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

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

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

Mutagenesis of Aspergillus oryzae IPT-301 to improve the production of ¥â-fructofuranosidase

Aspergillus oryzae IPT-301, previously reported as a ¥â-fructofuranosidase producing microorganism, was successfully mutated using UV irradiation at 253.7 nm followed by the screening of survivors resistant to certain stress conditions. Strains were first subjected to the ¥â-fructofuranosidase activity assay using a portion from the colony grown in Petri dish as the enzyme source. Seven mutants with fructofuranosidase activity values relative to the parent culture between 140 -190 percent were selected from survivors grown at temperature of 40¨¬C or 0.018 percent (w/v) sodium dodecyl sulfate concentration. They were cultivated on a rotary shaker to characterize mycelium and extracellular fructosyltransferase activities. Three mutants named IPT-745, IPT-746 and IPT-748 showed the highest amount of mycelium activity whose values increased 1.5 -1.8 fold, compared with the parent strain. It was found that more than 55 percent of total enzyme activity (mycelium- plus extracellular- activity) from these strains was detected in the mycelium fraction. Only one mutant, IPT-747, exceeded the amount of extracellular enzyme exhibited by the parent strain (1.5 times). This mutant also showed the highest value of total fructosyltransferase activity.

Determinación in vivo del papel de las enzimas esterasas y glutation transferasa en la resistencia a piretroides en Aedes aegypti (Diptera: Culicidae) / Determination in vivo of the role of esterase and gluthation transferase enzymes in pyrethroid resistance of Aedes aegypti (Diptera: Cullicidae)

Se realizó un estudio in vivo a través del uso de 2 sinergistas, el trifenil fosfato (TFF) inhibidor específico de esterasas y el ácido etacrínico (AE), inhibidor específico de la enzima glutation transferasa (GST), para determinar si estas enzimas eran responsables de la resistencia a piretroides en Aedes aegypti. Para el trabajo se utilizaron 2 cepas de Aedes aegypti resistentes a insecticidas, una cepa que fue seleccionada con temefos por 6 generaciones de selección (SAN-F6) y otra con deltametrina por 12 generaciones de selección con este insecticida (SAN-F12), ambas resultaron ser resistentes a insecticidas piretroides. Se demostró a través del uso de los sinergistas TFF y AE que las enzimas esterasas y GST son responsables de la resistencia a los piretroides en estas cepas. Esos resultados demuestran la existencia de un fenómeno de resistencia cruzada y multirresistencia, lo cual debe tenerse en cuenta en las estrategias de uso de insecticidas para el control de este vector.

An in vivo study of two synergists, that is, Triphenil phosphate -specific esterase inhibitor- and ethacrynic acid specific gluthation transferase inhibitor- was performed to determine if these enzymes were responsible for pyrethroid resistance of Aedes aegypti. To this end, two insecticide resistant Aedes aegypti strains were used, one strain selected with temephos by six selection generations (SAN-F6) and the other strain with delmamethrin by 12 selection generations (SAN-F12), being both strains resistant to pyrethroid insecticices. Through the use of TPP and EA synergists, it was proved that esterase and gluthation-s-transferase (GST) enzymes were responsible for pryrethroid resistance of these strains. These results showed the existence of cross-resistance and multidrug resistance, which should be taken into account for insecticide use strategies aimed at vector control.

Alteraciones clínicas y bioquímicas en ratas tratadas con dosis altas de vitamina A / Clinical and biochemical alterations in rats treated with high doses of vitamin A

En el presente trabajo se estudió el efecto de la administración intramuscular de 30.000, 50.000 y 100.000 UI de palmitato de vitamina A/día, durante 7 días, respectivamente, sobre la actividad enzimática hepática en 45 ratas Wistar machos, de 12 semanas de edad, con pesos entre 180 y 200 gramos. El grupo control estuvo integrado por 15 ratas Wistar sanas, con género, edad y peso similares a los animales tratados. El consumo de alimentos y de agua, y el peso de las ratas se determinó al finalizar el período experimental. Las ratas se examinaron en busca de manifestaciones clínicas de toxicidad. Al final el estudio, las ratas se sacrificaron bajo anestesia con éter y se tomaron muestras de tejido hepático para la determinación de la actividad enzimática. La administración de vitamina A en exceso incrementó de manera significativa (p menor que 0,05) el contenido hepático del retinol, determinó diversos y variados signos clínicos (tales como: anorexia, pérdida de peso, alopecia, conjuntivitis, hemorragias internas y externas, alteraciones cutáneas y muerte de los animales) e incrementó (p menor que 0,05) la actividad de las siguientes enzimas: alanina aminotransferasa, aspartato aminotransferasa, maltasa ácida (alfa-1,4-glucosidasa ácida), proteasas ácidas, lactato dehidrogenasa y fosfatasa alcalina mientras que las actividades de la glucosa-6-fosfatasa, glucógeno fosforilasa, alfa-amilasa, colinesterasa y arginasa disminuyeron (p menor que 0,05) al comparar con los controles no tratados. Estos cambios son proporcionales a las dosis inyectadas de vitamina A. En conclusión, nuestros resultados proporcionan evidencias que la administración de dosis altas de vitamina A a corto plazo determina diversos y variados signos clínicos y produce una marcada alteración de la actividad enzimática hepática.

In the present work the effect of intramuscular administration of 30.000, 50.000 and 100.000 IU of vitamin A palmitate daily for seven days, respectively, on the liver enzyme activity in 45 white male Wistar rats, aged 12 weeks and weighing 180-200 g, have been studied. The group control was integrated by 15 healthy rats with similar characteristics (strain, gender, age and weight) to treated animals. Food and water consumption and body weights were recorded at the end of the experimental period. Rats were observed for clinical signs of toxicity. At the end of the study, rats were sacrificed under ether anesthesia. Liver samples were taken for the determination of enzyme activity. Administration of excess of vitamin A produced a significant (p menor 0.05) increase in the content of liver vitamin A, determined diverse and variable clinical signs (such as, anorexia, loss of body weight, alopecia, conjunctivitis, external and internal hemorrhages, skin abnormalities and death) and increased (p menor que 0.05) the activity of the following enzymes: alanine aminotransferase, aspartate aminotransferase, acid maltase (acid alfa-1,4-glucosidase), acid proteases, lactate dehydrogenase and alkaline phosphatase while glucose-6-phosphatase, glycogen phosphorylase, alfa-amylase, cholinesterase and arginase decreased (p menor que 0.05) as compared with untreated controls. These changes depend on the doses given of vitamin A. In conclusion, our results provide evidence that short-term administration of high doses of vitamin A determined diverse and variable clinical signs and produces a marked alteration of activity of liver enzymes.

Envolvimento hepático em pacientes com dengue hemorrágico: manifestação rara? / Liver involvement in patients with dengue hemorrhagic fever: a rare phenomenon?

As manifestações hepáticas são descritas como não usuais no dengue e podem evoluir com quadros graves e potencialmente letais. Avaliamos as alterações hepáticas em 41 pacientes com dengue hemorrágico com confirmação laboratorial (ELISA IgM positivo) em Campo Grande, Mato Grosso do Sul, Brasil e observamos 61 por cento (25/41) de alteração na alanina aminotransferase e 80,5 por cento (33/41) na aspartato aminotransferase, sendo que não houve diferenças estatisticamente significativas quando comparamos as várias formas clínicas. A variação nos valores de ALT foi de 14-547U/l, nos valores da AST foi de 11-298U/l. Náuseas e/ou vômitos foram referidos por 90 por cento (37/41) dos pacientes, 46,3 por cento (19/41) referiram dor abdominal e 10 por cento (3/29) apresentavam hepatomegalia ao exame físico. A idade variou de 18 a 88 anos, 23 (56 por cento) eram mulheres e 18 (44 por cento) homens.

Hepatic manifestations are described as unusual complications of dengue and may lead to severe and potentially lethal conditions. Liver abnormalities in 41 patients diagnosed with dengue hemorrhagic fever in Campo Grande, Mato Grosso do Sul, Brazil, between January 1 and March 31, 2002, were evaluated. All were serologically positive for dengue in laboratory tests (IgM ELISA). ALT alterations were observed in 61 percent (25/41) and AST alterations in 80.5 percent (33/41), but there were no statistically significant differences between the various clinical forms. The range in ALT levels was 14-547U/l and in AST levels was 11-298U/l. Nausea and/or vomiting were reported by 90 percent (37/41) of the patients; 46.3 percent (19/41) had abdominal pain and 10 percent (3/29) presented hepatomegaly at clinical examination. The patients' ages ranged from 18 to 88 years; 23 (56 percent) were female and 18 (44 percent) were male.