ELF (Enhanced Liver Fibrosis) como marcador não invasivo de fibrose hepática na hepatite C crônica / ELF (Enhanced Liver Fibrosis) as a non invasive predictor of liver fibrosis in hepatitis C

A fibrose hepática é o aspecto mais relevante e o mais importante determinante de morbimortalidade na hepatite C crônica (HCC). Historicamente, a biópsia hepática é o método de referência para avaliação da fibrose causada pela HCC, apesar de apresentar limitações. O estudo de marcadores não invasivos, que possam obviar a necessidade da biópsia, é uma área de constante interesse na hepatologia. Idealmente, a avaliação da fibrose hepática deveria ser acurada, simples, prontamente disponível, de baixo custo e informar sobre o prognóstico da patologia. Os marcadores não invasivos mais estudados são a elastografia hepática transitória (EHT) e os laboratoriais. A EHT já foi extensamente validada na HCC e está inserida na rotina de avaliação destes pacientes. Dentre os laboratoriais, existem diversos testes em continua experimentação e, até o momento, nenhum foi integrado à prática clínica no Brasil, embora já aplicados rotineiramente em outros países. O Enhanced Liver Fibrosis (ELF), um teste que dosa no soro ácido hialurônico, pró-peptídeo amino-terminal do colágeno tipo III e inibidor tissular da metaloproteinase 1, tem se mostrado bastante eficaz na detecção de fibrose hepática significativa e de cirrose na HCC. Neste estudo o ELF teve o seu desempenho avaliado em relação a biópsia hepática e demonstrou apresentar boa acurácia na detecção tanto de fibrose significativa quanto de cirrose. Na comparação com a EHT apresentou acurácia semelhante para estes mesmos desfechos, com significância estatística. No entanto, foi observada uma superestimação da fibrose com a utilização dos pontos de corte propostos pelo fabricante. Este achado está em acordo com a literatura, onde não há consenso sobre o melhor ponto de corte a ser empregado na prática clínica. Com a ampliação da casuística foi possível propor novos pontos de corte, através da análise clássica, com a biópsia hepática como padrão ouro...

Liver fibrosis is the most relevant issue concerning chronic hepatitis C (CHC) and determines its prognosis. Historically, liver biopsy has been the reference method for evaluating fibrosis related to CHC, though it presents many drawbacks. There is a continuing interest in the development of non invasive markers capable of replacing liver biopsy. The ideal surrogate for fibrosis evaluation should be accurate, simple, low cost and yield prognostic information. So far, the most well known non invasive methods are transient hepatic elastography (TE) and laboratory panels. TE has already been extensively validated and is integrated in patients routine. There is plenty of laboratory panels in continuing evaluation and some are already integrated in daily practice abroad. In Brasil, until the present moment, it is not a reality. Enhanced Liver Fibrosis (ELF) panel comprises the serum concentration of hyaluronic acid, tissue inhibitor of matrix metalloproteinases-1, and aminoterminal propeptide of type III procollagen and has demonstrated good performance in detecting significant fibrosis and cirrhosis in CHC patients. In the present study ELF had it’s performance evaluated against liver biopsy and obtained satisfactory accuracy in detecting significant fibrosis and cirrhosis. In comparison to TE no statistically significant diference was observed, for the same endpoints mentioned before. However, the application of manufacturer’s cutoff points produced overestimation of fibrosis stages. These findings are in accordance with other author’s results, in that there is no consensus so far on the most adequate cutoff points for main clinical end points. Enlarging the data permited calculating new cutoff points, through the classical statistical approach, using liver biopsy as the gold standard...

Espectro morfológico de la biopsia hepática / Morphologic spectrum of liver biopsy

La biopsia hepática constituye un excelente método diagnóstico en el espectro de la patología hepática. Para algunos autores la biopsia hepática no es considerada como el "método más indicado" debido al error de muestreo y las variaciones interobservador, sin embargo, sigue considerándose por muchos el "método de elección". Se recopilaron y analizaron en forma retrospectiva, las preparaciones histológicas y las boletas de solicitud de biopsias de todos los casos de biopsias hepáticas, provenientes de la Sección de Patología Gastrointestinal y Hepática "Dr. Pedro Grases" del Instituto Anatomopatológico "Dr. José A. O’Daly" de la Universidad Central de Venezuela, en el lapso comprendido entre enero de 1996 y diciembre de 2006. Pacientes 50,8% eran mujeres y 46,8% hombres. El grupo etario más afectado (55,4%) fue entre 31 y 60 años. Los hallazgos clínicos más frecuentes fueron ictericia (7,9%) y dolor en hipocondrio derecho (5,3%). Frecuencia de los diagnósticos histopatológicos: esteatosis (15,1%), hepatitis por virus C (12,3%), tumores metastásicos (8,9%), cirrosis (8,1%), esteatohepatitis (6,6%), patologías vasculares (5,4%), tumores primarios hepáticos (4,1%). La biopsia hepática es una excelente herramienta para el diagnóstico y tratamiento, si se realiza una buena correlación clínico patológica

Liver biopsy is an excellent diagnostic method in the spectrum of liver pathology. For some authors liver biopsy is considered the "best method" due to sampling error and interobserver variations, however is still considered by many the "method of choice". We collected and analyzed retrospectively, the histological preparations and request ballots biopsies of all cases of liver biopsies, from the Section of Gastrointestinal and Liver Pathology "Dr. Pedro Grases "Institute of Pathology" Dr. José A. O’Daly "Central University of Venezuela, in the period between January 1996 and December 2006. 50.8% patients were female and 46.8% male. The most affected age group (55.4%) was between 31 and 60 years. The most frequent clinical findings were jaundice (7.9%) and right upper quadrant pain (5.3 %). Frequency of histopathological diagnoses: steatosis (15.1%), hepatitis C virus (12.3%), metastatic tumors (8.9%), cirrhosis (8.1%), steatohepatitis (6.7%), vascular diseases (5.4%), primary liver tumors (4.1%). Liver biopsy is an excellent tool for diagnosis and treatment, if you do a good clinicopathologic correlation

Antioxidant effect of aqueous extract of propolis on hepatotoxicity induced by octylphenol in male rats / Efecto antioxidante del extracto acuoso de propóleos sobre la hepatotoxicidad inducida por el octilfenol en ratas macho

4-tertiary-octylphenol (4-tert-OP) is an alkylphenol that affects human health by stimulating free radical production. Aqueous propolis extract is a natural product rich in favonoids that have antioxidant activity. This study was designed to investigate the ability of aqueous propolis extract to reduce the hepatotoxicity induced by 4-tert-OP in male rats. Animals were assigned to 5 groups and treated for 6 weeks. Group 1: control; group 2: 100 mg 4-tert-OP/kg b.wt./day; group 3: 100 mg aqueous propolis extract /kg b.wt./day; group 4: 100mg 4-tert-OP/kg b.wt./day plus 100 mg aqueous propolis extract /kg b.wt./day; group 5: 100 mg 4-tert-OP/kg b.wt./day for 6 weeks followed by 100 mg aqueous propolis extract /kg b.wt./day for 6 weeks. Group 4-tert-OP signifcantly elevated AST, ALT, ALP, GGT, bilirubin, creatinine, urea, total lipids, total cholesterol, triglycerides, LDL-C and MDA with a signifcant decrease in total proteins, albumin, globulin, HDL-C, total antioxidant capacity, SOD, CAT and GST compared to control group. Administration of aqueous propolis extract either alone or combined with 4-tert-OP ameliorated the hepatotoxicity induced by 4-tert-OP. DNA fragmentation supported the deleterious effect of 4-tert-OP and the ameliorative effect of propolis on liver cellular proteins and enzymes. Histopathological fndings revealed the hepatotoxicity induced by 4-tert-OP and the protective effect of aqueous propolis extract. In conclusion, aqueous propolis extract could reduce the damage and toxicity effects on liver cells induced by 4-tert-OP.

El 4-terc-octilfenol (4-terc-OP) es un alquilfenol que afecta a la salud humana mediante la estimulación de la producción de radicales libres. El extracto acuoso de propóleos es un producto natural rico en favonoides que tienen actividad antioxidante. Este estudio fue diseñado para investigar la capacidad del extracto de propóleos de reducir la hepatotoxicidad inducida por el 4-terc-OP en ratas macho. Los animales fueron asignados a 5 grupos y tratados durante 6 semanas. Grupo 1: control; grupo 2: 100 mg de 4-terc-OP/kg/día; grupo 3: 100 mg de extracto de propóleos/kg/día; grupo 4: 100 mg de 4-terc-OP/ kg/día más 100 mg de extracto de propóleos/kg/día, grupo 5: 100 mg de 4-terc-OP/kg/día durante 6 semanas, seguidos de 100 mg de extracto de propóleos/kg/día durante 6 semanas. El grupo 4-terc-OP mostró niveles signifcativamente elevados de AST, ALT, ALP, GGT, bilirrubina, creatinina, urea, lípidos totales, colesterol total, triglicéridos, LDL-C y MDA, con una disminución signi-fcativa de proteínas totales, albúmina, globulina, HDL-C, la capacidad antioxidante total, SOD, CAT y GST, en comparación con el grupo control. La administración de extracto de propóleos, ya sea solo o combinado con 4-terc-OP redujo la hepatotoxicidad inducida por 4-terc-OP. Los estudios de fragmentación del ADN apoyan el efecto deletéreo observado por el tratamiento con 4-terc-OP y el efecto protector del extracto de propóleos, sobre las proteínas y las enzimas celulares hepáticas. Los resultados histopatológicos revelaron la hepatotoxicidad por 4-terc-OP y efecto protector inducido por el extracto de propóleos. En conclusión, el extracto de propóleos podría reducir el daño hepático y los efectos celulares de toxicidad en las células del hígado inducidos por 4-terc-OP.

Fasting adiponectin in relation to the metabolic syndrome in patients with coronary artery disease

Metabolic syndrome and coronary artery disease [CAD] are increasing worldwide. The relationship between metabolic syndrome and fasting serum adiponectin concentration in CAD patients is not well elucidated. The aim of present study is to explore the relationship between serum adiponectin concentrations and the presence of metabolic syndrome [MetS] among patients with CAD. Sixty five patients with CAD; defined as more than 50% stenosis in any segment by coronary angiography, and twenty five matched controls, were enrolled in this study. The study was carried out in Cardiology Department Assuit University hospital between October 2009 and July 2010. Metabolic syndrome was defined according to International Diabetes Federation criteris. The blood samples including complete blood count, fasting blood glucose, liver function tests, creatinine, urea, adiponectin, high sensitive-C reactive protein [hs-CRP], insulin and lipids profile were obtained after overnight fasting. The homeostatic model assessment of insulin resistance [HOMA-IR] was calculated as: HOMA-IR = fasting blood glucose [mmol/l] x fasting serum insulin [micro U/ml]/22.5. Patients with CAD had significantly lower plasma adiponectin concentrations than those without CAD [P<0.013] and higher hs-CRP [P<0.009] and HOMA-IR [P<0.03]. Metabolic syndrome was present in 41 patients [63%] among CAD group. Fasting adiponectin values for these patients tended to decrease significantly in comparison to patients without metabolic syndrome [P value= 0.037]. Negative correlations were found between adiponectin and body mass index [BMI] [r=-0.205, P<0.05], waist circumference [WC] [r= -0.306, P<0.003], triglycerides [r= -0.222, P < 0.036] and hs-CRP [r= -0.223, P< 0.035] whereas a positive correlation was found between adiponectin and HDL [r= 0.273, P<0.003]. Also, adiponectin was significantly lower in patients with multi-vessel disease compared to other [P<0.05] whereas hs-CRP and HOMA-IR were significantly higher in patients with multi-vessel disease with [P<0.01 and 0.03] respectively. Serum adiponectin concentration is inversely correlated with metabolic syndrome among patients with CAD. Lower adiponectin concentration, and higher HOMA-IR and hs-CRP are associated with Cad and metabolic syndrome, and may be useful for risk stratification of CAD patients. The measurement of plasma adiponectin, HOMA-IR and hs-CRP levels may be useful for prediction of severity of coronary artery disease

Funcionalismo hepático en ratas wistar tratadas con dosis terapéuticas de nimesulide / Liver function in wistar rats treated with therapeutic doses of nimesulide

Introducción: El nimesulide es un analgésico antiinflamatorio no esteroideo, asociado en reportes de casos clínicos con hepatotoxicidad. Sin embargo, se han publicado pocos estudios controlados en animales. Objetivo: Determinar si la administración de dosis terapéuticas de nimesulide, durante diferentes periodos, altera el funcionalismo hepático en ratas Wistar machos y hembras. Materiales y métodos: Cuarenta ratas Wistar fueron distribuidas en 4 grupos de 10 cada uno (5 hembras y 5 machos). Grupo I (control): recibió 0.1 mL de solución salina durante 7 días, los animales de los grupos II, III y IV fueron tratados con nimesulide (3 mg/kg) durante 7, 21 y 35 días, respectivamente. Se determinaron niveles séricos de bilirrubina, fosfatasa alcalina y transaminasas. Resultados: La actividad de la enzima alanino-amino-transferasa (ALT) aumentó en machos (p< 0.01) y hembras (p < 0.02) de los grupos III y IV respecto a los controles. En los machos de los grupos II y IV aumentó la fosfatasa alcalina en comparación con las hembras de los mismos grupos (p < 0.05). Las bilirrubinas di - recta y total disminuyeron en las hembras del grupo IV respecto al control (p < 0.03). Conclusiones: Los resultados sugieren que a dosis terapéuticas el nimesulide altera el funcionalismo hepático en ratas Wistar.

Introduction: Nimesulide is a non-steroidal antiinfflamatory drug associated with hepatotoxicity. Nevertheless, there have few published controlled studies with animals. Objec - tive: Determine whether the administration of therapeutic doses of nimesulide during differents periods alters hepatic function in male and female rats. Materials and me - thods: Forty Wistar rats were classified into 4 groups of 10 rats each. Group I received 0,1 ml of saline for 7 days, whe reas the animals from groups II, III and IV were treated with Ni mesulide (3 mg/kg) during 7, 21 and 35 days, respectively. It has determined serum levels of bilirubin, alkaline phos pha tase and transaminases. Results: Alanino-amino-transferase (ALT) enzyme was increased in males (p<0.01) and females (p<0.02) from groups III and IV in com parison with the control group. Alkalin phosphate increased in males from groups II and IV in comparison with the females from these same groups (p< 0.05). Direct and total bilirubins decreased in group IV females (p< 0.03) in comparison with the control group. Conclusions: The administration of therapeutic doses of nimesulide affects hepatic function on Wistar rats.

[Survey the changes of thyroid functional tests in patients with liver cirrhosis due to hepatitis B and C and correlation of thyroid hormone levels with severity of liver dysfunction]

The liver played an important role in the metabolism of thyroid hormones and was involved in their conjugation, excretion and peripheral deiodination in synthesizing Thyroid Binding Globulin [TBG]. Thus liver dysfunction can be influenced thyroid function. Determine the changes of thyroid functional tests in patients with liver cirrhosis due to hepatitis B and C and correlation of thyroid hormone levels with severity of liver dysfunction. Sixty Four Cirrhotic patients due to hepatitis B and C referring to Razi hospital were studied during 2007-2009 years. Data were collected by prepared questionnaire. Thyroid hormone levels were measured in a unit laboratory. Liver dysfunction was scored by MELD and child pugh scoring systems. Mann-Whitney U, chi square and kruskal wallis test were used for measuring severity of liver dysfunction. Among 64 patients, [42 patients were male and 22 patients were female]. Mean age of patients was 55.03 +/- 12.05. Level of TT3 TT4 and FT3 had decreased in the majority of patients, TT3, TT4 and FT3 levels. There was a correlation between level of TT3 and severity of liver dysfunction base on Child score [p=0.0001] and MELD [p=0.02].There was a reciprocal correlation between TT3 level and probability of the history of digestive systems bleedings, Ascites and encephalopathy [P=0.01, P=0.011, P=0.009] .It means that when TT3 level was low probability of this complication was high. This study showed that liver disease is accompanied by changes in thyroid hormone levels specially decrease the level of TT3, TT4, FT3 and it is indicated that TT3 level can be used as liver function index in cirrhotic patients due to hepatitis B and C

Effect of Ficus sycomorus and Azadirachta indica extracts on liver state of mice infected with Schistosoma mansoni

The potential role of hepatoprotective and antipathological effect of Ficus sycomorus and Azadirachta indica extracts was evaluated for scavenging the reactive oxygen species [ROS] and reduced the oxidative damage and pathological changes in the liver of S. mansoni infected mice. The levels of alanine aminotransferase [ALT], asparate aminotransferase [AST] and gamma glutamyl transferase [GGT] were evaluated in the infected mice and treated orally with each plant extract 12 weeks post infection [P.I.] in a dose of 500 mg/kg of each plant extract for five consecutive days and sacrificed two weeks P.I. The infection of mice showed an elevation of ALT, AST and GGT. Treatment of mice with 70% methanol extract of each plant extract reduced significantly ALT, AST and GGT elevation. The highest reduction was with the methanolic extract of F. sycomorus [42%, 35% and 44% for ALT, AST and GGT respectively]. Fractionation of the methanolic extract of each plant was carried out. The effect of ethyl acetate and butanolic fractions of each plant was also evaluated. The result showed that the two fractions lowered the levels of the tested enzymes and decreased the number and size of granuloma diameters with an increased in the percentage of degenerated ova

Role of GGT in diagnosis of metabolic syndrome : A clinic-based cross-sectional survey.

Background & objectives: The aim of this study is to know if the liver function tests (LFT), especially gamma glutamyl transferase (GGT), have a predictive value in diagnosis of metabolic syndrome (MS). Methods: A cross-sectional, single-center study was carried out with 908 subjects. Four hundred and forty two of these subjects were diagnosed with MS with IDF criteria; while other 466 were sex and age matched healthy control subjects. Blood pressure, liver function tests, fasting blood glucose levels and lipid profile of the subjects were recorded. Results: The mean values of alanine amino transferase (ALT), aspartate aminotransferase (AST) and GGT levels were statistically significantly higher in MS group. The mean values of liver enzymes, for female/ male subjects in MS group, AST; ALT and GGT respectively, were; 20.5/19.7 U/l; 25.9/28.5 U/l; 35.9/42.1 U/l. When the sample is divided into quartiles of the GGT levels, increase in GGT is positively correlated with increased MS prevalence. In ROC analysis GGT is as strongly associated with the IDF diagnostic components as is each individual IDF component, except elevated systolic blood pressure. In covariance analysis, there was significant relationship between elevated GGT levels and MS presence after adjustment for age, sex and MS diagnostic criteria; but not AST and ALT levels. In multivariance analysis, in MS group, a high GGT was positively associated with CVD prevalance (odds ratio: 2.011, 95% CI 1.10-4.57) compared to low GGT group independent of age, sex and smoking habits. Interpretation & conclusion: Elevated liver enzymes, although in normal ranges, especially at upper quartiles, play a central role in early diagnosis of fat overflow to the liver. Regarding the availability and simplicity of these tests in routine clinical practice, they, especially GGT, have potential to be considered in algorithms for metabolic syndrome.

Pegylated interferon with ribavirin in the treatment of chronic active hepatitis C in Egyptian patients: efficacy of response in a retrospective study

Chronic hepatitis C is one of the major causes of cirrhosis, hepatocellular carcinoma and considered the main indication for liver transplantation. In Egypt, high HCV rates were reported among several population groups reaching up to 20%. Interferon Alfa is the current therapy forchronic hepatitis C .Yet, combination therapy of Alfa interferon and ribavirin is more effective than interferon alone in increasing the response rates. Aim of work is to study efficacy of response in Egyptian patients with chronic active hepatitis C who had received pegylated interferon plus ribavirin as regarding the biochemical and virologic response. The results of this study showed that patients received Pegylated interferon alfa-2a plus ribavirin had significant improvement in serum ALT levels in around 71% of them. Also 58.94%of these patients achieved sustained clearance of the virus six months after stopping treatment. The combination therapy of Pegylated interferon alfa and ribavirin is effective in achieving biochemical and virological responses and is highly recommended as an initial therapy for patients with chronic hepatitis C

Chronic hepatitis C virus infection: prevalence of cryoglobulinemia and renal affection in the Egyptian patients

The association between mixed cryoglobulinema [MC], chronic hepatitis C virus [CHC], and renal insufficiency was documented. This paper aimed to determine the prevalence of cryoglobulinemia [CG], and renal affection drug-naive Egyptian patients suffering from CHC-in a cross-sectional study So, 53 patients with CHC and 20 healthy controls were included. Parameters investigated covered; HCV antibodies, HCV RNA, liver profile [AST, ALT, serum albumin, total bilirubin, prothrombin time], renal profile [urea, uric acid, creatinine clearance, urinary albumin], CG, C3, .C4, and three MDRD equations to calculate the GFR. The results showed that CG was found in all patients, but none in controls. The renal markers showed that none of the patients suffered frank nephropathy, but were at increased risk for developing kidney disease

Protective effect of grape seeds oil [Vitis Vinifera] on methomyl induced liver damage in albino rats

Liver damage was induced in adult male albino rats, weighting about 130-140 g, by oral administration of methomyl with single dose at two concentrations [1/10 or 1/20 LD[50]/day for short term [4 weeks] and long term [8 weeks]. The markers of liver damage were investigated by evaluating biochemical parameters in serum and liver tissues such as activities of aspartate aminotransferase [AST], alanine aminotransferase [ALT]], alkaline phosphatase [ALP], total bilirubin [TB], total protein [TP], total lipids [TL], total cholesterol [TC], triacylglycerols [TAG] and malondialdhyde [MDA] levels. In addition serum urea, creatinine and uric acid were assessed after 4 and 8 weeks. The effect of oral administration of grape seed oil [GSO] 4 ml/kg. Body weight/day on the above parameters for 4 and 8 weeks were investigated as a protective and antihepatotoxic effect. Oral administration of methomyl with single dose of concentration [1/10 or 1/20 LD[50]/day for 4 and 8 weeks, showed significant increase [p < 0.05] in serum liver enzymes activity [ALT, AST, ALP], TB, and MDA levels, while total protein showed a highly significant reduction as compared to negative control and control group received GSO, and the more effect was observed at the high dose of methomyl 1/lOLDso. ALT was not affected at the methomyl dose 1/20 LD[50]/day after 4 weeks. Serum lipid profile [TL, TC and TAG], creatinine and uric acid were also elevated in methomyl intoxicated rats with slight changes in TC and TL as compared to normal group at dose 1/20 LD[50]/day after 4 and 8 weeks. A significant - decrease [p < 0.05] and a high decrease [p < 0.01] in urea values were observed after short and long term in methomyl intoxicated rats. In liver tissues, elevation was found in ALP, TB, MDA, TC and TL levels after long term, while ALT, AST and total protein were significantly decreased, and intoxicated group treated with methomyl 1/10 LD[50] /day for 4 and 8 weeks was more acute effect as compared to control groups. Oral treatment with grape seed oil GSO 4 ml/kg body weight/day improved all the above parameters being almost similar to control values with treated low dose of methomyl

Cellular enzyme values in hunter/jumper and dressage horses with dermatophytosis / Valores de enzimas celulares em cavalos de caça e de esportes com ou sem dermatofitose

Valores de enzimas celulares envolvendo testes da função hepática em 16 equinos de caça e de salto com tricofitose naturalmente adquirida foram comparados com 16 equinos saudáveis, para avaliar os efeitos da doença sobre as atividades dessas enzimas hepáticas. Todos os cavalos diagnosticados com tricofitose ou positivos para Tricophyton equinum foram isolados. Soro aspartato aminotransferase (AST), alanina aminotransferase (ALT), lactato desidrogenase (LDH), fosfatase alcalina (ALP) e gama glutamil transferase (GGT) foram analisados por calorimetria. Não houve diferenças significativas entre os animais doentes e os saudáveis quanto às atividades enzimáticas.

A função hepática em mulheres menopausadas tratadas com extrato seco padronizado do rizoma e raízes de Cimicifuga racemosa L / The hepatic function in postmenopausal women treated with a standardized dry extract of the roots and rhizome of Cimicifuga racemosa L

Objetivo: Avaliar a resposta hepática ao tratamento durante 12 meses com extrato seco padronizado de raízes e rizoma de Cimicifuga racemosa L. (Acteae racemosa L.) (CR) em mulheres menopausadas.Justificativa: O uso do CR é reconhecidamente seguro na literatura mundial, mas há referências de casos de hepatite em usuárias de CR.Método: Estudo duplo-cego, placebo-controlado, randomizado, prospectivo. Durante 12 meses consecutivos foram tratadas 64 mulheres menopausadas, divididas em dois grupos de 32, com 20mg de CR (Aplause®. Marjan) ou placebo, uma cápsula duas vezes ao dia, cada cápsula de CR contendo, no mínimo, 1mg de 27-deoxiacteína. A média etária cronológica do grupo CR foi 54,2 anos e a idade menopausal média 7,8 anos e do grupo placebo (P) 54 e 6,6 anos, respectivamente. O intervalo entre as consultas foi quatro meses, tendo sido realizadas as dosagens de transaminase glutâmico-oxalacética (TGO), transaminase glutâmico-pirúvica (TGP), gama-glutamil-transferase (GGT) e fosfatase alcalina (FAL) na consulta inicial e nas três consultas quadrimestrais do seguimento.Resultados: Não houve em ambos os grupos diferença estatística significativa entre os resultados de TGO (p=0,15), TGP (p=0,92), GGT (p=0, 92) e FAL (p=0,89) nas cinco consultas.Conclusão: O tratamento de 12 meses com CR não afetou a função hepática de uma população de mulheres menopausadas.

Comparative effect of petroselinum sativum extract and rutin on liver functions

Serum enzymes are very important in clinical diagnosis of diseases and estimation of liver damage of intoxicated rats by CCL[4]. In this study the effect of Petroselinum sativwn extracts was measured on the enzyme activities of liver transaminase "ALT, AST, ALP, and LDH". Also, the activity of lysosomal enzymes "ACP; beta-GAL, and beta-NAG In addition to superoxide dismutase as an antioxidant enzyme were determined after oral treatment with two concentrations "50 and 100 mg/kg b.w" for 21 days after injection i.p. of CCL[4] to evaluate the possible curative effect for the ethanolic extract of parsley. The activity of SOD as an antioxidant enzyme was also studied. Rutin as a standard antioxidant was orally administered as single dose "100 mg/kg b.w" for the same periods "10, and 20 days". This experiment was performed in two groups of rats "intoxicated and nontoxicated treatments". The results revealed that the liver enzymes activity "ALT, AST, ALP, and LDH" were markedly increased in hepatotoxic rats after the duration time. The higher activities of these enzymes could be referred to induced cell damage after CCL[4] treatment. Also, the lysosomal enzymes such as "ACP, beta-GAL, and beta-NAG" were markedly increased in parallel to the hepatoxic rats, SOD activity was significantly decreased. After plant extract administration by the two concentrations and Rutin by single dose, the enzyme activities of "ALT, AST, ALP, LDH, ACP, beta-GAL, and beta-NAG" were ameliorated and decreased significantly as compared to the control group. SOD activity was increased. Petroselinum sativum ethanolic extract exerted a curative effect on the enzyme activities of transaminase, "ALP, LDH, and the activities of lysosomal enzymes of rat liver. Also, this extract suppressed the oxidative stress by enhancement of the SOD activity

Prophylactic and curative effects of oat bran [Avena sativa] against hyperlipidaemia in albino rats

The aim of this study was to evaluate the hypolipidaemic effect of oat bran in albino rats. To achieve this goal, two main experiments included 56 female Swiss rats were conducted. The first was Prophylactic experiment comprised of 24 rats in three groups as follows: Group 1: negative control, fed on normal diet, Group 2: positive control received hyperlipidaemic diet [HL-D] and Group 3: received daily HL-D along with oat bran at a dose of 2.70 g kg[-1] b.w. for 8 weeks. The second was Curative experiment comprised of 32 rats. Eight rats served as negative control [Group 1], and the other rats were subjected to the induction of experimental hyperlipidaemia for 4 weeks. Then the hyperlipidaemic rats were divided randomly into equal three groups as follows: Group 2: Hyperlipidaemic rats served as positive control for 4 weeks. Group 3: Hyperlipidaemic rats received oat bran at a daily dose of 2.70 g kg[-1] b.w. for 4 weeks Group 4: Hyperlipidaemic rats received a daily p.o dose of 3.6 mg kg[-1] b.w of simvastatin as reference drug for the same period. The results revealed that HLD supplementation increased plasma lipid profile [triglycerides, total cholesterol [T.C] and LDL], risk ratio [T.C/HDL and LDL/HDL], liver cholesterol, serum enzymes [aspartate aminotransferase [AST], alanine aminotransferase [ALT] and alkaline phosphatase [ALP]]. However, a daily administration of oat bran with HL-D was significantly able to suppress the lipotropic effects of HL-D in plasma and liver in both experiments. This study concluded that oat bran supplemented diet is an effective hypolipidaemic agent

Plasma and ascitic fluid level of calprotectin in chronic liver disease: malignant and non malignant

Calprotectin was widely investigated in alcoholic liver disease and proved to be a new prognostic marker of survival independent of the severity of liver disease as well as marker of malignancy. However it was not widely investigated in other causes of liver cirrhosis. Of the present work was to study the level of calprotectin both in plasma and ascitic fluid in patients with hepatitis C [HCV] related chronic liver disease with and without malignancy, and to find out whether one or both of them correlate with the severity of liver damage and presence of malignancy. This study was conducted at the Faculty of Medicine, Alexandria University and the National Liver Institute, Menoufiya University. Thirty patients with Hepatitis C related liver cirrhosis were recruited. Fifteen of these patients suffered from concomitant hepatocellular carcinoma [HCC] diagnosed by elevated alpha foeto-protein [AFP] and one imaging technique OR by two imaging techniques in the case of normal AFP. Calprotectin was significantly elevated in patients with cirrhosis and cirrhosis/HCC than in controls [p=<0.01]. However there was no significant difference in the levels of plasma or ascitic calprotectin between the cirrhotic group and the group with HCC. There was no correlation between plasma and ascitic calprotectin levels. Ascitic calprotectin correlated significantly with bilirubin, and markers of synthetic liver function [p=<0.05], but plasma calprotectin correlated only with prothombin activity [p=<0.05]. In patients with spontaneous bacterial peritonitis, ascitic calprotectin was significantly higher in patients having this complication [879.8 +/- 67.5] than patients without SBP [534.2 +/- 59.3 [p<0.01] and a highly significant correlation was found between ascitic calprotectin and total leucocytic count in ascitic fluid [p=<0.01]. Calprotectin is elevated in HCV-related cirrhosis but not further elevation with the occurrence of hepatocellular carcinoma. Ascitic calprotectin correlated with the degree of hepatocellular injury and was significantly higher in patients with SBP. Further studies are warranted to establish a role of plasma calprotectin for the risk assessment of infectious complications secondary to bacterial translocation in patients with HCV- related liver cirrhosis

Glypican 3 amino terminal marker for early detection of hepatocellular cacinoma

HCC is the 5[th] common cancer worldwide. Due to global increase of hepatitis B and C infection, the incidence of hepatocellular carcinoma [HCC] has been steadily increasing. The seroprevalence of HCV in Egypt is currently between 20 -35%. Because Alfa Feto protein [AFP] has limited sensitivity for small hepatocellular carcinoma foci, Glypican-3 [GPC-3] oncofetal protein which is over expressed in HCC could represent a hope for early detection. Evaluating the validity of Glypican-3 as an early detector of HCC. 10 healthy controls and 40 HCV positive patients distributed as follows: 10 patients with chronic hepatitis C virus infection [CH], 10 patients with compensated cirrhosis [CC], 10 patients with decompensated cirrhosis [DC] and 10 patients with HCC. Liver functions: ALT, AST, Bilirubin [T], Albumin, gamma GT. Tumor markers: AFP and GPC-3.Viral markers: HCV antibodies, HBs Ag and HBc Ab. AFP mean was126 ng/ml and GPC-3 mean was 34.63 ng/ml in HCC group which were significantly higher than the other studied groups. No significant correlation was found between AFP and GPC-3.The area under ROC of GPC-3 was higher than AFP suggesting increased GPC-3 sensitivity. AFP showed sensitivity of 70% in HCC, 30% in D.C and 20% in C.C with 100% PPV, also AFP had 100% specificity with low NPV compared to GPC-3. GPC-3 was detected in all HCC groups, DC and CH showing 100% diagnostic performance. GPC-3 in C.C revealed 70% sensitivity with 100% PPV and 100% specificity with low NPV. GPC-3 was elevated in context of patients with CH, CC and DC as it is an oncofetal protein produced by regenerating liver cells. GPC-3 and AFP improve the prediction accuracy of HCC in those seronegative to AFP

Transfer factor activation of the natural killer cell in patients with chronic hepatitis C infection

Infection with hepatitis C virus [HCV] is a leading cause of chronic liver disease worldwide, little is known about how this virus is able to persist or whether this persistance might be because of its ability to alter the early innate immune response. The major HCV envelope protein E2 has been shown to bind to CD81; this leads to restricted cytotoxicity mediated by NK cells. Transfer factor advanced formula plus is formed of bovine and egg colostrum and has been found to increase NK cell activity by 437% above the base line. It is produced by 4 life research company/USA. Also, it contains several growth factors as insulin growth factors [IGF I], [IGF II], Transforming growth factor beta [TGF-B] and epidermal growth factor [EGF]. Assessment of Natural Killer [NK] cell activation by transfer factor in patients with chronic HCV infection whom are not candidate for standard therapy. 30 patients with chronic HCV infection, who are not candidate for standard therapy were subjected to: [1] History and clinical examination. [2] Liver function tests. [3] Viral markers [HBS Ag, HCV Ab]. [4] HCV RNA by PCR in the serum. [5] Flow cytometric analysis of NK cells in blood sample. [6] Patients were given transfer factor plus capsules twice daily before meals for 3 months then re-evaluation was done. Significant reduction of Mean alanine aminotransferase [SGPT] from 79.27 +/- 71.47 to 30.35 +/- 6.21, aspartate aminotransferase [SGOT] from 80.73 +/- 46.88 to 36.40 +/- 3.23 and serum Bilirubin from 1.58 +/- 0.72 to 0.86 +/- 0.33. Significant elevation of serum albumin from 3.19 +/- 0.70 to 3.59 +/- 0.54 and prothormbin activity from 0.63 +/- 0.14 to 0.82 +/- 0.12. No significant change in serum HCV RNA by PCR nor NK cell count by flow cytometry. Transfer factor advanced formula plus is an effective new therapeutic option for patients with chronic HCV infection who are not candidate for standard therapy

Role of tomato against lead induced hepatic and kideny toxicty in rats

Lead is toxic even in low dose, causes both chronic and acute intoxication. Therefore this study aimed to investigate the effect of plants, tomato [Lycopersium esculentum] against lead toxicity in male rats. Five groups of animals was used in this study, the first group received a basal diet and served as negative control, the second group received basal diet supplemented with lead acetate [0.05mg/kg] as positive control. The other three groups received basal diet supplemented with lead acetate [0.05mg/kg] and 1%, 3% and 5% tomatoes for 30 days. The results revealed that positive control gave a significant increase in alanine aminotransferase [ALT], aspartate minotransferase [AST], glutathione-S-transferase [GST], alkaline phosphatase [ALP] activities, creatinine and urea; significantly depleted glutathione content [GSH], total protein [TP] and albumin. These results indicate the toxicity of lead on liver and kidney. However tomatoe supplemented to lead treated group significantly alleviated GSH, TP and albumin depletion and the elevation of ALT, AST, GST, ALP, creatinine and urea. These results indicate the protective action of tomato as a potential protective agent against lead toxicity. This may be due to multiple defense powerful antioxidants, fiber and glutathione which present in high levels in tested plant

Evaluation of apri test as a liver fibrosis marker / Avaliação do modelo APRI como marcador de fibrose hepática

Objective: to evaluate the performance of APRI test as an indirect marker of liver fibrosis in patients of FSCMPA with chronic viral hepatitis. Methods: laboratorial and histopathological (META VIR) data of 102 patients were collected with the aim of comparing biopsy reports to test results, considering: FO- F 1 as absent/ insignificant fibrosis and F2-F4 as presence of expressive fibrosis; FO-F3 and F4 as absence and presence ofcirrhosis, respectively. The evaluation was based on the use of simultaneous cut-off points suggested by Wai et ar (2003) and also the development of single cut-off points, through ROC curves,for this sample. Results: the specificities found through the original cut-off points were 96% and 87% for significant fibrosis and cirrhosis, respectively. A superior perforinance was detected for the diagnosis of expressive fibrosis (PPV 90%) and for the exclusion ofliver cirrhosis (NPV 95%). The only advantages accomplished with the use ofthe single cutoffpoints definedfor this study were the classification of all patients and an increase insensibility, which do not justify their applicability. Conclusion: APRI test is able to confirm the existence of significant fibrosis and exclude cirrhosis, what makes it available, as an altemative, in clinical practice.

Objetivo: avaliar o desempenho do teste APRI como marcador indireto de fibrose hepática em pacientes portadores de hepatites virais crônicas da FSCMPA. Método: foram avaliados dados laboratoriais e histopatológicos (META VIR) de 102 pacientes afim de comparar os resultados da biópsia com o cálculo do teste. Considerou-se: F0-F1 e F2-F4 como fibrose ausente/inexpressiva e presença de fibrose expressiva, respectivamente; F0-F3 e F4 como ausência e presença de cirrose, respectivamente. Utilizou-se os pontos de corte simultâneos sugeridos por Wai et al. (2003) e desenvolveu-se pontos de corte únicos, através de curvas ROC, para esta amostra. Resultados: as especificidades encontradas com os cortes originais foram, parafibrose significativa e cirrose, 96% e 87%, respectivamente. Evidenciou-se melhor desempenho ao confirmar diagnóstico de fibrose expressiva (VPP 90%) e em excluir cirrose hepática (VPN 95%). As únicas vantagens obtidas com os pontos definidos neste estudo foram a classificação de 100% dos pacientes e aumento da sensibilidade, o que não justifica sua aplicabilidade. Conclusão: o teste APRI é capaz de afirmar a existência de fibrose importante e de excluir o diagnóstico de cirrose, o que viabiliza seu uso, como alternativa, na prática clínica.