scholarly journals (P2-63) An Evaluation of 57 Tick Bite Cases

2011 ◽  
Vol 26 (S1) ◽  
pp. s156-s156
Author(s):  
M. Ortatatli ◽  
R. Gumral ◽  
H. Uckardes ◽  
M. Eroglu ◽  
L. Kenar ◽  
...  
Keyword(s):  
Rural Areas ◽  
Emergency Departments ◽  
White Blood Cells ◽  
Hemorrhagic Fever ◽  
Health Staff ◽  
Gamma Glutamyl Transferase ◽  
Tick Bites ◽  
Number Of Patients ◽  
Glutamyl Transferase

Crimean-Congo Hemorrhagic Fever (CCHF) is a fatal zoonotic viral infection. The agent belongs to the Nairovirus of the Bunyaviridae species. The virus naturally recycles in vector-vertebrate-vector. This study aimed to evaluate cases of tick bites admitted to Infectious Diseases and Emergency Departments in 2008, and to develop management recommendations of such cases. Fifty-seven patients who admitted to a hospital due to tick bites in 2008 were included in the study. A 10-day clinical follow-up was performed to assess for symptoms including fever, fatigue, abdominal pain, headache, nausea/vomiting, diarrhea, disseminated somatic pain, and other hemorrhagic signs. During this period, laboratory analyzes, including white blood cells, thrombocytes, aspartate aminotransferase, alanine aminotransferase, gamma-glutamyl transferase, lactate dehydrogenase, creatinine phosphokinase (CK), and pentylenetetrazol were performed. Personal data of the patients, location of the bite, and the removal of the tick were recorded.ResultsOf the 57 patients, 37% were from the city, and 63% were from rural areas. The tick was removed by health staff in 25 (44%) of the cases. The bites occurred on body areas including the head/neck, trunk, upper extremities, and lower extremities in 14%, 24%, 27%, and 13% of the cases, respectively. During the follow-up period, none of the patients exhibited any of the signs or symptoms listed above. Laboratory tests did not reveal any abnormalities, except for high levels of CK in 15 patients. Thus, 57 cases did not develop CCHF.Discussion and ConclusionSince 2002, CCHF has caused an increased mortality in Turkey, and has resulted in high anxiety and concern among the Turkish public regarding tick bites. This has resulted in a rise in the number of patients admitting to emergency departments with tick bites. Due to CCHF's incubation period, patients with tick bites should be evaluated for 10 days using a multidisciplinary approach involving both clinical and laboratory evaluations in order to prevent the unnecessary administration of ribavirine.

scholarly journals Determinants of Change in Glycemic Status in Individuals with Prediabetes: Results from a Nationwide Cohort Study in Germany

2018 ◽  
Vol 2018 ◽  
pp. 1-12 ◽  
Author(s):  
Rebecca Paprott ◽  
Christa Scheidt-Nave ◽  
Christin Heidemann
Keyword(s):  
Multinomial Logistic Regression ◽  
Undiagnosed Diabetes ◽  
Gamma Glutamyl Transferase ◽  
Glycemic Status ◽  
Prediabetic State ◽  
Parental History ◽  
Female Sex ◽  
Glutamyl Transferase ◽  
Diagnosed Diabetes

Previous studies investigating determinants of changes in glycemic status among individuals with prediabetes mainly focused on glucose-defined prediabetes. In this study, we examined determinants of a regression to normoglycemia or a progression to diabetes among individuals with HbA1c-defined prediabetes. The study included 817 participants (18–79 years) with prediabetes (HbA1c 5.7–6.4% (39–47 mmol/mol)) at baseline. Glycemic status at follow-up was categorized as diagnosed diabetes (self-reported physician diagnosis or antidiabetic medication), undiagnosed diabetes (HbA1c ≥ 6.5% (≥48 mmol/mol)), prediabetes (as defined at baseline), and normoglycemia (HbA1c < 5.7% (<39 mmol/mol)). Determinants of glycemic changes were identified by multinomial logistic regression (OR (95% CI)), with those remaining in the prediabetic state as reference. During a mean follow-up time of 12.0 years, 33.8% of the participants reverted to normoglycemia, 7.2% progressed to undiagnosed diabetes, 12.8% progressed to diagnosed diabetes, and 46.2% remained prediabetic. Determinants of a regression to normoglycemia were female sex (male vs. female: 0.67 (0.46; 0.98)) and higher HDL cholesterol levels (1.17 (1.02; 1.35) per 10 mg/dl). Determinants of a progression to undiagnosed or diagnosed diabetes were higher values of BMI (1.10 (1.02; 1.18); 1.13 (1.06; 1.21) per kg/m2), waist circumference (1.04 (1.01; 1.07); 1.06 (1.03; 1.09) per cm), alanine aminotransferase (1.06 (1.03; 1.09); 1.07 (1.03; 1.10) per U/l), and gamma-glutamyl transferase (1.02 (1.00; 1.03); 1.03 (1.01; 1.04) per U/l). Higher age (1.04 (1.02; 1.06) per year), female sex (male vs. female: 0.56 (0.33; 0.97)), and parental history of diabetes (yes vs. no: 1.82 (1.05; 3.15)) were further associated with a progression to diagnosed diabetes, whereas higher triglyceride levels (1.03 (1.01; 1.06) per 10 mg/dl) were associated with a progression to undiagnosed diabetes. In conclusion, among the investigated determinants, potentially modifiable anthropometric and metabolic markers were associated with glycemic changes in individuals with HbA1c-defined prediabetes. The findings of this study demonstrate the need for more refined case finding strategies for diabetes prevention.

scholarly journals Lifetime duration of lactation and chronic inflammation among middle-aged women with a history of gestational diabetes

2020 ◽  
Vol 8 (2) ◽  
pp. e001229
Author(s):  
Sylvia H Ley ◽  
Jorge E Chavarro ◽  
Stefanie N Hinkle ◽  
Mengying Li ◽  
Michael Y Tsai ◽  
...  
Keyword(s):  
Gestational Diabetes ◽  
Chronic Inflammation ◽  
Density Lipoprotein ◽  
Lipoprotein Cholesterol ◽  
Health Study ◽  
Gamma Glutamyl Transferase ◽  
Middle Aged ◽  
History Of ◽  
Glutamyl Transferase

IntroductionLonger duration of lactation is associated with lower cardiometabolic disease risk, but pathogenic pathways involved in the disease progression are unclear, especially among high-risk women. We aimed to examine the associations of lifetime lactation duration with cardiometabolic biomarkers among middle-aged women with a history of gestational diabetes (GDM).Research design and methodsWomen with a history of GDM participating in the Nurses’ Health Study II, a prospective cohort study, were identified and followed through biennial questionnaires beginning in 1991. Lactation history was asked in three follow-up questionnaires to calculate lifetime duration. In 2012–2014, fasting blood samples were collected through the Diabetes & Women’s Health Study to measure inflammatory (C-reactive protein (CRP), interleukin (IL) 6), liver enzyme (alanine aminotransferase, aspartate aminotransferase, and gamma-glutamyl transferase), and lipid biomarkers (total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol).ResultsAt follow-up blood collection, women were at median age 58.2 (95% CI 51 to 65) years and 26.3 (95% CI 15.7 to 34.1) years since GDM index pregnancy. After multiple adjustment including prepregnancy body mass index (BMI), longer duration of lactation was significantly associated with lower CRP (least squares (LS) mean 1.90 mg/L (95% CI 1.47 to 2.45) for 0-month lactation, 1.98 mg/L (95% CI 1.68 to 2.32) for up to 12-month lactation, 1.67 mg/L (95% CI 1.42 to 1.97) for 12–24 month lactation, and 1.39 mg/L (95% CI 1.19 to 1.62) for >24-month lactation; p trend=0.003) and IL-6 (1.25 pg/L (95% CI 0.94 to 1.68), 1.19 pg/L (95% CI 0.99 to 1.42), 1.04 pg/L (95% CI 0.87 to 1.25), and 0.93 pg/L (95% CI 0.78 to 1.11); p trend=0.04). Longer duration of lactation was associated with lower risk for chronic inflammation using CRP 3 mg/L cut-off in middle-aged women (OR 0.81 (95% CI 0.69 to 0.940 per 1-year increase) with multiple adjustment.ConclusionsLonger lifetime duration of lactation was associated with favorable inflammatory biomarker concentrations in middle-aged women with a history of GDM. Chronic inflammatory pathways may be responsible for previously reported associations between lactation and long-term risk for cardiometabolic diseases.

scholarly journals Evolving liver inflammation in biochemically normal individuals with anti-mitochondria antibodies

2019 ◽  
Vol 10 (1) ◽  
Author(s):  
Danielle Cristiane Baldo ◽  
Alessandra Dellavance ◽  
Maria Lucia Gomes Ferraz ◽  
Luis Eduardo C. Andrade
Keyword(s):  
Liver Fibrosis ◽  
Rat Kidney ◽  
Surrogate Marker ◽  
Serum Levels ◽  
Autoimmune Response ◽  
Primary Biliary Cholangitis ◽  
Gamma Glutamyl Transferase ◽  
Normal Individuals ◽  
Glutamyl Transferase

Abstract Background Anti-mitochondria autoantibodies (AMA) occur in > 95% primary biliary cholangitis (PBC) patients. Biochemically normal AMA-positive (BN/AMA+) individuals, occasionally noticed by indirect immunofluorescence (IIF) on HEp-2 cells and confirmed in AMA-specific assays, may represent early stages of PBC. The Enhanced Liver Fibrosis (ELF) score is a surrogate marker for liver fibrosis. This prospective study investigated the ELF score in BN/AMA+ individuals and PBC patients, considering autoantibody avidity and serum levels along the years. Methods 327 samples from 35 PBC and 59 BN/AMA+ were prospectively obtained in average 3.83 (range 0.50–7.40) years apart. Samples were tested by IIF on rat-kidney (IIF-AMA), western-blot for AMA (WB-AMA), and ELISA for antibodies against pyruvate-dehydrogenase (PDC-E2), gp210, sp100 and CENP-A/B. Anti-PDC-E2 avidity was determined by 6 M urea-elution ELISA. Alkaline phosphatase (ALP), gamma glutamyl transferase (ɣGT) and ELF score were measured by automated methods. Results Along the follow-up period BN/AMA+ subjects and PBC patients presented significant increase in serum anti-PDC-E2 (mean 10.45% and 8.86% per year; respectively), anti-PDC-E2 avidity (3.02% and 4.94%/year) and ELF score (3.24% and 2.71%/year). IIF-AMA and ɣGT increased in BN/AMA+ (6.59% and 2.36%) and decreased in PBC (− 4.89%/year and − 3.88%/year). In BN/AMA+ individuals there was positive correlation of ELF with IIF-AMA titer (r = 0.465; p < 0.001) and with anti-PDC-E2 levels (r = 0.239; p < 0.001). Expansion of autoantibody targets along time occurred in 39% BN/AMA+ and 49% PBC patients. The frequency of BN/AMA+ with high probability of having established PBC increased from 7 to 14%. Conclusions BN/AMA+ individuals present an orchestrated increase in ELF score and humoral autoimmune response over time, indicating an opportunity for early therapeutic intervention and prevention in autoimmunity.

scholarly journals COVID-19 associated variations in liver function parameters: a retrospective study

2020 ◽  
pp. postgradmedj-2020-138930
Author(s):  
Ram Krishan Saini ◽  
Neha Saini ◽  
Sant Ram ◽  
Shiv Lal Soni ◽  
Vikas Suri ◽  
...  
Keyword(s):  
Liver Injury ◽  
Liver Function ◽  
Liver Enzyme ◽  
Inflammatory Markers ◽  
Liver Enzymes ◽  
Tertiary Care ◽  
Abnormal Liver Function ◽  
Gamma Glutamyl Transferase ◽  
Number Of Patients ◽  
Glutamyl Transferase

BackgroundCharacteristics of laboratory findings of COVID-19 patients are of great significance for diagnosis and treatment. Studies that have analysed the variations in hepatic profile in correlation with the inflammatory markers in SARS-CoV-2 are limited.MethodsWe retrospectively analysed liver function tests and inflammatory markers of 170 admitted patients with confirmed COVID-19 in the tertiary care centre, Post Graduate Institute of Medical Education and Research (PGIMER), India, using Roche Cobas Autoanalyzer.ResultsNumber of patients with normal liver enzyme levels were 63 (41.5%), while with raised levels of any of the liver enzymes were 89 (58.5%), out of which 43 (48.31%) had liver injury which manifested as increased severity in terms of intensive care unit (ICU) requirement (p=0.0005). Significantly raised levels of liver enzymes and liver injury were observed with age (p<0.0001) and in males (p=0.004). Significantly decreased levels of albumin and total proteins and increased levels of total bilirubin (p<0.0001) were seen in patients with abnormal liver enzyme levels and liver injury as compared to patients with normal levels. Significant increase in the levels of alanine transaminase and gamma-glutamyl transferase was seen on the 7th day, CRP and ferritin (p<0.0001) peaks were observed on 2nd and 3rd day respectively. A significant positive correlation was found between the levels of these inflammatory markers and liver function parameters.ConclusionsMore than half of patients admitted to the hospital with SARS-CoV-2 infection had an abnormal liver function which was found to be associated with raised levels of inflammatory markers. Significantly higher proportions of patients with abnormal liver function were elderly and males and were at higher risk of progressing to severe disease.

scholarly journals Commonly used clinical chemistry tests as mortality predictors: Results from two large cohort studies

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0241558
Author(s):  
Lars Lind ◽  
Daniela Zanetti ◽  
Marieann Högman ◽  
Lars Sundman ◽  
Erik Ingelsson
Keyword(s):  
Risk Factors ◽  
Clinical Chemistry ◽  
Mortality Prediction ◽  
Gamma Glutamyl Transferase ◽  
Normal Range ◽  
Normal Ranges ◽  
All Cause Mortality ◽  
Glutamyl Transferase ◽  
Clinical Chemistry Tests

Background The normal ranges for clinical chemistry tests are usually defined by cut-offs given by the distribution in healthy individuals. This approach does however not indicate if individuals outside the normal range are more prone to disease. Methods We studied the associations and risk prediction of 11 plasma and serum biomarkers with all-cause mortality in two population-based cohorts: a Swedish cohort (X69) initiated in 1969, and the UK Biobank (UKB) initiated in 2006–2010, with up to 48- and 9-years follow-up, respectively. Results In X69 and in UKB, 18,529 and 425,264 individuals were investigated, respectively. During the follow-up time, 14,475 deaths occurred in X69 and 17,116 in UKB. All evaluated tests were associated with mortality in X69 (P<0.0001, except bilirubin P<0.005). For calcium, blood urea nitrogen, bilirubin, hematocrit, uric acid, and iron, U-shaped associations were seen (P<0.0001). For leukocyte count, gamma-glutamyl transferase, alkaline phosphatases and lactate dehydrogenase, linear positive associations were seen, while for albumin the association was negative. Similar associations were seen in UKB. Addition of all biomarkers to a model with classical risk factors improved mortality prediction (delta C-statistics: +0.009 in X69 and +0.023 in UKB, P<0.00001 in both cohorts). Conclusions Commonly used clinical chemistry tests were associated with all-cause mortality both in the medium- and long-term perspective, and improved mortality prediction beyond classical risk factors. Since both linear and U-shaped relationships were found, we propose to define the normal range of a clinical chemistry test based on its association with mortality, rather than from the distribution.

scholarly journals Impact of the cardio-hepatic syndrome on outcomes after transcatheter mitral valve edge-to-edge repair

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
L Stolz ◽  
M Orban ◽  
N Karam ◽  
E Lubos ◽  
M Wild ◽  
...  
Keyword(s):  
Liver Function ◽  
Cox Regression ◽  
Cox Model ◽  
Hepatic Function ◽  
Gamma Glutamyl Transferase ◽  
Prognostic Impact ◽  
Laboratory Parameters ◽  
Glutamyl Transferase ◽  
The Impact

Abstract Background The prognostic value of impaired liver function in the presence of moderate-to-severe and severe mitral regurgitation (MR), also called cardio-hepatic syndrome (CHS), for outcomes in patients undergoing transcatheter edge-to-edge repair (TEER) has not been studied yet. Purpose In this work, we aimed at identifying the prognostic impact of the CHS on two-year all-cause mortality in patients undergoing TEER compared to established risk factors. Furthermore, we evaluated the change in hepatic function after TEER. Methods Hepatic function was assessed by laboratory parameters of liver function (bilirubin, gamma glutamyl transferase [GGT], alkaline phosphatase [AP], aspartate and alanine aminotransferase [AST and ALT]). We defined CHS as elevation of at least two out of three laboratory parameters of hepatic cholestasis (bilirubin, GGT, AP). The impact of CHS on two-year mortality was evaluated using a proportional hazards Cox model. The change in hepatic function after TEER was evaluated by repeat laboratory testing at follow-up. Results We included 1083 patients who underwent TEER for highly symptomatic primary or secondary MR at four high volume academic European centers between 2008 and 2019. In 66.4% of patients, we observed elevated levels of either bilirubin, GGT or AP. CHS was present in 23% of patients and showed strong association with a reduced two-year survival (52.9% vs. 87.0% in patients without CHS, p&lt;0.01). In a multivariate Cox regression model, CHS was identified as a strong and independent predictor of increased two-year mortality (hazard ratio 1.49, p=0.03). In patients with successful MR reduction ≤2+ (90.7% of patients), parameters of hepatic function significantly improved from baseline to follow-up (−0.2 mg/dl for bilirubin; −21 U/l for GGT, respectively, p&lt;0.01), while they did not in case of residual postprocedural MR &gt;2+. Conclusions CHS can be observed in up to 25% of patients undergoing TEER and is associated with impaired two-year survival rates. Successful TEER is associated with decreased levels of hepatic enzymes at follow-up evaluation. FUNDunding Acknowledgement Type of funding sources: None. Cardio-hepatic syndrome TEER

scholarly journals Gamma-glutamyl Transferase Levels are Associated with the Occurrence of Post-stroke Cognitive Impairment: A Multicenter Cohort Study

2021 ◽  
Author(s):  
Siqi Li ◽  
Xiaoling Liao ◽  
Yuesong Pan ◽  
Xianglong Xiang ◽  
Yumei Zhang
Keyword(s):  
Cohort Study ◽  
Cognitive Impairment ◽  
Gamma Glutamyl Transferase ◽  
Multicenter Cohort Study ◽  
Gamma Glutamyl ◽  
Post Stroke ◽  
Multicenter Cohort ◽  
Glutamyl Transferase ◽  
The Impact

Abstract Background: Gamma-glutamyl transferase (GGT) can maintain the physiological concentration of glutathione in cells, and protect them from oxidative stress-induced damage. However, its role in post-stroke cognitive impairment (PSCI) remains unknown. Here, we explored the impact of serum biomarker-GGT on PSCI. Methods: We conducted a prospective, multicenter cohort study. 1, 957 participants who suffered a stroke and measured baseline GGT were enrolled from the Impairment of Cognition and Sleep (ICONS) study of the China National Stroke Registry-3 (CNSR-3). They were categorized into four groups according to the quartiles of baseline GGT levels. Cognitive function was assessed by using the Montreal Cognitive Assessment (MoCA) approach. The multiple logistic regression models were performed to evaluate the relationship between GGT and PSCI at 3 months follow-up.Results: Among 1,957 participants, 671 (34.29%) patients suffered PSCI at 3 months follow-up. The highest GGT level quartile group exhibited a lower risk of PSCI in the fully adjusted model [OR (95% CI): 0.69 (0.50-0.96)], relative to the lowest group. Moreover, incorporation of GGT to the conventional model resulted in a slight improvement in PSCI outcomes after 3 months (NRI: 12.00%; IDI: 0.30%).Conclusions: Our findings demonstrated that serum GGT level was inversely associated with the risk of PSCI, with extremely low levels acting as a risk factor for PSCI.

scholarly journals EBV Infection Unmasking a Choledochal Cyst in an Infant

2019 ◽  
Vol 2019 ◽  
pp. 1-3
Author(s):  
Hassan El Khatib ◽  
Batoul Kawtharany ◽  
Diyaa Mohammad ◽  
Mohammad Siblini ◽  
Nahida El-Rifai
Keyword(s):  
Choledochal Cyst ◽  
Stone Formation ◽  
Liver Function Tests ◽  
Gamma Glutamyl Transferase ◽  
Barr Virus ◽  
Ebv Infection ◽  
Hepatic Involvement ◽  
Epstein Barr ◽  
Glutamyl Transferase

Hepatic involvement is common in acute Epstein–Barr virus (EBV) infection in children. It usually manifests as a transitory elevation of transaminases in up to 80% to 90% of patients, and they normalize by 2 to 6 weeks. A cholestatic pattern with elevated gamma-glutamyl transferase (γGT) and alkaline phosphatase (ALP) is common, in up to 60% in young adults. However, jaundice is very rare occurring in only 5% of pediatric patients. We report here an 8-month-old female with EBV infection who developed obstructive jaundice 2 weeks after the initial infection. Radiologic investigations were compatible with choledochal cyst type IVa complicated by stone formation in the common bile duct. In case of clinical exacerbation or nonamelioration of liver function tests in EVB infection, another diagnosis should be addressed. This highlights the importance of close follow-up in these patients in order not to miss a serious underlying condition such as choledochal malformation.

scholarly journals Complex Immunometabolic Profiling Reveals the Activation of Cellular Immunity and Biliary Lesions in Patients with Severe COVID-19

2020 ◽  
Vol 9 (9) ◽  
pp. 3000
Author(s):  
Adam Klocperk ◽  
Marketa Bloomfield ◽  
Zuzana Parackova ◽  
Irena Zentsova ◽  
Petra Vrabcova ◽  
...  
Keyword(s):  
Cd8 T Cells ◽  
Severe Form ◽  
University Hospital ◽  
Gamma Glutamyl Transferase ◽  
Markers Of Inflammation ◽  
Laboratory Features ◽  
Fatal Course ◽  
Glutamyl Transferase ◽  
The University

This study aimed to assess the key laboratory features displayed by coronavirus disease 2019 (COVID-19) inpatients that are associated with mild, moderate, severe, and fatal courses of the disease, and through a longitudinal follow-up, to understand the dynamics of the COVID-19 pathophysiology. All severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive patients admitted to the University Hospital in Motol between March and June 2020 were included in this study. A severe course of COVID-19 was associated with an elevation of proinflammatory markers; an efflux of immature granulocytes into peripheral blood; the activation of CD8 T cells, which infiltrated the lungs; transient liver disease. In particular, the elevation of serum gamma-glutamyl transferase (GGT) and histological signs of cholestasis were highly specific for patients with a severe form of the disease. In contrast, patients with a fatal course of COVID-19 failed to upregulate markers of inflammation, showed discoordination of the immune response, and progressed toward acute kidney failure. COVID-19 is a disease with a multi-organ affinity that is characterized by the activation of innate and cellular adaptive immunity. Biliary lesions with an elevation of GGT and the organ infiltration of interleukin 6 (IL-6)-producing cells are the defining characteristics for patients with the fulminant disease.

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