RESUMO
Background: Oxidant stress is defined as either an overproduction of free radicals or diminution in antioxidant defenses. Determination of lipid peroxide products is used as a measure of oxygen radical activation. Vitamin E [alpha- tocopherol], a nutritional antioxidant, blocks the chain reaction of lipid peroxidation
Aim: To determine lipid peroxidation as measured by malondialdhyde [MDA] and the level of an enzymatic antioxidant glutathione reductase [GSH-reductase], as well as, ci-tocopherol in children suffering from chronic liver disease [CLD] and try to find out if they are affected by the etiology or the severity of liver disease
Methodology: Thirty seven children suffering from CLD aged [1-15] years were selected from the specialized hepatology outpatient clinic, Children's Hospital, Ain Shams University. They were divided according to Child-Pugh classification to [A=18, B=11 and C=8]. Thirty healthy children of similar age and sex, were selected as controls. All children were subjected to history taking, clinical examination, laboratory investigation: complete blood picture, liver function tests, hepatitis markers, urine and stool analysis; and abdominal ultrasonography. Plasma alpha-tocopherol, GSH-reductase and MDA were also measured
Results: Malondialdhyde showed significantly higher mean plasma level in CLD patients [0.71 +/- 0.20 nmol/ml] than healthy children [0.38 +/- 0.09 nmol/ml] p<0.001, while GSH-reductase showed significantly lower mean plasma level in CLD patients [45.7 +/- 17.4 U/L] than healthy children [125.8 +/- 30.4 U/L] p<0.001. Also, alpha-tocopherol, was significantly lower in diseased children [0.78 +/- 0.44 umol/L] than healthy controls [0.98 +/- 0.28 umol/L] p0.029. There were no significant differences between mean plasma levels of MDA, alpha-tocopherol, and GSH-reductase among CLD patients with different etiologies. alpha-tocopherol showed significantly higher mean plasma level in CLD patients with Child's grade A [1 +/- 0.52 umol/L] than patients with more severe CLD, grades B+C [ 0.57 +/- 0.2 umol/L] p = 0.003, while there were no significant differences in MDA nor in GSH-reductase between Child's grade A and grades B + C. There were no significant correlations between MDA, GSH-reductase, nor alpha-tocopherol and liver function tests in CLD except for alpha-tocopherol which significantly negatively correlated with the bilirubin level [r = -0.33, p 0.49]
Conclusion: Children with CLD, irrespective of the underlying etiology, were having a clear evidence of oxidant stress in the form of significant increase in lipid peroxidation and significant decrease of some antioxidants as alpha-tocopherol and GSH-reductase enzyme. Lipid peroxidation did not reflect the severity of CLD while alpha-tocopherol was lower in grades [B+C]. Thus, it is recommended that efforts to improve the hepatic antioxidant system should be taken eg. optimizing the patient's diet, by supplementation with precursors for antioxidants, or by supplementation with essential metals and/or antioxidants
RESUMO
Acute acalculous cholecystitis is most often associated with a systemic illness, whether acute or chronic. Although some gallbladder abnormalities in the form of gallbladder wall thickening, luminal abnormalities or alteration in volume are defined during the course of hepatitis A. acute cholecystitis is extremely rare. This is a report of a case that presented with acute acalculous cholecystitis due to hepatitis. A virus infection. The aim of this report is to increase the awareness of this rare complication of hepatitis A infection
RESUMO
Objectives: Non-invasive diagnosis of hepatic fibrosis has become the focus, especially in the surveillance of treatment and in screening hepatic fibrosis. To investigate the clinical usefulness of fibrogenesis markers in evaluating liver fibrosis, we determined serum levels of TGF-beta1, collagen IV, and laminin., and their relationships with frequently used liver function tests, and findings of liver ultrasonography and liver biopsy were investigated
Methods: 50 patients with chronic liver diseases were enrolled from the National Liver Institute, Menoufiya University. Serum markers of fibrosis, liver function indices [for the patients and 30 controls], and ultrasonography for all patients were performed and compared with histologic fibrotic changes
Results: Serum levels of TGF-beta1, collagen IV. and laminin were significantly higher in patients than those in control [P<0.000]. The levels of serum fibrosis markers were not correlated with fibrotic scores [P>0.05], but laminin was positively correlated to histologic activity index. There were no significant changes in the level of serum fibrosis markers related to ultrasonographic findings. Their levels were also not correlated to ALT or AST. The cut-off values, specificity and sensitivity were determined for all markers, among which collagen IV was the marker with the highest sensitivity and specificity
Conclusion: Serum level of TGF-beta1, collagen IV, and laminin can be used as indices for the diagnosis of hepatic fibrosis. Among them, collagen IV is more sensitive. Biochemical markers of fibrogenesis might be useful in regular monitoring of disease development and treatment effectiveness and should be inseparable part of progression assessment in all chronic hepatopathies