Evaluation of Hepatic Biochemical Parameters during Antiviral Treatment in COVID-19 Patients

(1) Background: The antiviral treatment for COVID-19 disease started to be largely used in 2020 and has been found to be efficient, although it is not specific for SARS-CoV-2 virus. There were some concerns that it may produce liver damage or other side effects. (2) Methods: The aim of this study was to observe if antiviral therapy is affecting liver parameters or producing other side-effects in patients hospitalized for COVID-19 disease. The study included a group of patients hospitalized in the internal medicine department of Oradea Municipal Clinical Hospital, Romania, between August 2020–June 2021, diagnosed with SARS-CoV-2 viral infection by RT-PCR method or rapid antigen test. During hospitalization, patients were treated with a Lopinavir/Ritonavir (Kaletra) combination, or with Favipiravir or Remdesivir. In addition to monitoring the evolution of the disease (clinical and biochemical), also hepatic parameters were analyzed at admission, during hospitalization, and at discharge. (3) Results: In the group of studied patients, the mean value of aspartat aminotrensferase did not increase above normal at discharge, alanin aminotransferase increased, but below twice the normal values, and cholestasis registered a statistically insignificant slight increase. (4) Conclusions: In our study, we found that all three antivirals were generally well tolerated and their use did not alter liver function in a significant manner.

Fibrogenesis marker PRO-C3 is higher in advanced liver fibrosis and improves in patients undergoing bariatric surgery

Objectives Serum propeptides of type III and type VI collagen (PRO-C3 and PRO-C6) are elevated in advanced nonalcoholic fatty liver disease, but their value in patients with severe obesity and their evolution after bariatric surgery (BS) is unknown. It is unclear if these markers of fibrogenesis are affected by adipose tissue fibrosis (ATF). We studied the association of PRO-C3 and PRO-C6 with liver fibrosis before BS, examined their evolution after BS and how much patients’ ATF contribute to their levels. Methods Serum PRO-C3 and PRO-C6 were measured in 158 BS patients and compared with liver, subcutaneous and omental adipose tissue histology obtained during surgery. PRO-C3 and PRO-C6 levels of 63 patients were determined in follow-up at 3 and 12 months post BS. Results Patients in the highest quartile of PRO-C3 had a higher risk of advanced liver fibrosis (stage F3-4; odds ratio 5.8; 95% CI [1.5-29.9]; p=0.017) compared to the lowest quartile (adjustment for age, gender and BMI). PRO-C3 was positively correlated with markers of insulin resistance and liver enzymes. After BS, PRO-C3 levels decreased in patients with high baseline liver fibrosis. This decrease correlated with improvement of metabolic and liver parameters. PRO-C6 was not related to stage of liver fibrosis. ATF did not correlate with PRO-C3 or PRO-C6 levels at baseline or after BS. Conclusions PRO-C3 was associated with advanced liver fibrosis in patients with severe obesity, and decreased after BS, without being affected by ATF. These data suggest that BS prominently eliminates drivers of hepatic fibrogenesis in NAFLD.

HIF-1α associated logistic regression model serves for predicting decompensation of hepatitis B cirrhosis

Background HIF-1α is relevant to inflammation and fibrosis in hepatitis B virus (HBV)-related liver diseases. Thus, we designed a predictive model for decompensated cirrhosis. Methods Peripheral plasma HIF-1α levels were measured in 52 subjects, including 20 patients with HBV-related-compensated-cirrhosis (HBV-CC), 20 patients with HBV-related-decompensated-cirrhosis (HBV-DC) that underwent transjugular intrahepatic portosystemic shunt (TIPS), and 12 healthy controls (HC). Portal plasma HIF-1α levels were detected in HBV-DC patients. The correlation between clinical data and HIF-1α levels was assessed, logistic regression and nomogram were used to develop prediction model. Results Plasma HIF-1α levels were significantly higher in HBV-DC patients than that in HBV-CC patients and healthy controls (DC: 656.34±417.96, CC: 294.23±138.03, HC: 194.63±54.14, pg/ml; P = 0.0004). Plasma HIF-1α levels were positively correlated with total bile acid, total bilirubin, APRI, FIB-4, and MELD scores, and negatively correlated with albumin and platelets. Multivariate logistic regression manifested that total bilirubin (OR = 19.439; 95% CI: 1.486–254.320, P = 0.024), spleen thickness (OR = 75.144; 95% CI: 4.157–1358.440, P = 0.003) and HIF-1α concentrations above 341.78 pg/ml (OR = 23.580; 95% CI: 1.842–301.781, P = 0.015) were markedly associated with HBV-DC and thus included in the nomogram. The terrific cut-off value for the probability of HBV-DC was > 45%, and area under the curve was 0.954 (P < 0.001), with 95% sensitivity and specificity. Conclusions HIF-1α is related to biochemical liver parameters, cirrhosis grade, and progression to HBV-DC. Our model has preferable predictive value for HBV-DC.

Management of Polycystic Ovarian Disease/Polycystic Ovarian Syndrome (PCOD/PCOS), Fatty Liver and Cholelithiasis in Female Patient by Using Ayurvedic Interventions: A Case Report

Poly Cystic Ovarian Disease (PCOD), Non-Alcoholic Fatty Liver Disease (NAFLD) and cholelithiasis are the major female health issues in the modern times having significant potential to increase the chances of infertility. The allopathic treatment of these conditions relies on suppressing the symptoms only and are also not afforded by all. But in Ayurveda a holistic approach to disease is followed. An effective management of all three conditions with Ayurveda is well described with the present case study. A 40 years old Hindu non-smoking, non-alcoholic female residing Noida presented to the OPD of Shuddhi Ayurveda Clinic, Jeena Sikho Lifecare Pvt. Ltd. Noida on 12 September, 2020. The patient was presented with her previous ultasonographic reports which indicated the worst condition of her liver along with polycystic ovary and gall bladder stone. After Ayurvedic treatment for the duration of almost 10 months, a remarkable change in the liver was observed with reduced values of liver parameters. The ultrasonic reports of after treatment showed negligible presence of ovarian cyst and bladder stone showing effectiveness of Ayurvedic treatment in the management of these diseases without any side effect.

Prevalence of elevated liver enzymes and its association with type 2 diabetes: A Descriptive Cross-Sectional Study among Nepalese Adults from Biratnagar, Nepal

Background: Diabetes mellitus (DM) is a non-communicable metabolic disease resulting from either insulin deficiency or insulin resistance. Liver enzymes (ALT and AST) are the well-known markers of hepatocellular health while GGT also shows biliary tract function. Increased activities of liver enzymes are indicators of hepatocellular injury, are associated with insulin resistance and Type 2 Diabetes Mellitus. Aims and Objective: To study the status of Liver Enzymes in type 2 diabetes patients residing in the eastern part of Nepal. Materials and Methods: This was a descriptive cross-sectional study conducted at the Department of Clinical Biochemistry, Nobel Medical College Teaching Hospital, Biratnagar, Nepal dated from 27th Dec 2019 to 27th Dec 2020. The blood sample was taken from the patients coming to the outpatient department at Diabetic and Endocrinology Clinic for a regular check-up and follow-up and those willing to participate in research. All the data collected was entered in Microsoft Excel and Statistical Package for Social Service (SPSS) version 16. p < 0.05 was considered to be statistically significant. Results: A total of 375 subjects (255 DM and 120 healthy) were included. The age of the diabetic subjects ranges from 27-87 years with a mean of 56.91 ± 11.00 years while age of healthy subjects’ ranged from 31-86 years with the mean of 53.38 ± 13.28. Among the T2DM subjects, 11.76% (30/255) had raised AST, 17.25% (44/255) had raised ALT, 12.94% (33/255) had raised ALP, and 19.60% (50/255) had raised GGT. The level of liver enzymes (AST, p = 0.005, ALT, p = 0.007, ALP, p = 0.000 and GGT, p = 0.000) were showed statistically significant. Conclusion: This study concludes that liver enzyme activity was higher in T2DM subjects than individuals who do not have T2DM. In addition, Liver parameters were significantly correlated with diabetes mellitus in our study population; hence, timely diagnosis and management of the abnormal liver parameters may help to minimize liver-related morbidity and mortality in the diabetic population.

Metabolic and Hepatic Effects of Energy-Reduced Anti-Inflammatory Diet in Younger Adults with Obesity

Background. Associated with epidemics of obesity, nonalcoholic fatty liver disease (NAFLD) is becoming the most prevalent liver disease worldwide. The cornerstone of therapy for NAFLD is lifestyle intervention, mainly focused on weight loss. Significant weight loss results from energy-restricted diets, regardless of macronutrient distribution. An anti-inflammatory diet was related to lower odds of NAFLD among daily alcohol drinkers and individuals with metabolic syndrome. This study aims to evaluate the effect of an energy-reduced anti-inflammatory diet on liver status in younger adults with obesity after a 6-month follow-up. Methods. A two-arm randomized controlled trial surveyed 81 participants’ (mean age, 43 years) anthropometric and body composition changes. Metabolic status was determined with glycaemic and lipid status, inflammatory status with hs-CRP, IL-6, and TNF-α, and liver status with liver enzymes, NAFLD-FLS, FLI, and FIB-4 indices. The inflammatory potential of the diet was assessed by the Dietary Inflammatory Index, DII®. Results. Energy-restricted anti-inflammatory diet resulted in significant weight loss (−7.1%, p < 0.001), in reducing the visceral adiposity (−22.3%, p < 0.001), metabolic (HOMA-IR, −15.5%; total cholesterol, −5.3%; LDL-C, −4.6%; triglycerides, −12.2%), and inflammatory biomarkers (hs-CRP, −29.5%; IL-6, −18.2%; TNF-α, −34.2%), with significant improvement of liver parameters (NAFLD-FLS, −143.4%; FLI, −14.3%; FIB-4, −2.5%). Conclusion. The study showed the effectiveness of the anti-inflammatory diet with significant improvement of liver parameters in younger adults with obesity, which may reinforce the effectiveness of nutrition-based lifestyle programs, with an anti-inflammatory dietary approach for the treatment and resolution of NAFLD.