Correlation of Fischer’s Ratio with Liver Fibrosis in Naive Chronic Hepatitis B Patients without Comorbidities

Introduction: Hepatitis B virus infection is one of the most common health problems in the world. 20% Chronic hepatitis B can can change into liver fibrosis. The liver is the center of the body's Amino Acids metabolism. Amino acid changes can occur due to impaired liver function. Fisher's ratio (BCAA/AAA) has become one of the sign of liver fibrosis. This study wanted to find a relationship between Fischer Ratio values and liver fibrosis in naive chronic hepatitis B patients without comorbidities. Method: The research was conducted from October 2020-May 2021 at DR. Moewardi Hospital, Surakarta, Indonesia. Subjects were naive chronic hepatitis B patients without comorbidities with a minimum age of 30 years. The study used a cross-sectional method. Fischer Ratio values were assessed by spectrophotometry and liver fibrosis was assessed by transient elastography (fibroscan). A correlation test was conducted to determine the relationship between variables. Result: 20 patients were included in the study. The average age of the research subjects was 47 ± 10 years. The average Fisher's ratio value was 2.83 ± 1.16 and the average fibroscan value was 17.31 ± 18.50 kPa. Ratio Fischer had a correlation with liver fibrosis with r= - 0.571 (p=0.004). Conclusions: Ratio Fischer has a negative correlation with liver fibrosis in naive chronic hepatitis B patients without comorbidities.

Role of resveratrol and chrysin on inflammation and liver function in obese mice

The incidence of obesity has been spreading throughout the world. Many of the complications caused by obesity, such as inflammation and impaired liver function. This study aimed to determine the effect of supplementation resveratrol and chrysin on inflammation and liver function of obese mice fed a high-fat diet. 40 mice (C57BL/6) were randomly divided into four groups: 10 in the normal diet (NC), 10 control group on a high-fat diet (HC), 10 in the high-fat diet with resveratrol (HRE), and 10 in the high-fat diet group with chrysin (HCH). Resveratrol 25 mg and 50mg of chrysin supplement per kg body weight were orally given with 0.1ml solution of Dimethyl Sulfoxide (DMSO) dissolved in for 15 weeks (4 times/week). The calorie intake of the group supplemented by resveratrol and chrysin significantly decreased. Group with high-fat diet, resveratrol, and chrysin increased body weight significantly compared to the normal diet group. The liver weight decreased in the resveratrol but not in the chrysin group. TNFα did not decrease in the resveratrol and chrysin group while IL1β significantly decreased. TLR 4 significantly decreased only in the chrysin group, while IL10 only increased in the resveratrol group. The collagen was decreased by resveratrol and chrysin supplementation while fibronectin was not affected by resveratrol or chrysin. The inflammatory process in the liver of obese mice fed a high-fat diet can be reduced by supplementing resveratrol and chrysin.

Рembrolizumab as second line therapy for hepatocellular patient

The optimal hepatocellular cancer (HCC) therapy remains a challenge. Due to checkpoint inhibitors patients with intolerance to the targeted therapy and or those with the impaired liver function can get an appropriate drug therapy. This clinical observation illustrates the long-term effect of pembrolizumab as the 2-line therapy in a patient diagnosed with. Sorafenib in standard doses as first line therapy led to severe toxicity and necessitated the withdrawal of therapy. Although subsequently the doses were reduced and concomitant medications used, sorafenib therapy was discontinued due to pronounced side effects typical of kinase inhibitors. From August 2017 to September 2019, as a part of a clinical study, the patient received 35 courses of immunotherapy with pembrolizumab 200 mg i.v. every 3 weeks, with satisfactory tolerance. The best response - partial tumor regression – was achieved at 84 weeks of therapy and continues to this day. Favorable toxicity profile makes checkpoints inhibitors a good treatment option in patients with impaired liver function (Child-Pugh 7–8 points) or with intolerable toxicity of kinase inhibitors.

THE ROLE OF RESISTIN IN THE PROGRESSION OF NON-ALCOHOLIC FATTY LIVER DISEASE

The aim of the research was to study the relationship between plasma concentrations of resistin and indicators of enzyme and pigment metabolism in patients with non-alcoholic fatty liver disease (NAFLD) and its combination with type 2 diabetes mellitus (DM-2). Materials and methods. On the base of Kharkiv Regional Hospital a total of 90 patients were examined, including patients with NAFLD (n = 20) and its combination with DM-2 with normal body weight (n = 20) and obesity (n = 50), as well as 20 healthy volunteers. A complex of clinical, laboratory and instrumental (including liver biopsy in 9 patients) examinations of patients was performed. Results. A direct relationship was established between the level of resistin and indicators of enzyme and pigment exchange in groups of patients with combined pathology. A significant increase of resistin plasma level, as well as disorders of the liver function were determined in all groups of patients in comparison with the controls. The most marked changes were revealed in patients with combination of NAFLD, DM-2 and obesity. Conclusions. The established relationship between the level of resistin and the indicators of the liver functional state suggests that an increase of resistin level may reflect the presence of impaired liver function in patients with NAFLD in combination with DM-2, predicting the progression of NAFLD. In order to detect the disorders of liver function in patients with DM-2, it is recommended to determine the level of resistin in patients with NAFLD, especially when concomitant obesity is present. Patients with resistin level (> 8.06 ± 0.23 ng/ml) should be considered at risk of NAFLD progression.

Decreased mortality and increased side effects in COVID-19 patients treated with IL-6 receptor antagonists: systematic review and meta-analysis

There is controversy whether IL-6 (receptor) antagonists are beneficial in treating COVID-19 patients. We therefore update our systematic review to answer the following research questions: (1) Do patients hospitalized for COVID-19 treated with IL-6 (receptor) antagonists have lower mortality compared to standard of care? (2) Do patients hospitalized for COVID-19 treated with IL-6 (receptor) antagonists have more side effects compared to standard of care? The following databases were search up to December 1st 2020: PubMed, PMC PubMed Central, MEDLINE, WHO COVID-19 Database, Embase, Web-of-Science, COCHRANE LIBRARY, Emcare and Academic Search Premier. In order to pool the risk ratio (RR) and risk difference of individual studies we used random effects meta-analysis. The search strategy retrieved 2975 unique titles of which 71 studies (9 RCTs and 62 observational) studies comprising 29,495 patients were included. Mortality (RR 0.75) and mechanical ventilation (RR 0.78) were lower and the risk of neutropenia (RR 7.3), impaired liver function (RR 1.67) and secondary infections (RR 1.26) were higher for patients treated with IL-6 (receptor) antagonists compared to patients not treated with treated with IL-6 (receptor) antagonists. Our results showed that IL-6 (receptor) antagonists are effective in reducing mortality in COVID-19 patients, while the risk of side effects was higher. The baseline risk of mortality was an important effect modifier: IL-6 (receptor) antagonists were effective when the baseline mortality risk was high (e.g. ICU setting), while they could be harmful when the baseline mortality risk was low.

Efficacy of hepatoprotector jamu formula (combination of Curcuma longa, Curcuma xanthorrhiza, and Taraxacum officinale) compared to Fructus schizandrae extract in mild liver injury: a randomized controlled trial

The prevalence of impaired liver function in developing countries is increasing. Indonesia has several traditional medicines that can be used as alternative treatments for liver dysfunction. The aim of this study was to determine the efficacy of hepatoprotector jamu formula (combination of Curcuma longa, Curcuma xanthorrhiza, and Taraxacum officinale) compared to Fructus schizandrae fruit extract for treating mild liver injury. This study was a RCT using parallel open label design which involved 60 subjects for 42 days of intervention. The parameters used to evaluate efficacy were Serum Glutamic Pyruvic Transaminase (SGPT) and Serum Glutamic Oxaloacetic Transaminase (SGOT). There was a significant difference of average SGPT levels on day 21 and day 42 compared to day 0 in both hepatoprotector jamu group and Fructus Schizandrae extract group (p < 0.001). Compared to the baseline, there were a significant difference of average SGOT levels on the follow up days in hepatoprotector jamu group (p=0.023 on day 21; p=0.003 on day 42) as well as Fructus Schizandrae extract group (p=0.028 on day 21; p=0.042 on day 42. The efficacy of hepatoprotector jamu formula was comparable to Fructus schizandrae extract in improving mild liver injury.

COVID-19 Patients Symptoms: Gastrointestinal Presentations, Comorbidities and Outcome in a Canadian Hospital setting

Background: The Coronavirus disease 2019 (COVID-19) pandemic has had a significant global impact and Canada has seen significant morbidity and mortality nationwide. While public health interventions and provincially regulated health insurance coverage have been credited with minimizing transmission rates in Canada relative to neighboring countries, disease presentation has been presumed to be the same. Aim: We sought to determine factors associated with differences in gastrointestinal outcomes in COVID-19 patients at a Canadian hospital. Methods: We collected data from 192 hospital records of COVID-19 patients across seven Hamilton Health Sciences hospitals, a network of academic health centers located in Hamilton, Ontario serving one of the largest metropolitan areas in Canada. Statistical and correlative analysis of symptoms, comorbidities, and mortality were performed. Results: There were 192 patients. The mean age was 57.6 years (SD=21.0). For patients who died (n=27, 14%), mean age was 79.2 years old (SD=10.6) versus 54 years for survivors (SD=20.1). There was a higher mortality among patients with older age (p=0.000), long hospital stay (p=0.004), male patients (p=0.032), and patients in nursing homes (p=0.000). Patients with dyspnea (p=0.028) and hypertension (p=0.004) were more likely to have a poor outcome. Laboratory test values that were significant in determining outcomes were an elevated INR (p=0.007) and elevated creatinine (p=0.000). Cough and hypertension were the most common symptom and comorbidity, respectively. Diarrhea was the most prevalent (14.5%) gastrointestinal symptom. Impaired liver function was related to negative outcome (LR 5.6; p=0.018). Conclusion: In a Canadian cohort, elevated liver enzymes, prolonged INR and elevated creatinine were associated with poor prognosis. Hypertension was also linked to a higher likelihood of negative outcome.

COVID-19 Severity among Cancer-COVID Patients with Different Types of Cancer: A Case Series of Five Patients

Background: People with malignancy are under increased threat in the current COVID-19 pandemic. It is crucial to study the severity of COVID-19 in different cancer type as the microenvironments are different. Besides, the effect on specific organs should be studied to understand the long-term consequences of both the diseases and its treatment. Methods: In our retrospective case series, we are presenting degree of severity in 5 cancer-COVID patients based on their clinical characteristics. All the patients were RT-PCR confirmed COVID-19 patients with malignancy. The demographic and clinical data of the patients were retrieved from the hospital database.Results: The cancers include; stomach (1), bladder (2), glioma (3), lungs (4) and hard palate cancer (5). Patient-4 and 5 were receiving chemotherapy when they got infected and had highly dysregulated liver function and higher CT severity score (19/25) compared to the nonrecipients. In patient-2 inflammatory and other haematological parameters we highly dysregulated suggesting a possible bottle neck of older age. Interestingly in the patient-3 the COVID-19 markers like lymphocyte, neutrophil and platelet levels were close to or within the normal limits unlike other patients. Conclusions: All the patents included in our report died during hospitalization. The patients receiving chemotherapy had possible impaired liver function and died early compared to the nonrecipients. The characteristic COVID-19 markers like lymphopenia, neutrophilia and thrombocytopenia did not occur in the glioma patient. The effect of cancer-COVID and its treatment on specific organs like the liver and kidney need to be studied during treatment and follow-up.

The Correlation of Transaminase Enzymes on the Prognosis of Covid-19 Patients in the ICU Infection Center Dr. Wahidin Sudirohusodo General Hospital Makassar

Corona Virus Disease 2019 (COVID-19) is an infectious disease that has been designated as a worldwide pandemic. Symptoms of Covid-19 are not only respiratory symptoms but also extrapulmonary symptoms, including the discovery of impaired liver function in the form of increased transaminase enzymes. Therefore, this study was conducted to see the correlation of transaminase enzymes with the prognosis of COVID-19 patients treated in the Intensive Care Unit (ICU) Dr. Wahidin Sudirohusodo Hospital. The study was conducted on June to August 2021. The cross-sectional analytical research method used retrospective medical record data for the period from July to December 2020 with a sample of 137 patients with COVID-19 confirmed. From the results of the Pearson test, patients with increased SGOT were associated with a mortality prognosis (p=0.000, p<0.05) with a correlation coefficient (r) of -0.383 and an increase in SGPT were associated with a mortality prognosis (p=0.013, p<0.05) with a correlation coefficient (r) of -0.211. From the results of the Kruskal Wallis test, there were differences in prognosis in patients with increased SGOT and SGPT grades 1,2,3, and 4 (p = 0.000 and p = 0.028). There is a correlation between the increased transaminase enzymes with the prognosis of the patient's mortality. Patients with severe elevated SGOT and SGPT enzymes had a greater prognosis of mortality than those with mild enzyme elevations. Extrapulmonary symptoms of stroke were associated with increased SGOT and myocardial infarction symptoms, and nephropathy was associated with increased SGOT and SGPT. Comorbid coronary artery disease and hepatitis were associated with increased SGOT and SGPT.

Albendazole in malignant ascites: a case report and literature review on the successes and adverse effects of therapy

Malignant ascites places a significant burden on the healthcare system and has a profound effect on patient quality of life. Albendazole (ABZ) is an anti-helminthic agent that has shown to rapidly reduce malignant ascites with minimal side effects in pre-clinical trials. The following case study explores the effect of ABZ on ascitic volume in a patient with malignant ascites secondary to metastatic colorectal adenocarcinoma. The patient is a 54-year-old man who underwent an ultrasound guided ascitic drainage for worsening ascites secondary to hepatic metastases from sigmoid adenocarcinoma. He was commenced on ABZ based on literature demonstrating that ABZ decreases the volume of malignant ascites via the inhibition of vascular endothelial growth factor. Over the next week, the volume of ascitic fluid decreased significantly, however the patient developed neutropenia unresponsive to granulocyte colony stimulating factor likely in the context of impaired liver function. The efficacy of ABZ in this case study as well as in the literature demonstrates the promising potential for use in reducing malignant ascites. However, this case demonstrates the need for caution for use in patients with liver impairment due to changes to first pass metabolism leading to increased circulating drug toxicity and thus, adverse outcomes.