Detección de macroenzimas después de la precipitación con polietilenglicol: búsqueda de la población de referencia en el caso particular de las aminotransferasas / Detection of macroenzymes for aminotransferases after polyethylene glycol precipitation: search for the reference population / Detecção de macroenzimas após a precipitação com polietilenoglicol: busca da população de referência no caso particular das aminotransferases

Resumen Las macroenzimas son complejos de elevado peso molecular que podrían incrementar la actividad enzimática sérica en ausencia de signos y síntomas. Se pueden detectar al ser precipitadas con polietilenglicol. El objetivo del trabajo fue determinar la actividad de las aminotransferasas por el método IFCC, calcular y comparar la media del porcentaje de actividad precipitable (x̄), su intervalo de confianza del 95% (IC95%) y el desvío estándar (DE). Se trabajó con individuos con (n=42) y sin hipertransaminasemia (n=22). Los resultados para uno y otro fueron: porcentaje de actividad precipitable con polietilenglicol (%PPA) (x̄, DE, IC95%) = (28%; 1,82; 27,45%-28,55% y 44%; 24,52; 32,84%-55,16%) y (15%; 13,03; 11,01%-18,99% y 25%; 9,1; 20,96%-29,04%) para ALT y AST, respectivamente (p=0,003 y p=0,001; p<0,05). En conclusión, la estimación de la media poblacional podría ser más precisa en individuos con hipertransaminasemia.

Abstract Macroenzymes are high-molecular-mass complexes that might increase the serum enzymatic activity in the absence of symptoms. An easy-touse method to detect them is the polyethylene glycol precipitation. The aim of this study was to determine aminotransferases activity using the IFCC method, and to calculate the mean percentage of precipitable activity (x̄), its 95% confidence interval (CI95%), and the standard deviation (SD). The study included individuals with (n=42) and without hypertransaminasemia (n=22). The results were: percentaje of precipitable activity (%PPA) (x̄, SD, CI95%) = (28%; 1.82; 27.45%-28.55% and 44%; 24.52; 32.84%-55.16%) and (15%; 13.03; 11.01%-18.99% and 25%; 9.1; 20.96%-29.04%) for ALT and AST, respectively (p=0.003 and p=0.001; p<0.05). In conclusion, the estimation of the population mean could be more precise in individuals with hypertransaminasemia.

Resumo As macroenzimas são complexos de alto peso molecular que poderiam aumentar a atividade enzimática sérica na ausência de sinais e sintomas. Podem ser detectadas ao precipitar com polietilenoglicol. O objetivo do trabalho foi determinar a atividade das aminotransferases pelo método IFCC, calcular e comparar a média da porcentagem de atividade precipitável (x̄), seu intervalo de confiança de 95% (IC95%) e o desvio padrão (DP). O trabalho foi realizado com indivíduos com (n=42) e sem hipertransaminasemia (n=22). Os resultados para os dois foram: porcentagem de atividade precipitável com polietilenoglicol (%PPA) (x̄, DP, IC95%)=(28%; 1,82; 27,45%- 28,55% e 44%; 24,52; 32,84%- 55,16%) e (15%; 13,03; 11,01%-18,99% e 25%; 9,1; 20,96%-29,04%) para ALT e AST, respectivamente (p=0,003 e p=0,001; p<0,05). Concluindo, a estimativa da média populacional poderia ser mais precisa em indivíduos com hipertransaminasemia.

Elevated serum hepatic transaminases in apical periodontitis individuals.

AIM: Apical periodontitis (AP) is the chronic inflammation of the periradicular tissues in response to root canal infection. Whilst AP has been linked with systemic inflammation and noncommunicable diseases, its potential association with nonalcoholic fatty liver disease (NAFLD) is unknown. We aimed to evaluate the serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels as surrogate markers of hepatic injury, and the systemic inflammatory burden in otherwise healthy individuals with and without AP diagnosis. METHODOLOGY: Cross-sectional study. Individuals with AP (n = 30) and healthy controls (n = 29) were recruited. The number, mean diameter (mm) and periapical index of the apical lesions of endodontic origin (ALEO) were assessed. ALT and AST levels (pg/mL) were measured through enzyme-linked immunosorbent assays. The serum levels of TNF-α, IL-4, IL-9, IL-10, IL-17A and IL-22 were evaluated by Multiplex assay. Inferential analysis was performed using t-test or Mann-Whitney tests according to data distribution and linear regression models. Data were analysed with StataV16 (p < .05). RESULTS: ALT and AST levels were significantly higher in individuals with AP compared to controls (p < .05). Serum inflammatory biomarkers showed no significant differences between the study groups. Bivariate and multivariate analyses confirmed that AP diagnosis was independently associated with ALT and AST elevations (p < .05). Additionally, the number of ALEO positively influenced AST levels (p = .002). IL-22 on the other hand, was associated with reduced ALT levels (p = .043). CONCLUSION: AP is associated with higher serum hepatic transaminases ALT and AST, potentially contributing to NAFLD physiopathology in young adults.

Comparative plasma biochemistry analyte data in nesting leatherback (Dermochelys coriacea), foraging green (Chelonia mydas) and foraging and nesting hawksbill (Eretmochelys imbricata) sea turtles in Grenada, West Indies.

Blood biochemistry represents a minimally invasive tool for monitoring sea turtle health, assessing injured sea turtles and supporting conservation strategies. In Grenada, West Indies, plasma biochemical variables were examined in 33 nesting leatherback (Dermochelys coriacea), 49 foraging green (Chelonia mydas), 49 foraging hawksbill (Eretmochelys imbricata) and 12 nesting hawksbill sea turtles sampled between 2017 and 2022. Plasma biochemistry reference intervals are described herein except for nesting hawksbills, which are represented by descriptive statistics due to the low sample size. Select analyte concentrations were positively correlated with curved carapace length in leatherbacks (chloride), green turtles (total protein, albumin and globulin) and foraging hawksbills (total protein, albumin and phosphorus). Cholesterol (7.8 mmol/l ± 1.6 SD) and triglyceride (6.9 mmol/l ± 1.9 SD) concentrations were significantly higher in leatherbacks compared to foraging green turtles, foraging hawksbills and nesting hawksbills (P < 0.001 for all). Cholesterol was significantly higher in nesting hawksbills compared to foraging green turtles (P = 0.050) and foraging hawksbills (P = 0.050). Foraging hawksbills demonstrated significantly higher aspartate transaminase activities than leatherbacks (P = 0.002), green turtles (P = 0.009) and nesting hawksbills (P < 0.001). Biochemical results provide baseline population health data and support guidance for treatments during clinical sea turtle rehabilitation efforts. They also provide insight into species-specific physiologic differences and preludes further studies to better characterize the impacts of life-stage class on biochemistry reference intervals to better support wild sea turtle populations in Grenada.

Evaluación del desempeño de tres puntajes no invasivos para el diagnóstico de fibrosis avanzada en una población con hígado graso no alcohólico / Evaluation of the performance of three non-invasive scores for the diagnosis of advanced fibrosis in a population with non-alcoholic fatty liver disease

Introducción. La enfermedad hepática grasa no alcohólica (EHGNA) es la hepatopatía crónica más común en el mundo, y en aproximadamente el 10 % de los casos progresará a cirrosis o a carcinoma hepatocelular. La presencia de fibrosis hepática es el mejor predictor de esta progresión, pero su diagnóstico mediante biopsia hepática es invasivo y con riesgo de complicaciones (alrededor del 2,5 %). Existen puntajes no invasivos que se han desarrollado y validado para estadificar la fibrosis, pero no conocemos su rendimiento en la población colombiana. El objetivo de este estudio fue evaluar el desempeño de los puntajes fibrosis-4 (FIB-4), la relación AST/ALT y el índice AST/plaquetas (APRI) para la detección de fibrosis avanzada en pacientes colombianos con EHGNA. Metodología. Estudio observacional tipo transversal de pacientes con EHGNA, que entre 2008 y 2022 tuvieran disponible el resultado de una biopsia hepática. Se hizo una descripción demográfica básica y se calculó el FIB-4, la relación AST/ALT y el APRI con los laboratorios más recientes previos al procedimiento. Posteriormente se calcularon valores de sensibilidad, especificidad, valores predictivos, razones de verosimilitud y área bajo la curva-característica operativa del receptor (AUC-ROC) para los puntos de corte evaluados previamente en la literatura. Resultados. Se incluyeron 176 pacientes, de los cuales el 14,3 % tenían fibrosis avanzada. El FIB-4 presentó el mejor rendimiento con un valor AUC-ROC de 0,74 para el punto de corte de 1,30 y 2,67. En segundo lugar, estuvo la relación AST/ALT con un valor AUC-ROC de 0,68 con el punto de corte de 0,8, y finalmente el APRI con valor AUC-ROC 0,62 con el punto de corte de 1. Conclusión. En la población analizada los tres puntajes tienen menor rendimiento diagnóstico comparado a los resultados reportados en Europa y Japón. El FIB-4 es el único que alcanza una AUC-ROC con rendimiento razonable, con la limitación que 27,4 % obtuvieron un resultado indeterminado.

Introduction. Non-alcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease worldwide, with approximately 10% of cases progressing to cirrhosis or hepatocellular carcinoma. Liver fibrosis presence is the best predictor of this progression, yet its diagnosis through liver biopsy is invasive and poses risk of complications. Although non-invasive scoring systems have been developed and validated for fibrosis staging, their performance remains unexplored in the Colombian population. This study aims to assess the efficacy of the fibrosis-4 (FIB-4) score, AST/ALT ratio, and AST to platelet ratio index (APRI) in detecting advanced fibrosis among Colombian NAFLD patients. Methods. This cross-sectional observational study included NAFLD patients with available liver biopsy results from 2008 to 2022. Basic demographic characteristics were described, and FIB-4, APRI, and AST/ALT ratio were calculated using the latest laboratory data before the procedure. Subsequently, sensitivity, specificity, predictive values, likelihood ratios, and the area under the receiver operating characteristic curve (AUC-ROC) were computed for previously assessed cutoff points. Results. A total of 176 patients were included, among whom 14.3% had advanced fibrosis. FIB-4 demonstrated superior performance with an AUC-ROC value of 0.74 for cutoff points of 1.30 and 2.67. Following was the AST/ALT ratio with an AUC-ROC value of 0.68 for cutoff point of 0.8, and finally, APRI with an AUC-ROC of 0.62 for the cutoff point of 1. Conclusion. All three scores have lower diagnostic efficacy compared to results reported in Europe and Japan. FIB-4 is the only one that achieves an acceptable AUC-ROC performance with the limitation that an indeterminate result was obtained in 27,4% of the sample.

Nutritional parameters and productive performance of grazing sheep using castor bean cake as supplement or fertilizer.

The objective was to evaluate the effect of detoxified castor bean replacing soybean meal in the concentrate diet or as nitrogen organic fertilizer replacing urea on intake and nutrient digestibility, blood parameters and productive performance of sheep finished on irrigated Tamani grass pasture under continuous stocking and variable stocking rate. The treatments were two concentrate diets: standard (ground corn and soybean meal) and alternative diet (ground corn and detoxified castor bean cake), and two nitrogen fertilizers: chemical (urea) and organic (fresh castor bean cake). The randomized complete block design was used in a 2 × 2 factorial arrangement with four replications (500 m² paddocks). Four sheep (2 castrated males and 2 females) were distributed in each experimental unit, totaling 64 animals with an average initial weight of 19.42 ± 3.6 kg. No effects (P > 0.05) were observed on the variables inherent to the evaluation of the pasture. The average stocking rate (SR) among treatments was 85.50 sheep/ha, equivalent to 9.87 Animal Units (AU)/ha. The alternative diet presented lower dry matter digestibility (62.71%), with no negative effects on nutrient intake and kidney parameters. Animals fed the standard and alternative diet showed average daily gain of 103.75 and 86.76 g/day, respectively. A finishing period of up to 100 days is recommended for sheep selected for production systems in semi-arid regions managed intensively on pasture. Detoxified castor bean cake did not alter nutrient intake, liver and kidney parameters of the sheep and can be used in pasture-based sheep farming.

On a deterministic mathematical model which efficiently predicts the protective effect of a plant extract mixture in cirrhotic rats.

In this work, we propose a mathematical model that describes liver evolution and concentrations of alanine aminotransferase and aspartate aminotransferase in a group of rats damaged with carbon tetrachloride. Carbon tetrachloride was employed to induce cirrhosis. A second groups damaged with carbon tetrachloride was exposed simultaneously a plant extract as hepatoprotective agent. The model reproduces the data obtained in the experiment reported in [Rev. Cub. Plant. Med. 22(1), 2017], and predicts that using the plants extract helps to get a better natural recovery after the treatment. Computer simulations show that the extract reduces the damage velocity but does not avoid it entirely. The present paper is the first report in the literature in which a mathematical model reliably predicts the protective effect of a plant extract mixture in rats with cirrhosis disease. The results reported in this manuscript could be used in the future to help in fighting cirrhotic conditions in humans, though more experimental and mathematical work is required in that case.

The Role of Aspartate Aminotransferase-to-Lymphocyte Ratio Index (ALRI) in Predicting Mortality in SARS-CoV-2 Infection.

COVID-19 has a mortality rate exceeding 5.4 million worldwide. The early identification of patients at a high risk of mortality is essential to save their lives. The AST-to-lymphocyte ratio index (ALRI) is a novel biomarker of survival in patients with hepatocellular carcinoma, an organ susceptible to SARS-CoV-2 infection. For this study, the prognostic value of ALRI as a marker of COVID-19 mortality was evaluated. For this purpose, ALRI was compared with the main biomarkers for COVID-19 mortality (neutrophil-to-lymphocyte ratio [NLR], systemic immune-inflammation index [SII], platelet-to-lymphocyte ratio [PLR], lactate dehydrogenase (LDH)/lymphocyte ratio [LDH/LR]). A retrospective cohort of 225 patients with SARS-CoV-2 infection and without chronic liver disease was evaluated. In the non-survival group, the ALRI, NLR, SII, and LDH/LR were significantly higher than in the survival group (pcorrected < 0.05). ALRI had an area under the curve (AUC) of 0.81, a sensitivity of 70.37%, and a specificity of 75%, with a best cut-off value >42.42. COVID-19 patients with high ALRI levels had a mean survival time of 7.8 days. Multivariate Cox regression revealed that ALRI > 42.42 (HR = 2.32, 95% CI: 1.35-3.97; pcorrected = 0.01) was a prognostic factor of COVID-19 mortality. These findings prove that ALRI is an independent predictor of COVID-19 mortality and that it may help identify high-risk subjects with SARS-CoV-2 infection upon admission.

Fatty liver and celiac disease: Why worry?

Celiac disease (CD) is a chronic inflammatory intestinal disorder mediated by the ingestion of gluten in genetically susceptible individuals. Liver involvement in CD has been widely described, and active screening for CD is recommended in patients with liver diseases, particularly in those with autoimmune disorders, fatty liver in the absence of metabolic syndrome, noncirrhotic intrahepatic portal hypertension, cryptogenic cirrhosis, and in the context of liver transplantation. Non-alcoholic fatty liver disease is estimated to affect approximately 25% of the world's adult population and is the world's leading cause of chronic liver disease. In view of both diseases' global significance, and to their correlation, this study reviews the available literature on fatty liver and CD and verifies particularities of the clinical setting.

Liver Function in Patients with Long-Term Coronavirus Disease 2019 of up to 20 Months: A Cross-Sectional Study.

The long-term laboratory aspects of the effects of coronavirus disease 2019 (COVID-19) on liver function are still not well understood. Therefore, this study aimed to evaluate the hepatic clinical laboratory profile of patients with up to 20 months of long-term COVID-19. A total of 243 patients of both sexes aged 18 years or older admitted during the acute phase of COVID-19 were included in this study. Liver function analysis was performed. Changes were identified in the mean levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), gamma-glutamyl transferase (GGT), and ferritin. A ferritin level of >300 U/L was observed in the group that presented more changes in liver function markers (ALT, AST, and GGT). Age ≥ 60 years, male sex, AST level > 25 U/L, and GGT level ≥ 50 or 32 U/L were associated with an ALT level > 29 U/L. A correlation was found between ALT and AST, LDH, GGT, and ferritin. Our findings suggest that ALT and AST levels may be elevated in patients with long-term COVID-19, especially in those hospitalised during the acute phase. In addition, an ALT level > 29 U/L was associated with changes in the levels of other markers of liver injury, such as LDH, GGT, and ferritin.

Celiac disease screening in patients with cryptogenic cirrhosis.

We write a letter to the editor commenting the article "Who to screen and how to screen for celiac disease". We discuss the present literature on cirrhosis and celiac disease (CD) and recommend screening and treating CD in individuals with cryptogenic cirrhosis.

Fish Oil - Omega-3 Exerts Protective Effect in Oxidative Stress and Liver Dysfunctions Resulting from Experimental Sepsis.

Background: Sepsis is a severe global health problem, with high morbidity and mortality. In sepsis, one of the main affected organs is the liver. Hepatic alterations characterize a negative prognostic. Omega-3 fatty acids (ω3), eicosapentaenoic acid, and docosahexaenoic acid, are part of the main families of polyunsaturated fatty acids. ω3 has been used in studies as sepsis treatment and as a treatment for non-alcoholic liver disease. Aim: We aimed to evaluate the effects of treatment with fish oil (FO) rich in ω3 on liver changes and damage resulting from experimental sepsis. Methodology: A model of severe sepsis in Wistar rats was used. Oxidative stress in the liver tissue was evaluated by means of tests of thiobarbituric acid reactive substances, 2,7-dihydrodichlorofluorescein diacetate , catalase, and glutathione peroxidase, in the serum TBARS, DCF, thiols and, to assess liver dysfunction, alanine aminotransferase and aspartate aminotransferase. Hepatic tissue damage was evaluated using H&E histology. Results: In assessments of oxidative stress in liver tissue, a protective effect was observed in the tests of TBARS, DCF, CAT, and GPx, when compared the sepsis versus sepsis+ω3 groups. Regarding the oxidative stress in serum, a protective effect of treatment with ω3 was observed in the TBARS, DCF, and thiols assays, in the comparison between the sepsis and sepsis+ω3 groups. ω3 had also a beneficial effect on biochemical parameters in serum in the analysis of ALT, creatinine, urea, and lactate, observed in the comparison between the sepsis and sepsis+ω3 groups. Conclusion: The results suggest ω3 as a liver protector during sepsis with an antioxidant effect, alleviating injuries and dysfunctions.

Genetic variants associated with circulating liver injury markers in Mexican Americans, a population at risk for non-alcoholic fatty liver disease.

Objective: Mexican Americans are disproportionally affected by non-alcoholic fatty liver disease (NAFLD), liver fibrosis and hepatocellular carcinoma. Noninvasive means to identify those in this population at high risk for these diseases are urgently needed. Approach: The Cameron County Hispanic Cohort (CCHC) is a population-based cohort with high rates of obesity (51%), type 2 diabetes (28%) and NAFLD (49%). In a subgroup of 564 CCHC subjects, we evaluated 339 genetic variants previously reported to be associated with liver injury markers aspartate aminotransferase (AST) and alanine aminotransferase (ALT) in United Kingdom and Japanese cohorts. Results: Association was confirmed for 86 variants. Among them, 27 had higher effect allele frequency in the CCHC than in the United Kingdom and Japanese cohorts, and 16 had stronger associations with AST and ALT than rs738409 (PNPLA3). These included rs17710008 (MYCT1), rs2519093 (ABO), rs1801690 (APOH), rs10409243 (S1PR2), rs1800759 (LOC100507053) and rs2491441 (RGL1), which were also associated with steatosis and/or liver fibrosis measured by vibration-controlled transient elastography. Main contributors to advanced fibrosis risk were rs11240351 (CNTN2), rs1800759 (LOC100507053), rs738409 (PNPLA3) and rs1801690 (APOH), with advanced fibrosis detected in 37.5% of subjects with 3 of these 4 variants [AOR = 11.6 (95% CI) = 3.8-35.3]. AST- and ALT-associated variants implicated distinct pathways (ethanol and galactose degradation versus antigen presentation and B cell development). Finally, 8 variants, including rs62292950 (DNAJC13), were associated with gut microbiome changes. Conclusion: These genotype-phenotype findings may have utility in risk modeling and disease prevention in this high-risk population.

Hematological and biochemical changes in a cow with metastatic cholangiocarcinoma

We describe here hematological and biochemical findings in a cow with metastatic cholangiocarcinoma. On physical examination, apathy with congested mucous membranes, tachycardia and enlarged abdomen; hypoperistalsis in rumen, abomasum and intestines. In hematological examination, icteric plasma with leukocytosis by neutrophilia with regenerative left shift and inversion of the proportion between lymphocytes and segmented neutrophils, and hypofibrinemia. In serum biochemistry: hyperproteinemia, hypoalbuminemia, hyperglobulinemia, low albumin/globulin ratio and high levels of aspartate aminotransferase, gamma-glutamyltransferase. The cow died and in necropsy was observed a severe and diffuse increase in volume predominantly on the hepatic right lobe and moderate increase of volume in mesenteric lymph nodes. Which was diagnosed microscopically as a cholangiocarcinoma, characterized by arrangements in irregular and coalescent ducts. In conclusion, cholangiocarcinoma may cause important hematological and biochemical changes in cattle.(AU)

In-hospital mortality and severe outcomes after hospital discharge due to COVID-19: A prospective multicenter study from Brazil.

Background: We evaluated in-hospital mortality and outcomes incidence after hospital discharge due to COVID-19 in a Brazilian multicenter cohort. Methods: This prospective multicenter study (RECOVER-SUS, NCT04807699) included COVID-19 patients hospitalized in public tertiary hospitals in Brazil from June 2020 to March 2021. Clinical assessment and blood samples were performed at hospital admission, with post-hospital discharge remote visits. Hospitalized participants were followed-up until March 31, 2021. The outcomes were in-hospital mortality and incidence of rehospitalization or death after hospital discharge. Kaplan-Meier curves and Cox proportional-hazard models were performed. Findings: 1589 participants [54.5% male, age=62 (IQR 50-70) years; BMI=28.4 (IQR,24.9-32.9) Kg/m² and 51.9% with diabetes] were included. A total of 429 individuals [27.0% (95%CI,24.8-29.2)] died during hospitalization (median time 14 (IQR,9-24) days). Older age [vs<40 years; age=60-69 years-aHR=1.89 (95%CI,1.08-3.32); age=70-79 years-aHR=2.52 (95%CI,1.42-4.45); age≥80-aHR=2.90 (95%CI 1.54-5.47)]; noninvasive or mechanical ventilation at admission [vs facial-mask or none; aHR=1.69 (95%CI 1.30-2.19)]; SAPS-III score≥57 [vs<57; aHR=1.47 (95%CI 1.13-1.92)] and SOFA score≥10 [vs <10; aHR=1.51 (95%CI 1.08-2.10)] were independently associated with in-hospital mortality. A total of 65 individuals [6.7% (95%CI 5.3-8.4)] had a rehospitalization or death [rate=323 (95%CI 250-417) per 1000 person-years] in a median time of 52 (range 1-280) days post-hospital discharge. Age ≥ 60 years [vs <60, aHR=2.13 (95%CI 1.15-3.94)] and SAPS-III ≥57 at admission [vs <57, aHR=2.37 (95%CI 1.22-4.59)] were independently associated with rehospitalization or death after hospital discharge. Interpretation: High in-hospital mortality rates due to COVID-19 were observed and elderly people remained at high risk of rehospitalization and death after hospital discharge. Funding: Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) and Programa INOVA-FIOCRUZ.

Changes in liver function test levels in HIV patients undergoing highly active antiretroviral therapy (HAART). Longitudinal study in Lima, Peru / Cambios en los valores de las pruebas de función hepática en pacientes con VIH en terapia antirretroviral de gran actividad (TARGA). Estudio longitudinal en Lima, Perú

Abstract Introduction: Estimating and monitoring changes in liver function tests is necessary to prevent the occurrence of chronic liver disease in HIV patients undergoing highly active antiretroviral therapy (HAART). Objective: To determine the variation liver profile test levels in HIV patients undergoing HAART. Materials and methods: Retrospective longitudinal study conducted in 100 HIV patients treated at the Hospital Nacional Hipólito Unanue, Lima, Peru, between 2015 and 2017. Patients in all stages of clinical infection under HAART and with liver function panel results for alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), and total protein (TP) were included. Three follow-up liver function tests (every 3 months) were performed while undergoing HAART and participants were categorized as having normal or elevated levels for all liver markers. Differences between the samples analyzed were determined using the paired-samples T test, with a 95% confidence interval and a significance level of p<0.05. Results: Participants' mean age was 33±9.56 years and 67% were male. Mean serum AST, ALT and ALP values decreased between the first and the third measurement (p=0.021, p=0.076 and p=0.002, respectively). No significant differences in GGT and TP levels were observed between the three measurements, nor between patients with normal and elevated AST, ALT, ALP and TP values, but significant differences were observed for GGT (p=0.010). Conclusions: Variations in liver marker levels were observed in all participants, with a decreasing trend in AST, ALT and ALP between the early and late stages of HAART, implying that this therapy could play a role in liver tissue damage.

Resumen Introducción. Para prevenir el desarrollo de enfermedad hepática crónica en pacientes con VIH, durante la terapia antirretroviral de gran actividad (TARGA) se deben estimar y monitorear cambios en el perfil hepático. Objetivo. Determinar la variación de las concentraciones del perfil hepático en pacientes con VIH durante la TARGA. Materiales y métodos. Estudio retrospectivo longitudinal realizado en 100 pacientes con VIH atendidos en el Hospital Nacional Hipólito Unanue, Lima, Perú, entre 2015 y 2017. Se incluyeron pacientes en todos los estadios de infección clínica que estuvieran recibiendo TARGA y en los que se contara con resultados del perfil hepático para alanina aminotransferasa (ALT), aspartato aminotransferasa (AST), fosfatasa alcalina (FA), gammaglutamiltranspeptidasa (GGT) y proteínas totales (PT). Se realizaron tres análisis de control de la función hepática durante la TARGA (1 cada 3 meses) y los participantes se agruparon en niveles normales y elevados para todos los marcadores hepáticos. Las diferencias entre las muestras analizadas fueron determinadas mediante la prueba t-Student para muestras relacionadas, con un intervalo de confianza de 95% y un nivel de significancia de p<0.05. Resultados. La edad promedio fue de 33±9.56 años y el 67% fueron varones. Los valores séricos promedio de AST, ALT y FA disminuyeron entre la primera y la tercera medición (p=0.021, p=0.076 y p=0.002, respectivamente). No se observaron diferencias significativas en los niveles de GGT y PT entre las tres mediciones, ni entre los pacientes con valores normales y elevados para AST, ALT, FA y PT, pero sí para GGT (p=0.010). Conclusiones. Se observaron variaciones en los niveles de los marcadores hepáticos de todos los participantes, con una tendencia a la reducción en AST, ALT y FA entre las etapas iniciales y finales de la terapia, lo que implica que la TARGA podría ejercer un rol en el daño tisular hepático.

Factores asociados a esteatosis hepática no alcohólica en pacientes del área rural del cantón Chambo / Factors Associated with Nonalcoholic Hepatic Steatosis in Patients from the Rural Area of Chambo town

La hepatopatía crónica más prevalente en el mundo es la esteatosis hepática no alcohólica. Así, se realizó una investigación con el objetivo de determinar los factores asociados a esa patología en pacientes atendidos en el Centro de salud tipo B Chambo, Ecuador, durante 2020. Se realizó un estudio con enfoque cuantitativo, de tipo no experimental, correlacional y retrospectivo. Las historias clínicas seleccionadas aportaron los datos de las variables de interés. La media de la edad de los involucrados fue de 54,43 ± 8,10 años. El 60,38% tenía hipertensión arterial, el 52,83% diabetes mellitus, el 62,26% sobrepeso u obesidad y el 49,06% dislipidemia, determi-nando que estas comorbilidades tuvieron una relación significativa con la enfermedad objeto de estudio, la que resultó más incidente en edades mayores de 50 años. Las personas sedentarias o con bajos niveles de actividad física mostraron de ALT y AST.

The most prevalent chronic liver disease in the world is nonalcoholic fatty liver disease. Thus, research aimed to determine the factors associated with this pathology in patients treated at the Type B Chambo Health Center, Ecuador, during 2020. A study was carried out with a quantitati-ve, non-experimental, correlational, and retrospective approach. The selected medical records provided the information for the variables of interest. The mean age of the population was 54.43 ± 8.10 years of age. 60.38% had arterial hypertension, 52.83% diabetes mellitus, 62.26% overweight or obesity and 49.06% dyslipidemia. It was determined that these comorbidities had a significant relationship with the disease under study, which was more incident in ages older than 50. Sedentary people or those ones with low levels of physical activity showed ALT and AST.

Prevalence and predictors of elevated liver enzyme levels in Mexico: The Mexican National Health and Nutrition Survey, 2016.

INTRODUCTION AND OBJECTIVE: To determine the prevalence of elevated liver enzyme levels and the fatty liver index according to specific sociodemographic, clinical, anthropometric, and metabolic risk factors in Mexican adult population. MATERIAL AND METHODS: The present analysis was conducted using data from the Mexican National Health and Nutrition Survey 2016. For the present study, 3,490 adults with complete information on liver enzymes, sociodemographic, lifestyle, and metabolic factors were analyzed. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyl transferase (GGT) levels were determined from blood samples. We computed the fatty liver Index (FLI), as a surrogate marker of non-alcoholic fatty liver disease. The associations are reported as adjusted odds ratios (OR) and 95% confidence intervals (95%CI). RESULTS: At the national level, the prevalence of high serum levels of ALT, AST, and GGT were 7.9%, 13.5, and 12.9 respectively. We observed that men had higher prevalences of altered ALT, GGT and FLI compared to women. Additionally, we observe that individuals with obesity, metabolic syndrome and insulin resistance are significantly more likely to present elevated concentrations of AST, ALT, GGT and FLI. Finally, we found that the subjects of the lowest socioeconomic level and indigenous population were more likely to present elevated levels of AST, ALT, GGT, and FLI. CONCLUSION: In Mexico, non-alcoholic fatty liver disease affect people with obesity, diabetes, and metabolic syndrome as well as men, subjects of low socioeconomic status, subjects who live in rural areas and indigenous population. Interventions to reduce this condition should be a public health priority.

Toxicity evaluation of Eleutherine plicata Herb. extracts and possible cell death mechanism.

Eleutherine plicata has been shown to be a promising medicinal plant, and its activity has been associated with naphthoquinones. The present study aimed at evaluating the cytotoxicity, genotoxicity, and oral toxicity of the ethanol extract (EEEp), dichloromethane fraction (FDMEp) of E. plicata, and isoeleutherin. For the cytotoxicity evaluation, the viability test (MTT) was used. Genotoxicity was accessed through the Comet assay (alkaline version), acute and subacute oral toxicities were also evaluated. The antioxidant capacity of the samples in the wells where the cells were treated with E. plicata was evaluated. Furthermore, the participation of caspase-8 in the possible mechanism of action of isoeleutherin, eleutherin, and eleutherol was also investigated through a docking study. FDMEp and isoeleutherin were cytotoxic, with higher rates of DNA fragmentation observed for FDMEp and isoeleutherin, and all samples displayed higher antioxidant potential than the control. In the acute oral toxicity test, EEEp, FDMEp, and isoeleutherin did not cause significant clinical changes. In the subacute toxicity assay, EEEp and FDMEp also did not cause clinical, hematological, or biochemical changes. The three compounds bound similarly to caspase-8. Despite the results of cytotoxicity, in vitro studies demonstrated that the use of EEEp appears to be safe and cell death may involve its binding to caspase-8.

Genotoxic risk in humans and acute toxicity in rats of a novel oral high-dose coenzyme Q10 oleogel.

Coenzyme Q10 (CoQ10) supplementation has demonstrated to be safe and effective in primary and secondary CoQ10 deficiencies. Previously, we have designed a high-dose CoQ10 oleogel (1 g/disk) with excipients used in quantities that do not represent any toxic risk. However, it was necessary to demonstrate their safety in the final formulation. Following this purpose, an acute toxicity study of the oleogel in rats was performed. Furthermore, the genotoxic risk was evaluated in human volunteers after CoQ10 supplementation with oleogel and compared to the solid form (1 g/three 00-size-capsules). In addition, the general health status and possible biochemical changes of the participants were determined using serum parameters. Results suggested the absence of adverse effects caused by the interaction of the components in the oleogel formulation. Therefore, we conclude that the designed novel high-dose CoQ10 oleogel was safe for oral consumption.

Prediction of impacts on liver enzymes from the exposure of low-dose medical radiations through artificial intelligence algorithms

SUMMARY OBJECTIVES: This study aimed to develop artificial intelligence and machine learning-based models to predict alterations in liver enzymes from the exposure of low annual average effective doses in radiology and nuclear medicine personnel of Institute of Nuclear Medicine and Oncology Hospital. METHODS: Ninety workers from the Radiology and Nuclear Medicine departments were included. A high-capacity thermoluminescent was used for annual average effective radiation dose measurements. The liver function tests were conducted for all subjects and controls. Three supervised learning models (multilayer precentron; logistic regression; and random forest) were applied and cross-validated to predict any alteration in liver enzymes. The t-test was applied to see if subjects and controls were significantly different in liver function tests. RESULTS: The annual average effective doses were in the range of 0.07-1.15 mSv. Alanine transaminase was 50% high and aspartate transaminase was 20% high in radiation workers. There existed a significant difference (p=0.0008) in Alanine-aminotransferase between radiation-exposed and radiation-unexposed workers. Random forest model achieved 90-96.6% accuracies in Alanine-aminotransferase and Aspartate-aminotransferase predictions. The second best classifier model was the Multilayer perceptron (65.5-80% accuracies). CONCLUSION: As there is a need of regular monitoring of hepatic function in radiation-exposed people, our artificial intelligence-based predicting model random forest is proved accurate in prediagnosing alterations in liver enzymes.