Résumé
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.
Résumé
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.
Sujets)
Virus de l'hépatite BRésumé
Objective@#To investigate the risk factors for susceptibility of abnormal liver function in patients with gout.@*Methods@#A total of 5 044 cases of male gout patients in remission were selected and divided into normal liver function group with 3 693 patients and abnormal liver function group with 1 351 patients. The clinical information was collected and relevant biochemical indices were detected. Serum uric acid(SUA) was divided into quartiles, and its associations with elevated ALT were evaluated.@*Results@#There were significant differences in the history of drinking, family history, combining with hyperlipidemia, fatty liver, and coronary heart disease between the abnormal liver function group and normal function group(P<0.05 or P<0.01). There were significant statistical differences in age, disease duration, body mass index, waist circumference, diastolic blood pressure, serum cholesterol and triglyceride, uric acid, and creatinine clearance rate between 2 groups(P<0.01), while without significant difference in history of smoking, regular exercise, combining hypertension and diabetes, the means of systolic blood pressure, and fasting blood glucose(all P>0.05). Further logistic regression analysis indicated that body mass, waist circumference, combining fatty liver, higher SUA level, higher cholesterol and triglyceride were risk factors of the early onset of abnormal liver function. ALT and the proportion of abnormal liver function were increased with the increase of UA. After adjustment for BMI, TG, TC and fatty liver, the ALT level and the proportion of abnormal liver function decreased significantly while still showed an upward trend.@*Conclusion@#Patients with obesity, high level of uric acid, high blood lipids and fatty liver were more likely to develop abnormal liver function, SUA was independently associated with elevated ALT.
Résumé
JUSTIFICATIVA E OBJETIVOS: Este estudo visa à investigação dos efeitos do tratamento com isotretinoína oral sobre o perfil lipídico e de lesão hepatocelular em pacientes com acne vulgar na população de Alagoas, de modo a comparar com os índices de alterações da população de outros países, pois não existe qualquer estudo na população brasileira, comprovando sua segurança quando usada de forma racional. MÉTODO: Através de estudo transversal, avaliaram-se dados de prontuários de pacientes que fizeram uso de isotretinoína oral, por intermédio da Farmácia de Medicamentos Excepcionais (FARMEX), sendo enquadrados no estudo os resultados referentes às dosagens de colesterol total e frações (HDL e LDL), triglicerídeos e enzimas hepáticas (ALT e AST). A amostra compreendeu aqueles que realizaram tratamento entre os anos de 2002 a 2009, perfazendo um total de 721 pacientes. RESULTADOS: Dos 721 pacientes; 15,27% apresentaram elevação sérica dos triglicerídeos; com aumento médio de 30,6% em seus níveis; 19,95% desenvolveram hipercolesterolemia, com elevação média de 7,5% em suas taxas; 12,55% apresentaram elevação da ALT e 3,26% evoluíram com aumento da AST, visto que, mostraram incremento sérico médio de 8,3% e 9,5%, respectivamente. Apenas 1,66% obtiveram algum valor laboratorial que exigisse a cessação da terapia. CONCLUSÃO: Pequeno número de pacientes desenvolveu níveis sanguíneos de quaisquer variáveis compatíveis com a descontinuidade do tratamento ou mesmo diminuição da dose administrada, corroborando a segurança da terapia com a isotretinoína oral.
BACKGROUND AND OBJECTIVES: This study aims to research of the effects of treatment with oral isotretinoin on lipid profile and tests of hepatocellular damage in patients with acne vulgaris in the population of Alagoas, in order to compare the rates of changes in the population of other countries, since there is no study in the Brazilian population, demonstrating its safety when used in a rational. METHOD: Through sectional study, data were evaluated from medical records of patients who used oral isotretinoin, by the Exceptional Drug Pharmacy - FARMEX, being framed in the study results concerning to total cholesterol and fractions (HDL and LDL), triglycerides and liver enzymes (ALT and AST). The sample included those who underwent treatment between the years 2002 to 2009, a total of 721 patients. RESULTS: Of the 721 patients, 15.27% had high serum triglycerides, with an average increase of 30.6% in levels, 19.95% developed hypercholesterolemia, with an average increase of 7.5% in their rates, 12.55% had addition of ALT and 3.26% developed increased AST, so that showed a serum increase of 8.3% and 9.5%, respectively. Only 1.66% had a laboratory value that required cessation of therapy. CONCLUSION: Small number of patients developed blood levels of any variables consistent with the discontinuation of treatment or dose reduction, confirming the safety of therapy with oral isotretinoin.