PURPOSE: We aimed to study the pattern of liver-injury in children with dengue fever (DF) and validate serum aminotransferase ≥1,000 IU/L as a marker of severe DF. METHODS: Children admitted with DF were included. DF was defined by presence of clinical criteria and positive serological or antigen tests in absence of other etiology. DF severity was graded as dengue without or with warning signs and severe dengue. Liver-injury was defined as alanine aminotransferase (ALT) more than twice the upper limit of normal (boys, 30 IU/L; girls, 21 IU/L). RESULTS: Of 372 children with DF, 144 (38.7%) had liver-injury. Risk of liver-injury and aminotransferase levels increased with DF severity (p < 0.001). Recommended ALT and aspartate aminotransferase (AST) cut-off at ≥1,000 IU/L had sensitivity 4.8% (5/105), specificity 99.3% (265/267) for detection of severe DF. In children with ALT and AST < 1,000 IU/L (n=365), the area under receiver operating curves for prediction for severe DF, were 0.651 (95% confidence interval [CI], 0.588–0.714; p < 0.001) for ALT and 0.647 (95% CI, 0.582–0.712; p < 0.001) for AST. Serum ALT at 376 IU/L and AST at 635 IU/L had sensitivity and specificity comparable to ≥1,000 IU/L for defining severe DF. CONCLUSION: Liver-injury is common in DF. The ALT and AST levels increase with DF severity. ALT and AST levels of ≥1,000 IU/L could be lowered to 376 IU/L and 635 IU/L respectively for defining severe DF.
Alanine Transaminase ; Arboviruses ; Aspartate Aminotransferases ; Child* ; Dengue ; Female ; Fever* ; Humans ; Sensitivity and Specificity ; Severe Dengue* ; Transaminases*

PURPOSE: With a remarkable increase in the prevalence of childhood obesity, the prevalence of nonalcoholic fatty liver disease is assumed to be increasing. The aim of this study is to evaluate the prevalence of nonalcoholic fatty liver disease, hyperlipidemia, and glucose intolerance in normal and obese children. METHODS: A total of 2,206 elementary students (boys: 1340, girls: 866) were grouped according to obesity index; normal group and obesity group (mild, moderate, severe). Aspartate aminotransferase (AST, SGOT) and alanine aminotransferase (ALT, SGPT) were measured with total cholesterol, triglyceride, and fasting blood glucose. RESULTS: Compared with the 4.6% of elevated aminotransferases in normal group, obese groups showed significantly higher prevalence; 12.1% in mild obesity group, 19.4% in moderate group, and 21.6% in severe group (p<0.0001). The prevalence of hypertriglyceremia was 16.9% in normal weight group, which was significantly lower than obesity group (mild obesity group 30.3%, moderate and severe 37.6%, 38.2% each). In boys, the prevalences of elevated aminotransferases in normal weight and obese groups (mild, moderate, severe) were 6.8%, 18.0%, 23.0%, and 26.0%, respectively (p<0.0001). In girls, those were 2.1%, 5.1%, 12.0%, and 12.6%, respectively (p<0.0001). The prevalence of hypertriglyceremia was relative to severity of obesity in boys and girls (p<0.0001). CONCLUSION: The prevalence of elevated serum liver enzymes increased with severity of obesity. For the prevention and treatment of fatty liver and hypertriglycemia, it is important to lower the obesity degree and enforce the education for a weight loss in the student and the parents.
Alanine Transaminase ; Aspartate Aminotransferases ; Blood Glucose ; Child* ; Cholesterol ; Education ; Fasting ; Fatty Liver ; Female ; Glucose Intolerance ; Humans ; Hyperlipidemias ; Liver* ; Obesity ; Parents ; Pediatric Obesity ; Prevalence* ; Transaminases ; Triglycerides ; Weight Loss

No abstract available.
Liver ; Norovirus ; Transaminases

When halothane was first introduced into the clinical anesthesia in 1956, it was acclaimed as the ideal anesthetic agent. Soon after its clinical introduction, reports were published regarding jaundice and hepatic necrosis following its use. Stock and Strunin group the etiologic factors as biotransformation, hypersensitivity (immune-related), hypoxia and pharmacogenetic. In contrast, Calahan and Mangano list as possible causes hypoxia, trauma, viral hepatitis and toxic injury. A few cases of hepatitis following enflurane anesthesia have been described and a diagnosis of enflurane hepatitis was made. However, it is much rare than halothane hepatitis and the case remains unproven. Regional anesthesia with local anesthetic agent (lidocaine or bupivacaine) does not cause hepatic injury, even patients with moderate hepatocellular disease may well be able to metabolize durgs normally. Decrease in hepatic blood flow in healthy individuals will cause no problems with regional anesthesia, as the blood flow and cardiac output can be reestablished with the use of fluids or appropriate vasoconstrictors. This study was undertaken to evaluate the effects of halothane, enflurane, and regional anesthesia with lidocaine or bupivacaine on liver function, particularly with serum glutamic oxaloacetic and pyruvic transaminases (SGOT and SGPT) values which are the most frequently determined indicators of possible liver disease. Whereas SGOT is present in a variety of tissues, SGPT appears to be the liver-specific transaminase. We studied randomly-selected 219 patients, ASA class I or II, aged 15-68 yr, scheduled for elective surgery. They had no history of liver disease, and preoperative liver function tests were within normal limit. And we excluded blood transfused cases in this study. They were divided into three groups according to the anesthetic agent used; Group I: Halothane anesthesia (116 cases). Group II: Regional anesthesia (50 cases). Group III: Enflurane anesthesia (53 cases). We also divided subgroups according to the duration of anesthesia in each group; Subgroup A (Subg-A): under 2 hours of anesthesia. Subgroup B (Subg-B): more than 2 hours of anesthesia. SGOT and SGPT were measured before surgery, and on 1st, 3rd and 5th postoperatine days. The results we as follows: 1) The values of SGOT and SGPT were increased (p<0.01) in both Subg-A and B of Group I. However, on the 1st post-operative day they were more prominently elevated than the other postoperative days (P<0.05), but clinically the change of values was all within normal limits. 2) The values of SGOT were increased (P<0.05) in Subg-B of Group II on the 3rd postoperatine day hut clinically were within normal limits. The values of SGPT in Group II were slightly increased within normal ranges. 3) The values of SGOT were increased in Subg-A (P<0.05) and Subg-B (P<0.01) of Group III on the 1st postoperatine day, but clinically were within normal limits. The values of SGPT in Group III were slightly increased within normal ranges. 4) In comparing Group I and Group II, the value of SGOT in Group I was significantly increased than Group II (P<0.05), but clinically was within normal limits, and the change in that of SGPT was not significant. 5) In comparing Group II and Group III, the value of SGOT in Group II was significantly increased (P<0.01) on the 5th postoperatine day than Group III, but clinically was within normal limits, and changes of SGPT were not significant. 6) In comparing Group II and Group III, the values of SGOT and SGPT were not significantly different. 7) The results show that the effect of halothane on liver function (SGOT, SGPT) is not significantly different from those of enflurane and regional anesthesia with local anesthetics.
Alanine Transaminase* ; Anesthesia ; Anesthesia, Conduction* ; Anesthetics, Local ; Anoxia ; Aspartate Aminotransferases* ; Biotransformation ; Bupivacaine ; Cardiac Output ; Diagnosis ; Enflurane* ; Halothane* ; Hepatitis ; Humans ; Hypersensitivity ; Jaundice ; Lidocaine ; Liver ; Liver Diseases ; Liver Function Tests ; Necrosis ; Reference Values ; Transaminases ; Vasoconstrictor Agents

PURPOSE: We sought to examine the relationship between the clinical manifestations of nonspecific reactive hepatitis and respiratory virus infection in pediatric patients. METHODS: Patients admitted to the pediatric unit of Konyang University Hospital for lower respiratory tract disease between January 1, 2014 and December 31, 2014 and who underwent reverse transcriptase polymerase chain reaction tests were examined. The patients were divided into those with increased levels of alanine aminotransferase (ALT) or aspartate aminotransferase (AST) and those with normal ALT or AST levels. Further, patients with increased ALT and AST levels were individually compared with patients in the normal group, and the blood test results were compared according to the type of respiratory virus. RESULTS: Patients with increased ALT or AST levels had one more day of hospital stay, on average, compared with patients in the normal group (5.3±3.1 days vs. 4.4±3.0 days, p=0.019). Patients in the increased ALT level group were younger and had a longer mean hospital stay, compared with patients in the normal group (p=0.022 and 0.003, respectively). The incidences of increased ALT or AST were the highest in adenovirus infections (6/24, 25.0%), followed by enterovirus (2/11, 18.2%) and respiratory syncytial virus A (21/131, 16.0%) infections. CONCLUSION: Nonspecific reactive hepatitis is more common among patients with adenovirus, enterovirus and respiratory syncytial virus infection, as well as among those infected at a younger age. Compared with AST levels, ALT levels are better indicators of the severity of nonspecific reactive hepatitis.
Adenoviridae ; Adenoviridae Infections ; Alanine Transaminase ; Aspartate Aminotransferases ; Child* ; Enterovirus ; Hematologic Tests ; Hepatitis ; Humans ; Incidence ; Length of Stay ; Respiratory Syncytial Viruses ; Respiratory Tract Diseases ; Respiratory Tract Infections ; Reverse Transcriptase Polymerase Chain Reaction ; Transaminases

PURPOSE: To study temporal pattern of serum liver enzymes levels in newborns with hepatic injury associated with birth asphyxia (BA). METHODS: Singleton term newborns with BA and < or =72 hours of age admitted to neonatal intensive care unit were prospectively enrolled. Term newborns with physiological jaundice and without BA were studied as controls. Serum liver enzymes were measured at <24 hours, 24-72 hours, and at 6-12 days of age for cases and at 1-6 days of age for controls. BA was defined by 1 minute Apgar score <7 or delayed or absent cry with hypoxic ischemic encephalopathy. BA-associated liver injury was defined as serum alanine aminotransferase (ALT) elevation beyond +2 standard deviation (ALT > +2 SD) above the mean of control subjects at any of the three time points. RESULTS: Sixty controls and 62 cases were enrolled. Thirty-five cases (56%) developed BA-associated liver injury (ALT>81 IU/L). They had higher serum levels of ALT, aspartate aminotransferase, lactate dehydrogenase than the control infants, with peak at 24-72 hours. In controls, serum liver enzyme levels were significantly higher in appropriate-for-date (AFD) babies than small-for-date (SFD) babies. Serum enzyme pattern and extent of elevation were comparable between SFD and AFD babies. Degree of serum liver enzyme elevation had no relationship with severity of hypoxic encephalopathy. CONCLUSION: Serum liver enzyme elevation is common in BA; it peaks at 24-72 hours followed by a sharp decline by 6-12 days of age. Pattern and extent of enzyme elevation are comparable between SFD and AFD babies.
Alanine Transaminase ; Apgar Score ; Aspartate Aminotransferases ; Asphyxia Neonatorum ; Asphyxia* ; Hepatitis ; Humans ; Hypoxia, Brain ; Hypoxia-Ischemia, Brain ; Infant ; Infant, Newborn ; Intensive Care, Neonatal ; Ischemia ; Jaundice ; L-Lactate Dehydrogenase ; Liver* ; Parturition* ; Prospective Studies ; Transaminases

Aripiprazole is an atypical antipsychotic that acts as a partial agonist of dopamine type 2 receptors as well as 5-HT1A receptors. It is used in the treatment of schizophrenia and in type 1 bipolar disorder for mania. Because aripiprazole is well tolerated with few side effects it is used off-label in other psychotic disorders. The prevalence of abnormal liver function tests with antipsychotic use is 32%, with clinically significant effects in 4% of cases. No cases of aripiprazole-induced liver injury have been published. We report a 28-year-old female who presented with non-affective first-episode psychosis and who was treated with aripiprazole. Initially she was medicated with 10 mg per day, with an increase to 20 mg per day on the 12th day of hospitalization. Nine days after she became icteric, with nausea and had a vomiting episode. Laboratory analysis revealed a very high level of alanine aminotransferase, and minor to moderately high levels of aspartate aminotransferase, alkaline phosphatase, gamma-glutamyl transferase, and bilirubin. Aripiprazole was tapered and paliperidone was started with the improvement of clinical and laboratory findings.
Adult ; Alanine Transaminase ; Alkaline Phosphatase ; Aripiprazole ; Aspartate Aminotransferases ; Bilirubin ; Bipolar Disorder ; Dopamine ; Female ; Hepatitis ; Hospitalization ; Humans ; Liver ; Liver Function Tests ; Nausea ; Paliperidone Palmitate ; Prevalence ; Psychotic Disorders ; Receptor, Serotonin, 5-HT1A ; Schizophrenia ; Transaminases ; Transferases ; Vomiting

BACKGROUND/AIMS: Noninvasive markers of liver fibrosis in alcoholic liver disease (ALD) are crucial to establish early intervention. Previous studies have suggested that plasma levels of cleaved keratin-18 (K18; M30) fragments can predict the severity of liver disease. The aim of this study was to correlate plasma M30 levels with stages of liver fibrosis in ALD. METHODS: Patients with ALD (n=139, 79.1% males) and liver histology were included, and plasma samples were collected to quantify plasma M30 levels. Patients were stratified into five groups by fibrosis stage (F0=14; F1=15; F2=35; F3=17; and F4=58) according to the Kleiner score. Differences between groups were evaluated using the chi-square test or analysis of variance. Trends by fibrosis stage were calculated by logistic regression analysis, and sensitivity, specificity and positive and negative predictive values were determined. RESULTS: There were no significant differences in M30 levels among fibrosis stages. The correlation between plasma M30 levels and fibrosis was poor (Pearson’s correlation coefficient=0.13, Spearman rho=0.20 [p=0.02]), and M30 levels did not correlate with alcohol-specific histological features. However, significant correlations of M30 levels with aspartate aminotransferase (Spearman rho=0.653, p < 0.001) and alanine aminotransferase (Spearman rho=0.432, p < 0.001) were found. M30 levels of >200 U/L reveal a sensitivity for predicting cirrhosis of 84.5% with a negative predictive value of 73.5%. CONCLUSIONS: Plasma M30 levels are often elevated in ALD and correlate with serum transaminases but do not reflect fibrosis. The usefulness as a prognostic marker awaits evaluation in prospective studies.
Alanine Transaminase ; Alcoholics* ; Apoptosis ; Aspartate Aminotransferases ; Caspases ; Early Intervention (Education) ; Fibrosis ; Humans ; Keratin-18 ; Liver Cirrhosis* ; Liver Diseases ; Liver Diseases, Alcoholic ; Liver* ; Logistic Models ; Plasma* ; Prospective Studies ; Sensitivity and Specificity ; Transaminases

ω-transaminases are able to catalyze the reversible transfer of amino groups between diverse amino compounds (such as amino acids, alkyl amines, aromatic amines) and carbonyl compounds (such as aldehydes, ketones, ketoacids). ω-transaminases exhibit great application prospects in the field of chiral amine biosynthesis because of their desirable properties, such as wide range of substrates, high stereoselectivity, and mild catalytic conditions. It is therefore important for China to develop efficient, specific, and environment-friendly chiral amine production technologies with independent intellectual property rights, which is of great significance for the development of pharmaceutical, pesticide, and material industries. This review systematically summarizes the Chinese patents regarding ω-transaminase filed by Chinese institutions in the recent decade. The development of ω-transaminase resource, enzymatic property improvement by protein engineering, application in chiral amine synthesis, and development of production technologies are elaborated. This review will shed light on further basic and application studies of ω-transaminase.
Transaminases/genetics* ; Amino Acids ; China ; Aldehydes ; Amines

The term "neonatal hepatitis" is used to designate hepatic inflammation of unknown cause. Liver failure is present with coagulopathy, metabolic instability, cholestasis, or other manifestations. It can be present with a chronic pattern with near normal serum aminotransferases, consistent with a prenatal liver injury. There have been case reports which show intrauterine intracranial hemorrhages associated with trauma, malformations or maternal coagulopathy. However, to our knowledge, there is no report of intrauterine intracranial hemorrhage resulting from fetal coagulopathy caused by chronic prenatal liver injury. We report a rare case of intrauterine intracranial hemorrhage due to intrauterine coagulopathy caused by chronic intrauterine liver failure.
Cholestasis ; Inflammation ; Intracranial Hemorrhages* ; Liver Failure* ; Liver* ; Transaminases