Effect of Diabetes Mellitus on the Excretory Function of the Liver

Diabetes mellitus is an internationally recognized health problem and a leading cause of death worldwide. However, the most significant increase in prevalence is expected to occur in Asia and Africa, where most patients will be found by 2030. Diabetic Mellitus is a clinical and metabolic syndrome characterized by abnormal carbohydrate, protein, and fat metabolism resulting in hyperglycemia, increased protein breakdown, Ketosis or acidosis due to absolute or relative deficiency, and insulin resistance, thereby leading to vascular complications such as retinopathy, neuropathy, and nephropathy. This study evaluated the levels of plasma bilirubin, ALP, and GGT among diabetic patients. A total of eighty (80) individuals were recruited for the study comprising of forty (40) diabetes patients with age range 25-80 years and forty (40) control subjects with the age range of 20-30 years in Irrua/Ekpoma, Edo State, Nigeria. The study was carried out within six months (December 2018 - May 2019). All patients were diabetes. The serum Alkaline Phosphatase (ALP), gamma-glutamyl transferase (GGT), total and conjugated bilirubin were assayed by spectrophotometric method, and the data obtained were statistically analyzed using SPSS version 23.0 software. Serum levels of ALP, GGT, Total and unconjugated bilirubin were significantly elevated (P<0.05) among diabetes patients than control subjects except for conjugated bilirubin which was lower (P>0.05) when compared with that of the control subjects. The mean serum levels of ALP, GGT, total, unconjugated and conjugated bilirubin of male diabetes patients were non statistically significant (P>0.05) when compared with female diabetes subjects except the age (P<0.05). These findings indicate that hepatic injury was more likely among diabetes, and liver enzymes (ALP, GGT) are critical for monitoring glucose control concomitant with hepatic injury. Bilirubin is a potentially important biomarker for the assessment of the hepatic excretory system in diabetes mellitus.

Protein-synthesizing, bile-forming, urea-forming and carbohydrate functions in cows with fatty degeneration of the liver

In dairy farms of Ukraine, where highly productive dairy cows are kept, liver lesions are often diagnosed in the postpartum period. Postmortem studies of the liver of cows that were forcibly slaughtered showed that in mostly animals were diagnosed with fatty degeneration of the liver. The main causes of fatty hepatosis were violations of the structure of rations, imbalance of feeding on essential nutrients and biologically active substances, low content of easily digestible carbohydrates and high protein content. The study was performed on cows aged 4–5 years with productivity for the previous lactation of 5.600–7.500 L of milk, in a winter-stall period of keeping, 2–3 weeks after calving. According to clinical and biochemical blood tests, two groups of cows were formed – 50 clinically healthy and 50 cows with fatty liver disease. In cows diagnosed with fatty liver degeneration, the disease was manifested by decreased productivity and fatness, loss of appetite, oppression, hypotony of the rumen, reticulum and omasum. In some cows, there was pain at the liver area, increasing boundaries of hepatic dullness, jaundice of the visible mucous membranes and sclera. The blood serum of all cows with fatty liver disease established a decrease in albumin content, indicating impaired protein synthesis function of the liver. In some cows, the content of total protein in the serum increased due to globulin fractions, mainly gamma globulins. The ratio between the content of albumins and globulins decreased, which indicates the development in the blood of sick animals dysproteinemia. The development of fatty infiltration of the liver caused an increase in the concentration of bile acids in the serum of all sick cows. This is due to reduced conjugation and excretion of cholates by affected hepatocytes from the bile capillaries. The formation, absorption, conjugation, and excretion of bilirubin in the bile is disturbed, which causes the accumulation of total and conjugated bilirubin in the serum of sick animals. The cholesterol content in the blood of cows decreased, caused a violation of the esterification of its esters by hepatocytes. The established changes in the content of bile acids, total and conjugated bilirubin, and cholesterol in the blood of sick cows indicate a violation of bile secretion, bile production, and cholestasis development. In some cows with fatty liver degeneration, urea formation function and carbohydrate function are impaired, leading to a decrease in blood urea content and glucose.

The Role of Ursodeoxycholic Acid and Phenobarbital in a Child with Cholestasis: A Longitudinal Study

BACKGROUND: Cholestasis is a condition that starts in the 1st months of life and progresses with direct (conjugated) bilirubin increase and jaundice as a result of impaired bile production or excretion. Its incidence is known as 1 in 2500 live births. This study shows the effectiveness of ursodeoxycholic acid (UDCA) and phenobarbital in infant cholestasis treatment. CASE REPORT: A 28-days-old boy came with a complaint of yellow eyes. At the age of 3 days, the patient looked yellow, had a fever and difficulty drinking, received phototherapy. After 2 weeks of treatment with neonatal sepsis, the patient was discharged in a stable. The skin appears yellow. The laboratory results show anemia, elevated conjugated bilirubin, and signs of infection; the abdominal ultrasonography shows that the liver and gallbladder were normal. The diagnosis is cholestasis due to sepsis. After 3 months of treatment with UDCA and phenobarbital, jaundiced disappeared, and liver function tests were normal. When the patient is 2 ½ years old, the growth and development suit his age. CONCLUSION: Early diagnosis and timely treatment of UDCA and phenobarbital play a role in cholestasis improvement. On long-term observation, the child’s growth and development are suitable according to his age and average laboratory results.

Recurrent episodes of jaundice in a young man with Dubin-Jhonson syndrome

Dubin-Johnson syndrome is a rare inherited disorder associated with a defect in the ability of hepatocytes to secrete conjugated bilirubin into bile. Patients usually present with chronic or recurrent attacks of jaundice with conjugated hyperbilirubinemia. A dark pigment accumulates in the liver,which is responsible for itscharacteristic black color.It is a benign condition with a normal life expectancy and no specific treatment is required. We report a case of Dubin-Johnson syndrome in a 20-year-old man with recurrent episodes of jaundice, whose laboratory data revealed a mild conjugated hyperbilirubinemia, remaining liver function tests were normal and diagnosis was confirmed by the presence of dark brown pigment on microscopy of liver biopsy. BIRDEM Med J 2021; 11(3): 235-238

Extracorporeal Albumin Dialysis in Liver Failure with MARS and SPAD: A Randomized Crossover Trial

<b><i>Introduction:</i></b> Liver failure is associated with hepatic and extrahepatic organ failure leading to a high short-term mortality rate. Extracorporeal albumin dialysis (ECAD) aims to reduce albumin-bound toxins accumulated during liver failure. ECAD detoxifies blood using albumin dialysis through an artificial semipermeable membrane with recirculation (molecular adsorbent recirculating system, MARS) or without (single-pass albumin dialysis, SPAD). <b><i>Methods:</i></b> We performed a randomized crossover open trial in a surgical intensive care unit. The primary outcome of the study was total bilirubin reduction during MARS and during SPAD therapies. The secondary outcomes were conjugated bilirubin and bile acid level reduction during MARS and SPAD sessions and tolerance of dialysis system devices. Inclusion criteria were adult patients presenting liver failure with factor V activity &#x3c;50% associated with bilirubin ≥250 μmol/L and a complication (either hepatic encephalopathy, severe pruritus, or hepatorenal syndrome). For MARS and SPAD, the dialysis flow rate was equal to 1,000 mL/h. <b><i>Results:</i></b> Twenty crossovers have been performed. Baseline biochemical characteristics (bilirubin, ammonia, bile acids, creatinine, and urea) were not statistically different between MARS and SPAD. Both ECAD have led to a significant reduction in total bilirubin (−83 ± 67 μmol/L after MARS; −122 ± 118 μmol/L after SPAD session), conjugated bilirubin (−82 ± 61 μmol/L after MARS; −105 ± 96 μmol/L after SPAD session), and bile acid levels (−64 ± 75 μmol/L after MARS; −56 ± 56 μmol/L after SPAD session), all nondifferent comparing MARS to SPAD. <b><i>Conclusion:</i></b> A simple-to-perform SPAD therapy with equal to MARS dialysate flow parameters provides the same efficacy in bilirubin and bile acid removal. However, clinically relevant endpoints have to be evaluated in randomized trials to compare MARS and SPAD therapies and to define the place of SPAD in the liver failure care program.

EXPRESS: A survey of the reactivity of in-vitro diagnostic bilirubin reagents developed in Japan using artificially prepared bilirubin materials: A comparison of synthetic delta, unconjugated, and taurine-conjugated bilirubin

Background: In-vitro diagnostic (IVD) bilirubin reagents based on oxidation with bilirubin oxidase (BOX) or vanadic acid (VA) for total and direct-reacting bilirubin (TB and DB) are widely used in Japan; however, their reactivity to unconjugated and conjugated bilirubin (UCB and CB) and delta bilirubin (DLB) has not been completely disclosed by manufacturers. We used artificially prepared bilirubin materials to investigate the reactivity with four IVD bilirubin reagents. Methods: Porcine UCB solution, chemically synthesized ditaurobilirubin (DTB) solution, and chemically synthesized DLB solution were used as surrogates of naturally occurring UCB, CB, and DLB, respectively. The TB and DB concentrations were measured by three BOX methods and one VA method, and the observed concentrations were compared with those obtained by the diazo-based reference measurement procedure (RMP). Results: The UCB and DLB concentrations were similar when any of the four IVD bilirubin reagents were used during TB measurement. This was consistent with RMP and exhibited a converged inter-method variation. Compared with RMP, significantly low DTB concentrations were observed by the IVD bilirubin reagents despite the converged inter-method variation. In DB measurement, some reagents reacted doubtfully with UCB, while showed lower DTB concentrations than its corresponding TB concentration. Reactivity with DLB was different for each method including RMP. Some reagents were developed to react less with DLB and others to strongly react with DLB. Conclusions: We revealed the reactivity of IVD-TB and IVD-DB reagents to artificially prepared bilirubin materials, and their consistency with RMP. The DB data results vary depending on the reagents used.

Clinicopathological Study of the Biliary and Duodenal Complications in Patients of Chronic Pancreatitis - A Prospective Observational Study in a Tertiary Care Centre in Eastern India

BACKGROUND Chronic pancreatitis is a chronic inflammatory disease, causing complications related to the duodenum like duodenal obstruction or complications related to the biliary system like cholestasis, cholangitis, secondary biliary cirrhosis and cholangiocarcinoma. The purpose of the study was to observe the occurrence, clinical manifestations and outcome of the complications and foster a deeper understanding of the long-term prognosis of patients suffering from chronic pancreatitis. METHODS This was a prospective observational study. After taking informed consent, total 50 patients admitted in hospital with features suggestive of chronic pancreatitis with or without duodenal or biliary complications were selected and were followed up throughout the course of the disease. All demographic parameters, diabetic status, liver function test, USG findings suggestive of duodenal obstruction or biliary abnormalities, upper GI endoscopy, computed tomography of whole abdomen, MR cholangio pancreatography and barium meal were studied. RESULTS Chronic pancreatitis is more common in male and the common age of presentation is between 45 and 54 years. 12 patients were diabetics. 42 % of the total 50 patients developed transient hyperbilirubinaemia. 5 male patients and 1 female patient had persistent hyperbilirubinaemia and had persistently raised values of alkaline phosphatase. 1 male and 2 female patients also suffered from hypoproteinaemia. About 42 % of the patients of chronic pancreatitis suffered from transient rise in conjugated bilirubin and were managed conservatively. 12 % of the patients suffered from persistently raised conjugated bilirubin, indicating biliary obstruction. 22 % of patients developed cholangitis responding to conservative management. 12 % of cases, 5 males and 1 female suffered from biliary stricture, and were managed surgically with hepaticojejunostomy. No cases of cholangiocarcinoma were detected. CONCLUSIONS The most common complication in patients of chronic pancreatitis is transient biliary stasis, others being cholangitis and persistent hyperbilirubinaemia. No cases of cholangiocarcinoma were detected. KEYWORDS Billiary, Duodenal, Complications, Stricture, Cholestasis, Cholangitis, Chronic, Pancreatitis

Changes in metabolic nutrients utilization and alterations in biochemical and haematological indices in broilers fed graded levels of dietary Moringa oleifera

Graded levels of full-fat undecorticated Moringa oleifera seed meal (MOSM) were evaluated in diets of 96-day old broilers at 2.5, 5.0 and 7.5% while a maize-soybean diet was used as a reference diet. Nutrients utilization by the broilers and effects of the virgin dietary MOSMon serum chemistry, haematology and some bio-data-protein efficiency ratio (PER) and nitrogen metabolism (NM) were used as response criteria for the evaluation. The metabolic utilization of nutrients, most of the serum chemistry and haematological parameters decreased in response to increasing dietary levels of MOSM except values on products of metabolism like creatinine, uric acid, bilirubin and conjugated bilirubin that tended to elevate with increasing levels of dietary unprocessed MOSM. Since no mortality was recorded in this experiment even at 7.5% MOSM inclusion, further research is on-going to determine the lethal level to poultry including other monogastric animals.