (BVS), LILACS y Google Académico, con las palabras MeSH "choledocholithiasis", "transaminases" y el conector "and", así como los términos DeCS "coledocolitiasis", "transaminasas" y el conector "y". Resultados. Se incluyeron en el análisis un total de 20 estudios relacionados con el tema coledocolitiasis y elevación de AST o ALT >400 UI/L. Se encontró que el aumento de AST o ALT entre 400 UI/L y 500 UI/L se presentó en el 5,76% de los casos, valores entre 500 UI/L y 800 UI/L en el 36,8%, entre 800 UI/L y 1.000 UI/L en el 9%, y valores >1.000 UI/L en el 6,43% de los casos. Conclusión. La coledocolitiasis con elevación de transaminasas AST o ALT >400 UI/L es una situación que debe tenerse presente, en particular en personas jóvenes, y en aquellos sin historia de problemas hepáticos previos. Es necesario que el médico tenga el diagnóstico presuntivo de coledocolitiasis, aun con niveles de transaminasas que puedan sugerir una hepatitis, y analizar las diferentes variables que son indispensables para lograr un diagnóstico preciso.

Introduction. Acute choledocholithiasis occurs when a stone impacts the distal bile duct. It usually manifests with a cholestatic pattern, with a mild or moderate increase in ASL and ALT. However, series of cases of choledocholithiasis have been reported with AST and ALT values >400 IU/L, which may lead the physician to consider hepatitis as a presumptive diagnosis, instead of choledocholithiasis. This scoping review is intended to explain this form of presentation, and to suggestthe steps that the clinician should take to identify these cases and provide a timely and accurate diagnosis. Methodology. A scoping review was carried out using PubMed, BIREME (BVS), LILACS and Google Scholar search engines, with the MeSH words "choledocholithiasis", "transaminases" and the "and" connector, as well as the DeCS terms "coledocolitiasis", "transaminasas" and the "y" connector. Results. A total of 20 studies related to the topic of choledocholithiasis and elevation of AST or ALT >400 IU/L were included in the analysis. It was found that the increase in AST or ALT between 400 IU/L and 500 IU/L occurred in 5.76% of the cases, values between 500 IU/L and 800 IU/L in 36.8%, between 800 IU/L and 1,000 IU/L in 9%, and values >1,000 IU/L in 6.43% of the cases. Conclusion. Choledocholithiasis with elevated AST or ALT transaminases >400 IU/L is an occurrence that should be taken into account, particularly in young people, and in those without a history of previous liver problems. It is necessary for the specialist to have a presumptive diagnosis of choledocholithiasis, even with transaminase levels that may suggest hepatitis, and to analyze the different variables that are essential to achieve an accurate diagnosis.

Asociación entre el síndrome metabólico y los niveles de transaminasas / Association between metabolic syndrome and transaminase levels

RESUMEN Introducción: En la patología del síndrome metabólico, de acuerdo con distintas investigaciones y la práctica clínica se han visto manifestaciones de daño hepático. Objetivo: Estimar la prevalencia de transaminasas elevadas (alanina aminotransaminasa y aspartato aminotransaminasa) y determinar su asociación con síndrome metabólico. Métodos: Estudio transversal con procedimientos analíticos. Análisis secundario de los datos generados por el registro electrónico en salud de un policlínico ocupacional. La variable principal fue el diagnóstico del síndrome metabólico. Para definir aspartato aminotransaminasa elevada se consideraron valores > 30 U/L en mujeres y valores > 36 U/L en hombres. Para alanina aminotransaminasa, se consideraron valores > 30 U/L en mujeres y valores > 40 U/L en hombres. Resultados: La prevalencia de síndrome metabólico fue de 21,82 %, de aspartato aminotransaminasa elevada fue del 10,30 % y alanina aminotransaminasa elevada del 16,67 %. En la regresión múltiple, se ajustó por las covariables confusoras sexo, edad, ocupación, índice de masa corporal, fumar, alcohol y actividad física. Se observó que los pacientes con aspartato aminotransaminasa elevada tenían 128 % mayor frecuencia de síndrome metabólico, respecto a quienes no presentaban valores elevados (razón prevalencia= 2,28; IC95 %: 1,64 - 3,17; p< 0,001). Se encontró que los pacientes con alanina aminotransaminasa elevada tenían 148 % mayor frecuencia de presentar síndrome metabólico respecto a quienes no presentaban valores elevados (razón prevalencia= 2,48; IC95 %: 1,77 - 3,47; p< 0,001). Conclusiones: Existe asociación entre las transaminasas hepáticas elevadas y la presencia de síndrome metabólico.

ABSTRACT Introduction: In the pathology of metabolic syndrome, manifestations of liver damage have been seen in different investigations and in clinical practice. Objective: To estimate the prevalence of elevated transaminases (alanine aminotransaminase and aspartate aminotransaminase), and to determine their association with metabolic syndrome. Methods: Cross-sectional with analytical procedure study. Secondary analysis of data generated by the electronic health record of an occupational polyclinic. The main variable was the diagnosis of metabolic syndrome. To define elevated aspartate aminotransaminase, values > 30 U/L in women and values > 36 U/L in men were considered. For alanine aminotransaminase, values > 30 U/L in women and values > 40 U/L in men were considered. Results: The prevalence of metabolic syndrome was 21.82%, elevated aspartate aminotransaminase was 10.30% and elevated alanine aminotransaminase was 16.67%. In multiple regression, we adjusted for the confounding covariates of sex, age, occupation, body mass index, smoking, alcohol and physical activity. It was observed that patients with elevated aspartate aminotransaminase had a 128% higher frequency of presenting metabolic syndrome, compared to those without elevated values (reason prevalence= 2.28; 95% CI: 1.64-3.17; p< 0.001). On the other hand, it was found that patients with elevated alanine aminotransaminase had a 148% higher frequency of presenting metabolic syndrome compared to those without elevated values (reason prevalence= 2.48; 95% CI: 1.77 - 3.47; p< 0.001). Conclusions: There is an association between elevated hepatic transaminases and the presence of metabolic syndrome.

Evaluation of inflammatory and liver injury biomarkers among drug-naive viral hepatitis B patients: A study in a referral laboratory, Ghana

Background and Aim: Globally, hepatitis B virus (HBV) infection is among the commonest chronic infections and the leading cause of liver cancer. This study evaluated inflammatory and liver injury biomarkers among newlydiagnosed HBV-infected patients to reveal inflammation and liver injury levels. Patients and Methods: This case-control study was conducted among 146 newly diagnosed drug-naive patients and 64 blood donors. Questionnaires were administered to obtain demographic data. Blood samples were collected to assess viral serological markers, inflammatory markers, liver function, and hematological indices. Also, noninvasive markers of liver fibrosis (APRI: aspartate transaminase - platelet ratio index, FIB-4: fibrosis 4 index, and AAR: aspartate - alanine transaminase ratio) were mathematically derived. The patients were categorized into acute and chronic infections based on their viral serological markers. Results: Overall, 81.5% of the patients had an acute HBV infection, whereas 18.5% had a chronic HBV infection. There was a significant increase in the biomarkers of inflammation, C-reactive protein (CRP) and interleukin 6, and liver injury (liver transaminases, FIB-4 index, and APRI) among the drug-naive chronic HBV-infected patients. The study also revealed significant anemia and leucocytosis in patients with chronic HBV infection. Further, the study showed a strong correlation between CRP and alanine transaminase among patients with chronic HBV infection. Conclusion: There was increased anemia, inflammation, and liver fibrosis among the drug-naive chronic HBVinfected patients; hence, public education is required so patients with viral hepatitis B in Ghana would visit the clinic earlier enough for proper clinical management.

Changes in serum albumin and liver enzymes following three different types of bariatric surgery: six-month follow-up. A retrospective cohort study

ABSTRACT BACKGROUND: Few reports have examined the effects of Roux-en-Y gastric bypass (RYGB), one-anastomosis gastric bypass (OAGB) and sleeve gastrectomy (SG) on changes to serum albumin (Alb) and liver enzyme levels. OBJECTIVE: To compare short-term post-surgery changes in serum Alb, aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase (ALKP) levels. Body composition changes were also measured and compared among three groups. DESIGN AND SETTING: Retrospective cohort study conducted in Tehran, Iran. METHODS: 151 OAGB, RYGB and SG patients referred to the obesity clinic of Hazrat-e Rasool General Hospital, Tehran, Iran, were evaluated. Physical characteristics and biochemical parameters were measured pre-surgery and then after three and six months. RESULTS: Through repeated measurements to determine intragroup changes, significant changes in serum AST (P = 0.003) and ALT (P < 0.001) were observed in follow-ups. However, Alb levels did not change (P = 0.413). Body fat, fat-free mass and muscle mass decreased significantly in each group (P < 0.05). In a univariate general linear model for determining intergroup changes, SG showed greater decreases in ALT and AST at three and six months (P < 0.05) and in ALKP at six months (P = 0.037), compared with OAGB. There were no significant differences in Alb levels. Also, RYGB had a greater effect on reducing fat percentage (three months, P = 0.011; six months, P = 0.059) and fat mass (three months, P = 0.042) than OAGB. CONCLUSION: SG and RYGB may be superior to OAGB in reducing liver enzymes and body fat, respectively. However, Alb levels showed no significant differences.

Hígado y SARS-CoV-2: aspectos claves de la literatura / Liver and SARS-CoV-2: Literature key aspects

Resumen El nuevo coronavirus del síndrome respiratorio agudo grave de tipo 2 (SARS-CoV-2), virus que se ha expandido por todo el mundo, produce una infección respiratoria aguda capaz de producir la muerte; sin embargo, el daño en otros órganos también es frecuente. Diversos estudios han evidenciado alteraciones en pruebas de lesión hepáticas, las cuales se han asociado con enfermedad grave y mayor estancia hospitalaria; así mismo, en la infección por el virus en pacientes con enfermedad hepática preexistente se observó una elevación significativa de las aminotransferasas durante el curso de la enfermedad y mayor riesgo de enfermedad grave. La explicación fisiopatológica de la afectación hepática en estos pacientes abarca el efecto citopático directo producido por la unión del virus a la enzima convertidora de la angiotensina II (ECA-II) a los hepatocitos y colangiocitos, una respuesta inmunitaria desproporcionada y, en algunos casos, la hepatotoxicidad por medicamentos.

Abstract The new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a virus that has spread around the world, causes an acute respiratory infection and it may also cause death. The damage that can cause in other organs is frequent. Many studies had also shown alterations in liver function tests, that are then related to serious illness and with hospitalization requirements. Moreover, in patients infected with the virus that had underlying liver disease, a significant increase in the level of aminotransferases was observed in the course of the disease. A greater risk of serious illness was also detected. The pathophysiological explanation of liver injury in those patients covers the direct cytopathic effect produced by binding the virus, the angiotensin-converting enzyme (ACE2) to the hepatocytes and the cholangiocytes, excessive immune response, and in some cases, drug-induced hepatotoxicity.

Hepatopatías autoinmunes. Hallazgos clínicos y de laboratorio en pacientes de un hospital de referencia nacional / Autoimmune liver diseases. Clinical and laboratory findings in patients in a national reference hospital

Introducción. Las enfermedades autoinmunes del hígado son un grupo de patologías caracterizadas por una respuesta autoinmune contra los hepatocitos y/o el epitelio biliar. Sus manifestaciones clínicas son variadas, con alteraciones en las pruebas de función hepática y presencia de autoanticuerpos. Metodología. Estudio observacional descriptivo con 101 pacientes atendidos en el Hospital Universitario de La Samaritana de Bogotá D.C., entre enero a diciembre de 2019, con los diagnósticos de hepatitis autoinmune, colangitis biliar primaria, colangitis esclerosante primaria y síndrome de sobreposición. Se evaluaron los parámetros clínicos y de laboratorio, con el fin de caracterizar su frecuencia en estas patologías, debido a la importancia de un diagnóstico precoz. Resultados. Se encontraron 54 casos de hepatitis autoinmune, 19 casos de colangitis biliar primaria, 4 casos de colangitis esclerosante primaria y 24 casos de síndrome de sobreposición. El 81% fueron mujeres y la edad promedio fue de 55 años. El 39% de los pacientes tenían cirrosis. En general, los resultados se ajustaron a lo descrito internacionalmente, como es el predominio en mujeres y la comorbilidad autoinmune. Conclusión. Los hallazgos indican que cualquier alteración del perfil bioquímico hepático debe ser considerado, y se debe descartar la presencia de hepatopatías autoinmunes para diagnosticarlas de manera precoz, evitando que lleguen a cirrosis y sus complicaciones, con la necesidad de un trasplante hepático como única alternativa terapéutica.

Introduction. Autoimmune liver diseases are a group of pathologies characterized by an autoimmune response against hepatocytes and/or the biliary epithelium. Their clinical manifestations are varied, with alterations in liver function tests and the presence of autoantibodies. Methodology. Descriptive study with 101 patients who attended at the Hospital Universitario de La Samaritana in Bogota D.C., between January and December 2019, with the diagnoses of autoimmune hepatitis, primary biliary cholangitis, primary sclerosing cholangitis and overlap syndrome. Clinical and laboratory parameters were evaluated in order to characterize their frequency in these pathologies, due to the importance of an early diagnosis. Results. There were 54 cases of autoimmune hepatitis, 19 cases of primary biliary cholangitis, 4 cases of primary sclerosing cholangitis, and 24 cases of overlap syndrome. Of all patients, 81% were women, the average age was 55 years, and 39% had cirrhosis. In general, the findings were consistent with what has been described worldwide, such as a higher prevalence in women and autoimmune comorbidity. Conclusion. The findings indicate that any alteration in the liver biochemical profile should be considered to rule out an autoimmune liver disease for an early diagnosis, avoiding the possibility of cirrhosis and its complications, with the need for a liver transplant as the only therapeutic alternative.

Variante "no clásica" o "atípica" del síndrome de Stauffer en paciente con carcinoma renal de células claras: reporte de caso / "Non-classical" or "atypical" variant of Stauffer syndrome in a patient with clear cell renal carcinoma: a case report

La manifestación paraneoplásica conocida como síndrome de Stauffer tiene una presentación atípica, caracterizada por ictericia y colestasis intrahepática. Presentamos el caso de un paciente de 53 años de edad, con antecedente de una masa renal derecha en plan de resección quirúrgica programada, con cuadro de evolución de dolor abdominal en hipocondrio derecho e ictericia. A su ingreso se documentó hepatoesplenomegalia, elevación de bilirrubinas a expensas de la directa, y de fosfatasa alcalina junto con elevación de transaminasas. Se descartaron causas obstructivas a nivel de vía biliar intra y extrahepática. No se documentaron metástasis o lesiones focales a nivel de parénquima, ni lesiones de etiología vascular que explicaran el cuadro. También se descartó hepatitis B, C e infección por VIH, por lo cual se consideró un probable síndrome de Stauffer. Fue llevado a nefrectomía intrahospitalaria, con posterior diagnóstico patológico compatible con carcinoma de células claras. Luego del procedimiento se normalizó la bioquímica hepática y se corrigió la ictericia. Es importante reconocer que la afectación hepática en el contexto de neoplasias, no es solo atribuida a metástasis a distancia, sino también a la existencia de síndromes paraneoplásicos como condicionantes.

The paraneoplastic manifestation known as Stauffer syndrome has an atypical presentation, characterized by jaundice and intrahepatic cholestasis. We present the case of a 53-year-old patient, with a history of a right renal mass with a planned surgical resection, who developed abdominal pain in the right upper quadrant and jaundice. Upon admission, hepatosplenomegaly, elevated bilirubin, at the expense of direct bilirubin, alkaline phosphatase and elevated transaminases were documented. Intra- and extrahepatic bile ducts obstruction were ruled out. There were no documented metastases or focal lesions at the level of the parenchyma, or lesions of vascular etiology that could explain the condition. Hepatitis B, C and HIV infection were also ruled out, and a probable Stauffer syndrome was considered. In-hospital nephrectomy was performed, with subsequent pathology compatible with clear cell carcinoma. After the procedure, liver biochemistry was normalized and jaundice was corrected. It is important to recognize that liver involvement in the context of neoplasms is not only attributed to distant metastases but to the existence of paraneoplastic syndromes as determining factors.

Plasma energetic substrates and hepatic enzymes in the four-eyed fish Anableps anableps (Teleostei: Cyprinodontiformes) during the dry and rainy seasons in the Amazonian Island of Maracá, extreme north of Brazil

ABSTRACT Anableps anableps is a viviparous teleost typical from Amazon Delta estuaries. It is representative of this biome in Maracá, which offers a potential for biomonitoring. The aim of this study is to apply different biomarkers to males and females of this species and verify possible seasonal influences on their physiology. To collect fish, three expeditions were carried out from the rainy season of April 2018 to the rainy season of February 2019. Biometric parameters and gonadosomatic (GSI), hepatosomatic (HSI), and viscerosomatic (VSI) indexes were calculated, and blood samples were taken to measure triglycerides, total proteins, glucose, and activity of the enzymes aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase (ALP). The GSI of males is higher in the rainy season and of females in the dry season. This is probably related to the embryogenesis process. Males show an increase in biomass during the dry season, a metabolic homogeneity, and females show an increase in plasma glucose, triglycerides, and ALT activity. The tested biomarkers are potential for biomonitoring, preliminarily suggesting that there is a seasonal asynchronism between males and females of A. anableps as for the allocation of energy resources at different times of their life cycle.

RESUMO Anableps anableps é um teleósteo vivíparo típico de estuários do Delta do Rio Amazonas, sendo representativo deste bioma na ilha de Maracá, com potencial para o biomonitoramento. O objetivo deste estudo foi aplicar diferentes biomarcadores em machos e fêmeas desta espécie e verificar a possível influência sazonal em aspectos de sua fisiologia. Para a coleta dos peixes foram realizadas três expedições, de abril/2018 (estação chuvosa), setembro/2018 (estação seca) até fevereiro/2019 (estação chuvosa). Foram obtidos parâmetros biométricos, índices gonadossomático (IGS), hepatossomático (IHS), viscerossomático (IVS) e amostras de sangue para dosagem de triglicerídeos, proteínas totais, glicose e a atividade das enzimas aspartato aminotransferase (AST), alanina aminotransferase (ALT) e fosfatase alcalina (ALP). O IGS dos machos foi maior na estação chuvosa e das fêmeas na estação seca, isso provavelmente ocorreu devido ao processo de embriogênese. Os machos aumentaram a biomassa na estação seca e apresentaram homogeneidade metabólica, já as fêmeas apresentaram hiperglicemia, hipertrigliceridemia e maior atividade da ALT. Os biomarcadores testados mostraram-se promissores para o biomonitoramento, sugerindo de forma preliminar que há um assincronismo sazonal entre machos e fêmeas de A. anableps na alocação de recursos energéticos em diferentes momentos do seu ciclo de vida.

Considerations on the elevation of aminotransferases in primary biliary cholangitis / 临床肝胆病杂志

Primary biliary cholangitis (PBC) is an autoimmune-mediated chronic cholestatic liver disease, with the typical biochemical manifestation of significantly elevated alkaline phosphatase (ALP) and gamma-glutamyl transpeptidase (GGT), with or without mild-to-moderate elevation of aminotransferases. ALP and GGT play an important role in the diagnosis and monitoring of PBC. With a deeper understanding of PBC, the significance of elevated aminotransferases in diagnosis and treatment has attracted more and more attention. This article briefly summarizes the significance of elevation of aminotransferases in PBC patients.

Considerations on the elevation of aminotransferases in primary biliary cholangitis / 临床肝胆病杂志

Primary biliary cholangitis (PBC) is an autoimmune-mediated chronic cholestatic liver disease, with the typical biochemical manifestation of significantly elevated alkaline phosphatase (ALP) and gamma-glutamyl transpeptidase (GGT), with or without mild-to-moderate elevation of aminotransferases. ALP and GGT play an important role in the diagnosis and monitoring of PBC. With a deeper understanding of PBC, the significance of elevated aminotransferases in diagnosis and treatment has attracted more and more attention. This article briefly summarizes the significance of elevation of aminotransferases in PBC patients.

Comparative study of serum ferritin levels and hepatic transaminases between uncomplicated paediatric dengue inpatients and other febrile illnesses in Kanchipuram, India

Background: Fever is the most common complaint with bringing children for hospital consultation. Dengue is a cause of public health concern with case fatality rate of 1%. Ferritin is an acute-phase reactant which is produced in response to infection and inflammation. Liver enzymes are also considered as markers of febrile illness. Aim of this study was to assess serum ferritin levels, aspartate-aminotransferase (AST) and alanine-aminotransferase (ALT) levels in pediatric inpatients with febrile illness, to correlate it with patient’s Dengue profile and to analyse these parameters with sub-group analysis of dengue and OFI.Methods: Among 120 children admitted for fever of more than 3 days duration were included in the study. 58 were Dengue-NS1 positive and the remaining 62 were considered to be OFI. Serum ferritin levels, AST and ALT were the investigative parameters measured at the time of admission for the study and treated as per WHO Dengue Guidelines. Data was coded and entered in Microsoft Excel 2013. Data was analysed using SPSS v16. p value of <0.05 was considered statistically significant.Results: Ferritin levels were higher in Dengue-IgM positive subgroup than in OFI subgroup (U= 173, Z score -6.09, p<0.00001). AST levels are higher in Dengue-NS1 positive subgroup than in OFI subgroup (U= 103, Z score -8.08, p<0.00001). AST levels were also higher in Dengue-IgM positive subgroup than in OFI subgroup (U= 377.5, Z score -4.86, p<0.00001). ALT levels are higher in Dengue-NS1 positive subgroup than in OFI subgroup (U=76, Z score -8.95, p<0.00001) as well as in Dengue-IgM positive subgroup than in OFI subgroup (U= 417, Z score -4.4, p<0.00001).Conclusions: Hyperferritinemia and elevation of hepatic-transaminases is seen in dengue. Although elevated in other febrile illnesses, it is elevated more so in dengue. This can be a predictor of severity of dengue fever, but needs to be confirmed in larger studies.

Regression of macular edema with topical brinzolamide and nepafenac alone and identification of a novel gyrate atrophy mutation / Regressão de edema macular com o uso tópico de brinzolamida e nepafenac e identificação de uma nova mutação na atrofia girata

ABSTRACT Gyrate atrophy is a rare metabolic autosomal recessive disorder caused by ornithine aminotransferase enzyme deficiency that leads to characteristic progressive, degenerative chorioretinal findings. Patients complain mostly of low vision, night blindness, and peripheral vision loss. Posterior subcapsular cataract, myopia, choroid neovascularization, and intraretinal cysts may be accompanying factors related to vision loss. We encountered a patient with vision loss secondary to posterior subcapsular cataract and intraretinal cysts. After treatment with topical brinzolamide and nepafenac (and without any diet mo dification and/or supplementation), we observed 143- and 117-mm macular thickness resolutions with 2 and 1 Snellen lines of visual gain in his right and left eyes, respectively. Also, we detected a novel homozygous mutation in the ornithine aminotransferase gene: c.1253T>C (p.Leu418Pro). Carbonic anhydrase inhibitors and/or non-steroid anti-inflammatory drugs can control macular edema in patients with gyrate atrophy-associated intraretinal cysts. The genetic variants may also be a determinant in the responsiveness to the therapy type.

RESUMO A atrofia girata é um distúrbio autossômico recessivo metabólico raro causado pela deficiência da enzima ornitina ami notransferase, que leva a achados degenerativos coriorretinianos progressivos característicos. Os pacientes queixam-se principalmente de baixa visão, cegueira noturna e perda de vi são periférica. A catarata subcapsular posterior, a miopia, a neovascularização da coróide e os cistos intrarretinianos podem ser fatores associados à perda da visão. Encontramos um paciente com perda de visão secundária à catarata subcapsular posterior e cistos intrarretinianos. Após o tratamento com brinzolamida tópica e nepafenaco (e sem modificação e/ou suplementação da dieta), observamos resoluções de espessura macular de 143 e 117 mm e com 2 e 1 linhas de Snellen de ganho visual nos olhos direito e esquerdo, respectivamente. Além disso, detectamos uma nova mutação homozigótica no gene da ornitina aminotransfera se: c.1253T>C (p.Leu418Pro). Inibidores da anidrase carbônica e/ou drogas anti-inflamatórias não esteróides podem controlar o edema macular em pacientes com cistos intrarretinianos associados à atrofia girata. As variantes genéticas também podem ser determinantes na responsividade ao tipo de terapia.

Clinico-laboratory profile and outcome of dengue fever among children attending a tertiary care hospital of rural Telangana, India

Background: Dengue is a self-limiting, vector-borne disease transmitted by Aedes mosquito, causing a major public health threat globally. The objective of this study is to assess the clinical profile and outcome of the dengue infection in children less than 14 years of age September 2018 to August 2019 at the Pediatric Department of S.V.S. Medical College, the tertiary care hospital in Mahabubnagar, Telanagana.Methods: Prospective study of 82 hospitalized children of <14 years with the diagnosis of dengue illness. Children with diagnosis of dengue were classified further in to two groups as per WHO guidelines, Non-severe dengue fever (probable dengue, dengue with warning signs) and 'Severe Dengue' (Dengue Haemorrhagic Fever and/or Dengue Shock Syndrome (DHF/DSS). A separate questionnaire form used for documenting clinical history, laboratory parameters. Haematological parameters were noted, chest x-ray, ultra-sonogram in required cases was done. Children were managed as per WHO protocol. The outcomes of the cases were mentioned as discharge, left against medical advice and death.Results: A total of 82 children with dengue were divided in to 55(67%) non severe dengue and 27(33%) severe dengue with males 56(68.2%) and females 26(31.7%). The most common age of presentation was between 6-10 years 34(41.5%). Fever 73(89%) was the most common presenting symptoms. Pleural effusion and hepatomegaly were the commonest clinical findings 28(34.1%) each, which were more among the severe dengue patients. Gall bladder edema 29(35.3%) was the most common ultra-sonogram finding. Significant elevation of transaminases (SGOP, SGPT) was seen in 39(47.5%). Severe thrombocytopenia was observed in 22(26.8%) children. Management was by administration of colloids and crystalloids.Conclusions: Dengue is a global problem. Presenting features include high grade fever, vomiting, abdominal pain, skin rash. Early recognition of symptoms and proper management can reduce the mortality.

Infección crónica por virus de hepatitis B. Instituto de Gastroenterología de Cuba, 2016-2018 / Chronic hepatitis B virus infection. Institute of Gastroenterology, Havana, Cuba; 2016-2018

Introducción: La efectividad del programa nacional de inmunización ha impactado en la reducción de la incidencia del virus de la hepatitis B en Cuba; sin embargo, no es despreciable la cantidad de pacientes infectados crónicos, que por esta causa, se detectan en la práctica asistencial, aunque insuficientes los estudios epidemiológicos que los caracterizan. Objetivo: Describir las principales características clínicas, biomoleculares e inmunológicas de los pacientes con VHB crónica atendidos en el Instituto de Gastroenterología de Cuba. Materiales y métodos: 97 pacientes que tenían al menos un historial de 6 meses de infección crónica con VHB fueron reclutados en la propia institución desde enero 2016 hasta enero 2018. Se realizaron análisis estadísticos descriptivos para las características clínicas, estudios bioquímicos, virológicos, grado de dureza hepática (medido por elastografía transitoria) y terapia antiviral. Resultados: Todos los pacientes completaron el seguimiento; 61,9 por ciento eran varones y la mediana (rango) de edad fue de 46 (18-84) años. La media de tiempo desde el diagnóstico de la infección fue de 11,7 ± 8,9 años. El 61,9 por ciento tenían enfermedad inactiva sin fibrosis hepática o fibrosis ligera. Solamente el 2 por ciento eran negativos para el antígeno de superficie de la hepatitis B con el DNA cuantificable del VHB, el 81,4 por ciento tenían carga viral detectable y el 85,5 por ciento recibieron uno o más tratamientos antivirales, principalmente los análogos del nucleótido/sido. Conclusiones: Los pacientes con la infección crónica del VHB estudiados, en su mayoría se encuentran en fase inactiva de su enfermedad, sin evidencia significativa de daño hepático, con niveles detectables de viremia y han recibido algún tratamiento antiviral(AU)

Introduction: The effectiveness of the national immunization program has impacted on the reduction of the incidence of hepatitis B virus (HBV) infection in Cuba; however, the number of chronically infected patients is not negligible. These patients are diagnosed in the clinical practice, although the epidemiological studies that indicate the presence of the disease are insufficient. Objective: To describe the main clinical, biomolecular and immunological characteristics of patients with chronic hepatitis B virus infection treated at the National Institute of Gastroenterology, Havana, Cuba. Materials and methods: A total of 97 patients who had at least a 6-month history of chronic HBV infection were recruited at the above mentioned institution from January 2016 to January 2018. Descriptive statistical analyzes were performed to identify the clinical characteristics. Biochemical and virological studies, analysis of both liver stiffness values measured by transient elastography and use of antiviral therapy were also carried out. Results: All patients completed the follow-up. It was observed that 61,9 percent of them were male and the median (range) age was 46 (18-84) years. The mean time since the diagnosis of the infection was 11.7 ± 8,9 years. Inactive disease without liver fibrosis or light fibrosis was present in 61,9 percent. Only 2 percent were negative for hepatitis B surface antigen with quantitative analysis of HBV DNA; also, 81,4 percent of patients had detectable viral load and 85,5 percent received one or more antiviral treatments, mainly nucleotide analogues. Conclusions: The patients with chronic HBV infection studied are mostly in the inactive phase of their disease, without significant evidence of liver damage and detectable levels of viremia. All of them have received some antiviral treatment(AU)