Fibrinogen storage disease without hypofibrinogenemia associated with estrogen therapy

BACKGROUND: Cytoplasmic inclusion bodies within hepatocytes may have different etiologies, including the Endoplasmic Reticulum Storage Diseases (ERSDs). ERSD is a pathological condition characterized by abnormal accumulation of proteins destined for secretion in the endoplasmic reticulum of hepatocytes; it may be congenital (primary) or acquired (secondary). Fibrinogen storage disease is a form of ERSD. CASE PRESENTATION: We present a case of fibrinogen storage disease secondary to estrogen replacement therapy. Its causal relationship to the drug is shown by histological, immunohistochemical and ultrastructural studies of paired liver biopsies obtained during and after the drug therapy. CONCLUSION: The liver biopsies of patients with idiopathic liver enzyme abnormalities should be carefully evaluated for cytoplasmic inclusion bodies and, although rare, fibrinogen deposits

Hyperammonemic Coma—Barking Up the Wrong Tree

Hepatic encephalopathy and myxedema coma share clinical features: coma, ascites, anemia, impaired liver functions, and a “metabolic” electroencephalogram (EEG). Hyperammonemia, a hallmark of hepatic encephalopathy, has also been described in hypothyroidism. Differentiation between the 2 conditions, recognition of their possible coexistence, and the consequent therapeutic implications are of utmost importance. We describe a case of an 82-year-old woman with a history of mild chronic liver disease who presented with hyperammonemic coma unresponsive to conventional therapy. Further investigation disclosed severe hypothyroidism. Thyroid hormone replacement resulted in gain of consciousness and normalization of hyperammonemia. In patients with an elevated ammonia level, altered mental status, and liver disease, who do not have a clear inciting event for liver disease decompensation, overwhelming evidence of hepatic decompensation, or who do not respond to appropriate therapy for hepatic encephalopathy, hypothyroidism should be considered and evaluated

Helicobacter pylori infection and circulating ghrelin levels - A systematic review

BACKGROUND: The nature of the association between ghrelin, an orexigenic hormone produced mainly in the stomach, and Helicobacter pylori (H pylori), a bacterium that colonises the stomach, is still controversial. We examined available evidence to determine whether an association exists between the two; and if one exists, in what direction. METHODS: We reviewed original English language studies on humans reporting circulating ghrelin levels in H pylori infected and un-infected participants; and circulating ghrelin levels before and after H pylori eradication. Meta-analyses were conducted for eligible studies by combining study specific estimates using the inverse variance method with weighted average for continuous outcomes in a random effects model. RESULTS: Seventeen out of 27 papers that reported ghrelin levels in H pylori positive and negative subjects found lower circulating ghrelin levels in H pylori positive subjects; while 10 found no difference. A meta-analysis of 19 studies with a total of 1801 participants showed a significantly higher circulating ghrelin concentration in H pylori negative participants than in H pylori positive participants (Effect estimate (95%CI) = -0.48 (-0.60, -0.36)). However, eradicating H pylori did not have any significant effect on circulating ghrelin levels (Effect estimate (95% CI) = 0.08 (-0.33, 0.16); Test for overall effect: Z = 0.67 (P = 0.5)). CONCLUSIONS: We conclude that circulating ghrelin levels are lower in H pylori infected people compared to those not infected; but the relationship between circulating ghrelin and eradication of H pylori is more complex

Association between Hepatic Steatosis and Entecavir Treatment Failure in Chinese Patients with Chronic Hepatitis B

Background: The coexistence of HBV infection and nonalcoholic fatty liver disease (NAFLD) becomes characteristic of liver disease in China, with unknown bilateral influence. We aimed to investigate the effect of hepatic steatosis, a common hepatocyte change in NAFLD, on antiviral therapy in patients with chronic hepatitis B (CHB). Methods and Findings: We carried out a prospective nested case control study in CHB patients receiving Entecavir for initial antiviral therapy, by recording demographic, anthropometric and clinical data at baseline, 24 wk,48 wk and 96 wk. Univariate analysis and multivariate logistic regression were applied to find out independent factors of hepatic steatosis and Entecavir treatment failure. The rates of HBV-DNA clearance, HBeAg seroconversion and ALT normalization were compared between CHB patients with and without steatosis by post hoc analysis. A total of 267 Chinese patients with CHB entered final analysis, with overall percentages of hepatic steatosis and HBeAg positive as 30.5 % and 62.4%. Multivariate analysis showed waist circumference, serum TG and uric acid levels were independent factors of hepatic steatosis. The response rates to Entecavir were 54.9%, 63.8%, 74.2 % at 24 wk,48 wk and 96 wk. Hepatic steatosis was revealed as an independent factor of Entecavir treatment failure by multivariate logistic regression at 24 wk,48 wk and 96 wk. In CHB patients with hepatic steatosis, HBV-DNA clearance and HBeAg seroconversion were both lower throughout the follow-up, but only the former reached statistical significance. Besides, ALT normalization was also significantly lower at 24 wk and 48 wk

Peroxisome proliferators-activated alpha agonist treatment ameliorates hepatic damage in rats with obstructive jaundice: an experimental study

<p>Abstract</p> <p>Background</p> <p>Peroxisome proliferators-activated receptor alpha (PPARα) activation modulates cholesterol metabolism and suppresses bile acid synthesis. This study aims to evaluate the effect of short-term administration of fenofibrate, a PPARα agonist, on proinflammatory cytokines, apoptosis, and hepatocellular damage in cholestasis.</p> <p>Methods</p> <p>Forty male Wistar rats were randomly divided into four groups: I = sham operated, II = bile duct ligation (BDL), III = BDL + vehicle (gum Arabic), IV = BDL + fenofibrate (100 mg/kg/day). All rats were sacrificed on 7^thday after obtaining blood samples and liver tissue. Total bilirubin, aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase (ALP), gamma-glutamyl transferase, (GGT), tumor necrosis factor alpha (TNF-α), interleukin 1 beta (IL-1 β), and total bile acid (TBA) in serum, and liver damage scores; portal inflammation, necrosis, bile duct number, in liver tissue were evaluated. Apoptosis in liver was also assessed by immunohistochemical staining.</p> <p>Results</p> <p>Fenofibrate administration significantly reduced serum total bilirubin, AST, ALT, ALP, and GGT, TNF-α, IL-1 β levels, and TBA (<it>P </it>< 0.01). Hepatic portal inflammation, hepatic necrosis, number of the bile ducts and apoptosis in rats with BDL were more prominent than the sham-operated animals (<it>P </it>< 0.01). PPARα induction improved all histopathologic parameters (<it>P </it>< 0.01), except for the number of the bile duct, which was markedly increased by fenofibrate therapy (<it>P </it>< 0.01).</p> <p>Conclusion</p> <p>Short-term administration of fenofibrate to the BDL rats exerts beneficial effects on hepatocellular damage and apoptosis.</p

A Meta-Analysis of Probiotic Efficacy for Gastrointestinal Diseases

Background: Meta-analyses on the effects of probiotics on specific gastrointestinal diseases have generally shown positive effects on disease prevention and treatment; however, the relative efficacy of probiotic use for treatment and prevention across different gastrointestinal diseases, with differing etiology and mechanisms of action, has not been addressed. Methods/Principal Findings: We included randomized controlled trials in humans that used a specified probiotic in the treatment or prevention of Pouchitis, Infectious diarrhea, Irritable Bowel Syndrome, Helicobacter pylori, Clostridium difficile Disease, Antibiotic Associated Diarrhea, Traveler’s Diarrhea, or Necrotizing Enterocolitis. Random effects models were used to evaluate efficacy as pooled relative risks across the eight diseases as well as across probiotic species, single vs. multiple species, patient ages, dosages, and length of treatment. Probiotics had a positive significant effect across all eight gastrointestinal diseases with a relative risk of 0.58 (95 % (CI) 0.51–0.65). Six of the eight diseases: Pouchitis, Infectious diarrhea, Irritable Bowel Syndrome, Helicobacter pylori, Clostridium difficile Disease, and Antibiotic Associated Diarrhea, showed positive significant effects. Traveler’s Diarrhea and Necrotizing Enterocolitis did not show significant effects of probiotcs. Of the 11 species and species mixtures, all showed positive significant effects except for Lactobacillus acidophilus, Lactobacillus plantarum, and Bifidobacterium infantis. Across all diseases and probiotic species, positive significant effects of probiotics were observed for all age groups, single vs. multiple species, and treatment lengths

Heavy metal removal in aerobic selector activated sludge

Bu çalışmanın temel amacı, aktif çamur sistemlerine ilave edilen aerobik seçicilerin, ağır metal biyosorpsiyonunu teşvik ederek ağır metal giderim verimini arttırıp arttırmadığım araştırmaktır. Laboratuvar ölçekli aktif çamur sistemlerinden alman çamurla kesikli sorpsiyon deneyleri yapılmıştır. Elde edilen sonuçlar, aerobik seçicili aktif çamur sisteminin klasik aktif çamur sisteminden daha fazla ağır metal giderme kapasitesine sahip olduğunu göstermiştir. Her iki sistemden alınan aktif çamurun bakıra, krom (VI)' dan daha yüksek bir eğilim gösterdiği tespit edilmiştir. Aktif çamurda ortalama giderim verimleri, Cu için %74, Cr (VI) için ise %37 oranında gerçekleşmiştir. Aktif çamurun metal adsorpsiyonlan Freundlich izotermine göre düzenlenmiştir. Metal gideriminin büyük kısmının ilk 15-30 dakikada gerçekleştiği, denge durumuna ise 3-8 saatte ulaştığı tespit edilmiştir. Freundlich izotermleri, aerobik seçicili sistemin adsorpsiyon kapasitesinin Cu+2 için %15, Cr (VI) için ise %30 oranında klasik sistemden daha yüksek olduğunu göstermiştir. Ayrıca kesikli deneylerden elde edilen sonuçlar, adsorpsiyonun pH değişimlerinden doğrudan etkilendiğini ve bu etkinin Cu+2 ve Cr (VI) metalleri için ters etki yaptıklarım göstermiştir.The overall objective of this study was to determine whether the installation of an aerobic selector enhanced biosorption of heavy metals, thus increasing the removal efficiency of the activated sludge system. Batch sorption experiments were conducted using sludge harvested from the continuous Lab-scale activated sludge systems. The results indicated that the selector sludge had a greater capacity of metal adsorption compared to that of the conventional system sludge. Affinities of metals for activated sludge from both systems were found to be greater for Cu than that of Cr (VI). Average removal efficiencies by activated sludge appeared to be 74% and 37 % for Cu+2 and Cr (VI), respectively. Adsorptions of metals by activated sludge were fitted to Freundlich equilibrium isotherm. The majority of metal uptake occurred within the first 15-30 minutes and equilibrium was attained in 3-8 hours. Freundlich isotherms suggested that the adsorption capacity of selector system sludge in comparison to conventional system sludge was 15 % and 30 % greater for Cu+2 and Cr (VI), respectively. The results of the batch experiments also showed that adsorptions of Cu+2 and Cr (VI) were pH dependent; the effect being reverse for the two metals examined

Determination of mass transfer rates and deposition levels of polycyclic aromatic hydrocarbons (PAHs) using a modified water surface sampler

AbstractThere are different approaches to determine dry deposition velocities (Vd) and mass transfer coefficients (KG) of individual polycyclic aromatic hydrocarbons (PAHs). A modified water surface sampler (MWSS) and a high volume air sampler were concurrently used to determine Vd and KG in this study. Ambient air and deposition samples were collected from August 2004 to May 2005 in Bursa, Turkey. The mean particle-phase dry deposition flux of PAHs was 890±520 ng/m2 d, while the mean gas-phase PAH flux was 5 060±4 260 ng/m2 d. The ratio between fluxes and air concentration values was used in calculation of Vd and KG. The average calculated Vd and KG values for PAH compounds were 0.52±0.36cm/s and 0.69±0.41cm/s, respectively. Despite the fluctuation on seasonal atmospheric concentrations due to regional sources and meteorological conditions, there was no significant difference on deposition velocities and mass transfer rates. KG was also calculated using some models reported in the literature and models developed using the MWSS. The predicted KG determined by models developed using the MWSS was 0.59±0.02cm/s showing a close agreement with the experimentally measured values

No significant effect of helicobacter pylori eradication on serum lipoproteins: CagA negative patients may be an exception

Objective: Helicobacter pylori infection ¡s associated with a modified lipid profile, especially lower HDL cholesterol levels. Cytotoxin Associated Gene A (CagA) positive strains with increased inflammation may further deteriorate lipids levels. Therefore, we investigated the effect of Helicobacter pylori eradication on serum lipid levels, apolipoproteins, and high sensitive C reactive protein (hsCRP) and its relation with CagA status. Methods: Fifty-one patients with positive rapid urease test (33 female, 18 male) were enrolled in the study. Seventeen (33%) patients were CagA positive. Serum lipids, apolipoproteins, and hsCRP levels were measured at baseline and 3 months after eradication therapy. According to the urea breath test, patients with successful eradication formed Group 1, and those in whom eradication treatment failed constituted Group 2. Results: Lipid, apolipoprotein, and hsCRP levels did not change after treatment in Group 2. Serum lipids, Apo-B, and Lp(a), and hsCRP levels were also similar in Group 1 after eradication, whereas Apo-Al levels increased significantly in this group (p=0.002). In subgroup analysis, CagA negative, but not CagA positive, patients in Group 1 had increased Apo-Al levels after successful eradication. Conclusion: With the exception of an isolated increase in Apo-Al levels in CagA negative subjects, eradication of Helicobacter pylori does not seem to have a significant effect on the lipid profile. ©Copyright 2012 by Gazi University Medical Faculty