Elevated Serum Alanine Transaminase (ALT) in Patients of Type 2 Diabetes Mellitus

Objective: The objective of this study was to determine the prevalence of raised serum alanine transaminase level in patients of type 2 diabetes mellitus. Design: cross-sectional study Study Settings: This study was conducted at Department of Internal Medicine Abbas Institute of Medical Sciences Muzaffarabad from November 2020 to April 2021. Material and Methods: Total 144 patients were included in the study having age from 18 to 60 of both genders with Type 2 DM. It was labeled as elevated if it was ≥50 IU/L. A written informed consent was taken from each patient. Results: Patient’s age ranged from 36 to 70 years having mean value of 44.4±8.3 y. BMI ranged from 21.2 Kg/m2 to 34.7 Kg/m2 with a mean of 27.2±3.7 Kg/m2. Disease duration was from 2 to 14 years with a mean of 7.1±3.8 years. Elevated serum ALT was noted in 38 (26.4%) patients with type-II diabetes. Conclusion: Elevated serum ALT was noted in a substantial proportion of patients with type-II diabetes and was significantly more frequent in patients with poor glycemic control which warrants good glycemic control to prevent and routine screening of such patients in future practice to timely identify and manage this complication to improve the outcome. Keywords: Type 2 Diabetes Mellitus, Serum Alanine Transaminase, Prevalence

An Observational Study to Determine Severity and Complications Associated with Non-Alcoholic Fatty Liver Disease with Special Emphasis on Riskfactors

Introduction: The clinical spectrum of NAFLD is wide extending and ranges from NAFL to NASH, advanced fibrosis, cirrhosis, HCC. It has emerged as the most prevalent chronic liver disease worldwide in adults and children's. NAFLD is commonly linked with MS such as obesity, DM, H0TN, hypercholesterolemia. Methods: This is an observational study conducted to determine risk factor, severity and complication associated with NAFLD. Data was collected from outpatient and inpatients of gastroenterology department and also through patient or care taker interview. Result: A total of 112 cases of liver disease were observed among them 61 cases were found with NAFLD. Majority of cases were examined with Grade I fatty liver. Males were more prone to develop NAFLD and the most highest prevalence was found in the age group 51-70yrs. DM is the main RF and PHTN is the common complication observed. Beta blocker, ARB, statins, are frequently observed prescribed drugs to manage risk factors and complication. Hepatoprotective drugs like ursodeoxycholic acid, SAMe are given. Conclusion: The study concluded that the prevalence of Grade I fatty liver was high followed by CLD. Further, patients with NAFLD were predominantly middle aged men, most of whom were overweight and obese. Prevalence of NAFLD appears to be substantially higher than that predicted on basis of elevated ALT levels. Male sex, BMI, abnormal transaminase level, and MS were independently associated with ultrasonographic severe fatty change. Early detection, as well as steps to prevent the condition through lifestyle modification may halt the progression of a benign disease to advanced illness. Sedentary behavior or physical inactivity is a developing issue quietly putting individuals at elevated risk.

A RETROSPECTIVE OBSERVATINAL STUDY OF SERUM AMINOTRANSFERSASE LEVELS IN THE ASSESSMENT OF SEVERITY OF DENGUE FEVER

Liver involvement in dengue fever is manifested by the elevation of transaminases due to direct attack of virus itself or the use of hepatotoxic drugs.Objective of our study was to assess the serum aminotransferase level in patient with dengue fever and to correlate serum aminotransferase level and severity of dengue fever. This is a prospective observational study. Atotal of 50 fever patients admitted with positive dengue serology in Medicial ward, ZMCH ,Dahod,were included after satisfying the inclusion and exclusion criteria. All the patients were subjected to complete history taking and clinical examination. Investigations like complete blood count, liver function test, dengue serology and abdominal ultrasound were done in all patients.A total of 50 dengue serology positive patient were included in the study. Among them there were 27 (54%) males and 24(46%) females. In our study 41 patients (82%) had elevated serum transaminase level, Mean ASTlevel was 134.84 IU/Land the mean ALTlevel was 107.88 IU/L. The level of AST is higher when compared to ALT in most of the patients. Among those who had elevated aminotransferase level 12 patients (24%) had both elevated aminotransferase level and free uid in the abdomen. Out of 50 patients 32 (64%) had reduced platelet count (less than one lakh) and all the 32 patients had elevated serum aminotransferase level. There was signicant negative correlation between serum aminotransferase level and platelet count (P value < 0.001).Hepatic dysfunction is very common in all forms of Dengue infection. Serum Aminotransferase level correlate with severity of Dengue fever. Aspartate Aminotransferase was signicantly raised when compared to Alanine Aminotransferase in most of the patients

Kawasaki Disease with Dilatation of the Common Bile Duct: A Case Report and Review of Literature

Background Kawasaki disease (KD), which was first described by Tomisaku Kawasaki in 1967, is a syndrome that results in acute systemic vasculitis, affecting mainly infants and children, and is a major cause of acquired heart disease in developed countries. KD is diagnosed based on certain characteristic symptoms and echocardiogram results. It has been reported that neck and abdominal ultrasound is also reliable diagnostic method. Nevertheless, abdominal ultrasound is not a routine procedure in KD. Moreover, dilatation of the common bile duct (CBD) has been rarely reported in previous cases. Case presentation: A 4-year-old boy presented with fever and markedly high transaminase level (AST, 5,323 U/L, ALT, 1,554 U/L). The patient was diagnosed as having KD based on characteristic symptoms and echocardiogram findings. Neck and abdominal ultrasound revealed dilatation of the CBD as well as cervical lymphadenopathy resembling a cluster of grapes, thickening of the gallbladder wall, and increased periportal echogenicity throughout the liver parenchyma. The patient received initial treatment with intravenous immunoglobulin (IVIG) at day 4 of fever, following which, transaminase level decreased. The patient received second-line treatment with IVIG and prednisolone because of recurrent fever on day 6. Dilatation of the CBD was improved from 6.6 mm on day 4 to 3.1 mm on day 8. Although re-dilatation was observed, it gradually diminished and normalized (4.3 mm on day 28, 4.0 mm on day 63, 3.3 mm on day 105, and 2.8 mm on day 182). Conclusion This case highlights the usefulness of abdominal ultrasound and the importance of considering dilatation of the CBD as one of the complications of KD. Because abdominal ultrasound is not a routine procedure in KD, it is possible that dilatation of the CBD in KD is quite latent if not investigated thoroughly. Further prospective studies to support these findings are warranted.

Enoxaparin-induced hepatotoxicity: clinical cases and literature review

Low molecular weight heparins, in particular enoxaparin, have a wide range of applications, including prevention and treatment of deep vein thrombosis. The most common adverse effects of these drugs are bleeding and thrombocytopenia, but a clinician should be aware of another less common but not less important adverse effect such as an elevated transaminase level. In 2019, we observed two cases of enoxaparin-induced hepatotoxicity. In the first one, enoxaparin 0.4 ml subcutaneously twice a day was prescribed to a 40-year-old woman as a bridge therapy to discontinue warfarin before elective surgery. In the second case, a 27-year-old man received enoxaparin 0.4 ml subcutaneously twice a day for the prevention of deep vein thrombosis. The elevation of transaminase level for more than 3 times above the norm was noted in both patients which required discontinuation of the drug.

Hepatoprotective Activity of Nigella sativa and Piper nigrum against Concanavalin A-Induced Acute Liver Injury in Mouse Model

Nigella sativa and Piper nigrum are implicated in the treatment of various disorders, especially in the management of metabolic, infectious and hepatorenal ailments. However, data on the mechanism behind therapeutic potential of N. sativa and P. nigrum in liver diseases is scarce. The present study investigated the hepatoprotective potential of 70% methanolic extract of N. sativa (NSE) and P. nigrum (PNE) at varying dose levels (100 to 400 mg/kg body weight) against concanavalin A (conA)-induced liver injury. Qualitative phytochemical analysis of plant extracts was performed. Acute hepatic injury was induced by administering intraperitoneally 12mg/kg conA in Balb/c mice. The extent of hepatic injury was measured by analysing serum biochemical parameters, liver antioxidant stress assay and histopathology. Data were analysed statistically. NSE and PNE showed dosedependent hepatoprotective efficacy by lowering the conA-dependent rise in liver transaminase level. Treatment with NSE (400 mg/Kg) and PNE (400 mg/Kg) ameliorated conA-induced alterations in serum oxidative stress markers, biochemical parameters, liver function markers and histopathology. NSE indicated greater effectiveness to ameliorate the acute hepatic injury in comparison with PNE at the same dose. Collectively, pretreatment with NSE and PNE attenuated the liver injury induced by conA, might be through alleviating the antioxidant capacity of experimental mice

A Comparative Study of Hepatic Enzymes Between Preeclampsia and Normal Pregnant Women

Background: Preeclampsia is a multisystem disorder, unique to pregnancy that is usually associated with high blood pressure and proteinuria after 20 week of gestation. Abnormal liver function tests occur in 20% to 30% of pregnancies complicated by preeclampsia and are associated with a higher risk of adverse maternal and fetal outcome. Objective: To observe the alteration of hepatic enzymes in preeclampsia. Methods: The present cross-sectional study was carried out in the Department of Biochemistry, Dhaka Medical College, and Dhaka from July 2015 to June 2016. A total number of one hundred pregnant women in third trimester of pregnancy with or without preeclampsia, attending in the outpatient Department of Obstetrics and Gynecology in DMCH, were selected as study subjects. Of them fifty pregnant women in third trimester of pregnancy were with preeclampsia and fifty were normal healthy pregnant women. Estimation of hepatic enzymes like aspartate transaminase, alanine transaminase and gamma glutamyl transferase were done in both preeclampsia and normal pregnant patients and mean values of the variables were compared between them. Results: The mean serum aspartate transaminase level was significantly higher in preeclampsia compared to normal pregnant woman (32.4 ± 15.4 IU/L vs 24.8 ±11.8 IU/L respectively and p 0.007). Serum alanine transaminase level was also significantly higher in preeclampsia than normal pregnancy (38.1±19.9 IU/L vs 18.8±6.95 IU/L, respectively and p < 0.001). Serum gamma glutamyl transferase was also significantly higher in preeclampsia than normal pregnancy (44.7±19.1 IU/L vs 26.6± 6.0 IU/L p < .001). Conclusions: Hepatic enzymes (alanine transaminase, aspartate transaminase, gamma glutamyl transferase) were increased. So routine assessment of these parameters may helpful to prevent worse outcome of preeclampsia patients. J Dhaka Medical College, Vol. 29, No.1, April, 2020, Page 18-22

Biochemical response of two fish species of Gobiidae (Gobiiformes) to Cryptocotyle (Opisthorchiida, Heterophyidae) metacercariae infection from the mouth of the river Chernaya (Black Sea)

Metacercariae of Cryptocotyle are among the most numerously recorded trematode parasites in the estuarine biocenoses of the Azov-Black Sea basin. These parasites can massively affect body surface, gills and fins of host fishes including gobiids. However, information on the influence of Cryptocotyle metacercariae on the physiological and biochemical status of gobies is extremely limited. Biochemical response of two fish species of Gobiidae - grass goby Zosterisessor ophiocephalus (Pallas, 1814) and mushroom goby Ponticola eurycephalus (Kessler, 1874) to Cryptocotyle spp. metacercariae infection at the mouth of River Chernaya (Black Sea) was investigated. Activities of superoxide dismutase, catalase, peroxidase, glutathione reductase, glutathione-S-transferase, alanine transaminase, aspartate transaminase, level of thiobarbituric acid-reactive substances were measured as parameters of biochemical response. The findings of this study demonstrate interspecific differences in fish response to parasite infections. High infection leads to an intensification of lipid peroxidation and a weakening of antioxidant protection in the muscles of mushroom goby but activation of the antioxidant enzyme system in the muscles of grass goby. The results show a greater resistance of grass goby to the infection when compared with mushroom goby.

Response to Trans-arterial Radioembolization Therapy for Liver Cancer According to Voxel-Based Dosimetry: A Retrospective Study

BackgroundUsual clinical dosimetry models for trans-arterial radioembolization (TARE) is based on assumption of uniform dose distribution in each tissue compartment. We performed a simple voxel-based dosimetry using post-treatment yttrium-90 (90Y) microsphere PET in TARE and investigated the prognostic value of dosimetry parameters from the voxel-based dosimetry.MethodTwenty-eight patients with hepatocellular carcinoma who underwent TARE using 90Y-microsphere were retrospectively included. Mean absorbed dose of each lesion (TDv) was analyzed using voxel-based dose maps derived from posttreatment 90Y-microsphere PET and voxel-wise S-value kernels. Heterogeneity of intra-tumoral absorbed dose was investigated using standard deviation and coefficient of variation of voxel doses in a tumor. The response of each lesion was classified as local control success (LCS) and local control failure (LCF) based on follow-up MRI or CT. Prognostic values of dosimetry parameters and clinicopathologic factors were evaluated using survival analysis for progression-free survival. ResultsFourteen lesions from 10 patients were analyzed. The LCS and LCF groups showed significant differences in TDv and intra-tumoral absorbed dose heterogeneity, but not in the tumor size. Univariate survival analysis identified high serum aspartate transaminase level (> 40 IU/L), large tumor size (> 66 mm), and low TDv (< 81 Gy) as significant prognostic factors. However, on multivariate analysis, only low TDv was identified as an independent predictive factor (P = 0.022; HR, 21.018; 95% CI: 1.549–258.204), with a cutoff value of 80–120 Gy. Spearman’s correlation analysis also showed a significant correlation between TDv and PFS (P = 0.009, r = 0.669). ConclusionsIn TARE using 90Y-microspheres, voxel-wise absorbed dose can be easily estimated on post-treatment 90Y PET using a simple method. The TDv calculated by the voxel-based dosimetry is an effective prognostic factor for PFS with a cutoff value of 80–120 Gy.