Introduction: ILeptospirosis is an important zoonotic disease commonly found in tropical or sub-tropical countries. The most severe form is Weil's syndrome which presents with jaundice, renal failure, and bleeding diatheses. Although jaundice occurs in 38% of patients with leptospirosis, no studies in Asia have focused on the liver biochemical profile of these patients. Characterization of liver biochemical profile and ultrasonographic findings may shed more light on the disease process. Identification of liver biochemical parameters that portend a poor prognosis may also allow for early aggressive intervention. Objective: To describe the liver biochemical profile and liver ultrasonographic findings in adult patients with laboratoryconfirmed leptospirosis, admitted at a tertiary hospital in Manila, Philippines. The association of clinical and laboratory features with clinical outcomes (i.e., severe liver injury, Weil’s syndrome, and mortality) was also investigated. Methods: This retrospective cross-sectional study reviewed all available cases of adult patients with laboratoryconfirmed leptospirosis admitted in the Philippine General Hospital from January 2009 to August 2018. The clinical features, liver biochemical profiles, and ultrasound findings were recorded and analyzed. Comparison between the means of each group based on clinical outcome (i.e., mortality, Weil’s syndrome) was done via Students’ t-test for continuous variables, and calculation of the Odds Ratio for categorical variables. Results: Total and direct bilirubin levels were elevated in patients with leptospirosis compared to serum aminotransferases and alkaline phosphatase levels which were only mildly elevated. Abdominal ultrasound showed typically un-enlarged livers with normal parenchymal echogenicity, normal spleens, and non-dilated biliary trees. Dyspnea was associated with an increased odds for mortality. Although jaundice was present in 39.5% of patients and significantly associated with severe liver injury, this was not associated with mortality. Liver biochemical test values did not differ among patients who expired and those who survived to discharge. The presence of myalgia and abdominal pain increased the odds for Weil's syndrome. Conclusion To date, no local studies have fully described the liver biochemical profile of patients with leptospirosis. Our findings are compatible with previous studies showing that leptospirosis typically presents with predominantly elevated direct bilirubin from cholestasis and systemic infection. Contrary to previous literature, however, our study found no association between jaundice and mortality.
Leptospirosis

Introduction: Rising prevalence of non-alcoholic fatty liver disease (NAFLD) suggests its correlation with liver failure worldwide. To date, there is no proven pharmacologic therapy for NAFLD. Pentoxifylline (PTX) with its anti-tumor necrosis factor properties has shown improvement of histological parameters, reductions in transaminase levels and serum cytokines among patients with NAFLD. The main objective is to determine the effectiveness of PTX in the reduction of progression of NAFLD in terms of reducing levels of aspartate transaminase (AST) and alanine transaminase (ALT), improving liver histology parameters and in decreasing TNF-α, IL-6 and IL-8. Methods: A comprehensive literature search showed seven randomized controlled trials (N=222) comparing PTX (1,200mg/day) with placebo. Two reviewers independently selected studies, assessed quality, and extracted and pooled outcomes including AST levels, ALT levels, serum cytokines and liver histology. All selected studies were found to be of low risk of bias based on Cochrane risk of bias assessment tool for randomized trials. Statistical analysis and forrest plot generation were done using the Review Manager Software 5.3. Results: Pooled results showed that PTX significantly reduced the ALT (WMD= -20.08; 95% CI: -40.20, 0.05; p=0.05) and AST (WMD= -11.38; 95% CI: -20.47, -2.29; p=0.01) in NAFLD patients. PTX significantly improved lobular inflammation (WMD= -0.45; 95% CI: -0.89, -0.01; p=0.04), fibrosis (WMD= -0.39; 95% CI: 0.83, 0.05; p=0.08) and NAS score (WMD= -0.52; 95% CI: -1.06, 0.0; p=0.051). Among serum cytokines, greater reduction was demonstrated in TNF-α (WMD= -20.20; 95% CI: -50.46, 10.41; p=0.20). Conclusion Pentoxifylline (PTX) decreases the aminotransferase activities, improves the liver histology and TNF-α of NAFLD patients. Demonstrating effects on serum TNF-α which plays a key role in progression to hepatic steatosis, it may be used as an adjunct to diet and lifestyle modifications in the treatment of NAFLD.
Meta-Analysis ; Non-alcoholic Fatty Liver Disease ; Pentoxifylline