The prevalence of delta virus infection in chronic liver disease in Egyptian children in comparison with some other countries.

BACKGROUND: Hepatitis Delta Virus (HDV) infection has a worldwide distribution. The aim of this study was to establish its prevalence in Egyptian children with chronic liver disease, and its role in the development and progress of hepatic illness. METHODS: A prospective study of 45 Egyptian children who had liver cirrhosis (n = 24) or chronic hepatitis (n = 21) was done. They were consecutively chosen. Their ages ranged from 2-15 years (median = 5). Serological studies were performed to detect the presence of hepatitis B surface antigen (HBs Ag) and HDV infection IgG antibody (IgG anti-HD). RESULTS: Anti-delta antibody (IgG anti-HD) was detected in only four children with hepatic cirrhosis and non of the chronic hepatitis, with an overall prevalence of 8.9% (4/45). Three of them (75%) were hepatitis B surface antigen (HBs Ag) negative. Significant statistical association between delta infection and the state of hepatic illness was detected (p < 0.05). Whereas HBs Ag was detected in 54% (13/24) of liver cirrhosis and 52% (11/21) of chronic hepatitis, with an overall prevalence of 53% (24/45). There was no statistically significant association between HBs Ag positivity and state of hepatic illness. CONCLUSIONS: The prevalence of HDV infection is 8.9% of Egyptian children with chronic liver disease. HDV infection in children is associated with advanced chronic liver disease.

Abnormal zinc and copper metabolism in hepatic steatosis.

Abnormal Zinc and Copper metabolism were studied in rats with tetracycline-induced fatty liver and compared with normal rats. The present work recorded decreased serum zinc concentration with increased copper concentration in the tetracycline-injected rats. The results also showed that the liver and heart zinc were significantly decreased; meanwhile it was observed that the concentration of zinc in the kidney tissue of fatty liver rats was significantly raised in comparison with those of normal rats. Histopathological studies of the kidney tissue showed degenerative changes in the tables with areas of focal necrosis. Renal tubular necrosis in such cases is largely caused by the toxic degradation products of tetracycline metabolism. The kidney lesion together with impaired gastrointestinal absorption contributed to the hypozincaemia observed in the present results. Although the present data showed a significant reduction in serum zinc and significant rise in plasma insulin in the fatty liver rats there was nonsignificant correlation between the two variables as compared with the normal rats. The positive correlation between serum zinc concentration and reduced high-density lipoprotein cholesterol (HDL-C) emphasizes the role of zinc deficiency in atherosclerotic disease in fatty liver.

Role of the hypoglycemic plant extract cleome droserifolia in improving glucose and lipid metabolism and its relation to insulin resistance in fatty liver.

In this work the mechanism of the hypoglycemic effect of the plant Cleome-Droserifolia (C.d.) was studied in a group of albino rats rendered glucose intolerant by tetracycline (T.) induced fatty liver, and compared with a normal control (C.) rats. The plant extract significantly suppressed the rise in peripheral blood glucose concentrations, both in the basal (fasting) state and after glucose intake. Suppression of basal blood glucose indicated a lowering effect of the plant extract on hepatic glucose output (HGO). The postprandial hypoglycemic effect of the plant extract without increasing insulin secretion was explained by; First: Potentiation of peripheral and hepatic insulin sensitivity. Second: by diminishing intestinal glucose absorption, which was evident by blunting plasma glucose levels throughout the oral glucose challenge. This plant might prove to have a promising therapeutic value in the treatment of diabetes mellitus, for besides its postprandial hypoglycemic effect, its suppression to hepatic glucose output in the fasting state is a beneficial therapeutic finding in favour of the plant as insulin is the most important drug that brings about this effect. The plant has also got a hypocholesterolemic effect more specifically on low density lipoprotein cholesterol (LDL-C) which consequently raised the high density lipoprotein cholesterol/low density lipoprotein cholesterol (HDL-C/LDL-C) ratio. This adds to its value as a protective and antiatherogenic agent.

Delta virus and hepatitis B surface antigen in chronic liver diseases.

This work was carried out on 45 patients with chronic liver diseases, including 24 cases of liver cirrhosis and 21 cases of chronic hepatitis. Their ages ranged from 2 to 15 years (median 5). All cases were examined clinically and assessed biochemically for liver function tests. Serological studies were performed to detect hepatitis B surface antigen (HBsAg) and delta IgG antibody (IgG anti-HD) using Enzyme Immunoassay (EIA) technique. The study showed that IgG anti-HD was detected in 8.9% of cases with chronic liver diseases (all positive cases were with liver cirrhosis). On the other hand, HBsAg was detected in 53.3% of cases (54.2% of them with cirrhosis and 45.8% with chronic hepatitis) with no significant association between HBsAg positivity and type of hepatic illness. Moreover, IgG anti-HD was positive in only 4.2% of HBsAg positive cases, while 14.3% of HBsAg negative cases were positive for IgG anti-HD. A significant association was also found between delta positivity and serum glutamic oxaloacetic transferase level (SGOT). We concluded that chronic delta hepatitis appeared to be more severe than other types of chronic viral hepatitis, as all delta positive cases were with liver cirrhosis and had elevated SGOT levels. Screening of delta markers in addition to hepatitis B viral markers could improve the understanding of a number of obscure cases of chronic hepatic illnesses and would help in the control of HBV and consequently HDV infection in the general population.

The effect of vitamin B12 on tetracycline-induced fatty liver.

The effect of vitamin B12 on the metabolic alterations due to tetracycline toxicity was studied experimentally on laboratory animals. Treatment of Sprague-Dawley rats with 120 or 250 mg tetracycline (i.p.) per kg per day for two or three days caused an accumulation of lipids, mainly triglycerides in the liver of 75% of animals studied, while phospholipid level tend to decrease. These doses are approximately twice and four times the recommended maximum dose for man. In the present work no direct relationship was observed between dose of tetracycline and hepatic accumulation of triglyceride, although livers of rats treated with 250 mg tetracycline/kg appeared uniformly pale yellow. Elevated serum triglyceride was found predominantly in rats treated with 120 mg/kg, while there was no obvious difference between serum triglyceride of rats treated with 250 mg tetracycline and control rats, indicating a block in the release of hepatic triglycerides. Where protection by vitamin B12 was studied, the vitamin was given i.m. (50 microgram/animal) 3 hours before the injection of 120 mg tetracycline per kg. There was a good evidence that lipid abnormalities caused by tetracycline improved by vitamin B12. Thus both hepatic and serum total lipid and triglycerides were significantly lower than those of rats treated with tetracycline, although hepatic total cholesterol was significantly increased as in case of tetracycline only.

Evaluation of the effect of lead exposure on the liver in Egyptian lead tank welders.

In a group of Egyptian lead tank welders who were exposed to lead fumes for periods to 22 years the changes in serum lipids and some of the liver function tests which may elucidate the effect of lead on the liver were investigated. The results revealed increased blood lead level associated with decreased blood haemoglobin and increased urinary excretion of delta amino levulinic acid. However, no clinical abnormalities were recorded in the exposed group of the present work. Thus the increase in serum triglycerides and B-lipoprotein together with the lowering of the phospholipid/cholesterol ratio which were found may indicate premature development of atherosclerosis. Indirect evidence of the beginning of liver fattening was also provided by the increase in serum GOT, GPT, LDH enzymes and decreased albumin/globulin ratio besides the changes in serum lipid values. It is concluded therefore that lead poisoning may have a vascular as well as hepato-toxic action.

Acute toxicity of organophosphorus and organochlorine insecticides in laboratory animals.

The influence of acute poisoning with Dursban (O.P.I.) and D.D.T. (O.cl.I.) on serum enzymes and histopathological examination of the liver, kidney and testes was investigated in albino rats. Two repeated i.p. injections of Dursban in a dose of half the LD 50 resulted in a significant increase in serum GOT, GPT and alkaline phosphatase activity and a decrease of cholinesterase. In case of DDT, two doses of 150 mg/kg orally resulted in a significant increase in the activity of serum GPT only, while three doses increased serum GOT and GPT. No significant change was observed in serum alkaline phosphatase and cholinesterase activity. Regarding the pathological examination it was found that in animals treated with Dursban there was liver necrosis of mid-zonal type and fatty change at the periphery. In case of DDT the liver cells lost their radial arrangements and showed fatty change. There was cellular infiltration in the centre, mostly mononucleolar cells. In both insecticides there was necrosis of some of the seminiferous tubules of the testes and cloudy swelling of the convoluted tubules of the kidney. Histochemical study of the liver in animals treated with Dursban showed that glycogen was deposited at one side of the cell. However, there was depletion of glycogen around the central vein. In liver treated with DDT there were large globules of fat inside the liver cells, indicating increased fat content compared to control liver, where there were tiny minute droplets of fat.

Effect of ATP on liver function tests in experimental diabetes.

Liver function tests were performed in severe and mild diabetic rats and under the influence of ATP. In mild diabetics the serum cholesterol was significantly increased, while in severe diabetes the serum cholesterol was significantly lower than in mild diabetes. The decreased serum cholesterol in severe diabetes may be an indication for the development of fatty liver. The serum alkaline phosphatase and serum bilirubin were significantly increased in both the severe and mild diabetic states, while the thymol turbidity test was insignificantly changed in both states of diabetes. Serum albumin was significantly decreased in 10 days mild diabetes, while it was insignificantly changed in 48 hrs severe diabetic animals. The effect of ATP was investigated in mild diabetes. ATP resulted in a significant increase in serum albumin and a decrease in total globulins with the resultant increase in A/G ratio. The serum alkaline phosphatase exhibited a significant reduction under the influence of ATP. The elevated cholesterol of mild diabetic rats remained significantly elevated and was not reduced by ATP, though the fat content of the liver showed a significant reduction. This may be due to more rapid mobilisation of fat from the liver under the influence of ATP. ATP showed no significant effect on serum bilirubin and thymol turbidity test. the histopathological examination of the liver revealed that administration of ATP to alloxan diabetic rats had a beneficial effect. It resulted in disappearrance of the fat globules from the liver cells.

Effect of AMP on serum minerals in carbon-tetrachloride hepatotoxicity.

Carbon tetrachloride twenty-four hours after its administration resulted in a significant increase in serum iron, copper, zinc, calcium, potassium and sodium, while for magnesium no significant change was observed. A portion of this rise was due to the known hepatotoxic effect of CCl4 on the liver. Pretreatment with adenosine-5-monophosphate led to a normalization of the level of serum iron, copper and zinc, while in case of calcium, magnesium, potassium and sodium there was no significant change from that found in CCl4. The normalization of serum copper and iron under the influence of AMP may be due to some protective action of AMP on the liver. However, the disturbance in minerals metabolism may be considered as one of the earliest lesions in CCl4 poisoning.

Serum enzyme changes associated with carbon disulfide hepatotoxicity in experimental animals.

Investigations were performed to evaluate the activities of serum glutamic oxalacetic and glutamic pyruvic transaminases, alkaline phosphatase and lactate-dehydrogenase enzymes in rats intoxicated by different doses of carbon disulfide. Serum GOT and GPT activities were elevated which may be due to CS2 effect on cell membrane permeability. Serum-alkaline-phosphatase activity showed also increment, which was again attributed to the liver affection. A significant rise in serum-lactate-dehydrogenase activity which was referred to be as a result of muscle-lactate dehydrogenase release into the blood circulation.

Effect of AMP on acute carbon-tetrachloride hepatotoxicity.

The effect of carbon-tetrachloride poisoning and the protection caused by AMP were studied. A single dose of CCl4 has resulted in a rapid development of a fatty liver, a considerable increase in serum enzymes, glutamic oxalacetic and pyruvic transaminases as well as serum-alkaline phosphatase. Total serum protein showed a tendency to decrease accompanied by a decrease in A/G ratio. Administration of adenosine-5-monophosphate prevented the increase in serum-alkaline phosphatase and increased the A/G ratio. There was, however, a slight but significant decrease in serum GOT and GPT within the 24-hrs. period of study, but it remained still higher than that of the control. AMP lowered liver fat without complete protection against the development of fatty liver.