Search

We report an imported case of myositis caused by a rare parasite, Haycocknema perplexum, in Australia in a 37-year-old man who had progressive facial, axial, and limb weakness, dysphagia, dysphonia, increased levels of creatine kinase and hepatic aminotransferases, and peripheral eosinophilia for 8 years. He was given extended, high-dose albendazole. [ABSTRACT FROM AUTHOR]

We report an imported case of myositis caused by a rare parasite, Haycocknema perplexum, in Australia in a 37-year-old man who had progressive facial, axial, and limb weakness, dysphagia, dysphonia, increased levels of creatine kinase and hepatic aminotransferases, and peripheral eosinophilia for 8 years. He was given extended, high-dose albendazole. [ABSTRACT FROM AUTHOR]

Background: (1) To determine the prevalence of hepatopancreatic injury in coronavirus disease 2019 (COVID-19) patients. (2) To correlate hepatopancreatic injury in COVID-19 with mortality, disease severity, and length of stay in this cohort. Results: Forty-five thousand three hundred sixty patients were included in the analysis, 62.82% of which had either hepatic or pancreatic injury. There was a significant upward trend in transaminases, alkaline phosphatase, prothrombin time, bilirubin, lactate dehydrogenase, and lipase and a downward trend in albumin with an increase in disease severity. COVID-19-positive patients with hepato-pancreatic injury have a significantly higher mortality (OR 3.39, 95%CI 3.15–3.65) after controlling for the differences in age, sex, race/ethnicity, liver cirrhosis, and medication exposures. They also have increased disease severity (OR 2.7, 95%CI 2.5–2.9 critical vs mild/moderate; OR 1.4, 95% CI 1.3–1.5 severe vs mild/moderate) and longer hospital length of stay (2 days). Conclusion: COVID-19 can cause liver injury. Mortality, disease severity, and hospital length of stay are increased in COVID-19 patients with hepatopancreatic injury. [ABSTRACT FROM AUTHOR]

Background Cutaneous leishmaniasis (CL) is a neglected tropical disease causing an estimated 1 million new cases annually. While antimonial compounds are the standard of care worldwide, they are associated with significant adverse effects. Miltefosine, an oral medication, is United States (US) Food and Drug Administration approved to treat CL caused by Leishmania braziliensis , Leishmania guyanensis , and Leishmania panamensis. Evidence of efficacy in other species and side-effect profiles in CL has been limited. Methods Twenty-six patients with CL were treated with miltefosine at the US National Institutes of Health. Species included L. braziliensis (n = 7), L. panamensis (n = 5), Leishmania mexicana (n = 1), Leishmania infantum (n = 3), Leishmania aethiopica (n = 4), Leishmania tropica (n = 2), Leishmania major (n = 1), and unspeciated (n = 3). Demographic and clinic characteristics of the participants, response to treatment, and associated adverse events were analyzed. Results Treatment with miltefosine resulted in cure in 77 % (20/26) of cases, with cures among all species. Common adverse events included nausea/vomiting (97%) and lack of appetite (54%). Clinical management or dose reduction was required in a third of cases. Gout occurred in 3 individuals with a prior history of gout. Most laboratory abnormalities, including elevated creatinine and aminotransferases, were mild and normalized after treatment. Conclusions Our data suggest that miltefosine has good but imperfect efficacy to a wide variety of Leishmania species. While side effects were common and mostly mild to moderate, some resulted in discontinuation of therapy. Due to oral administration, broad efficacy, and manageable toxicities, miltefosine is a viable alternative treatment option for CL, though cost and lack of local availability may limit its widespread use. [ABSTRACT FROM AUTHOR]

Objective: We sought to evaluate the relationship between acute liver injury (ALI) and statins utilizing the Veterans Affairs Informatics and Computing Infrastructure (VINCI) database. Methods: This retrospective cohort study, spanning January 2000–December 2018, compared ALI (aminotransferase > 200 U/L, severe ALI, and hospitalization with ALI) in statin users and non-users among uninfected, hepatitis C virus (HCV) mono-infected, human immunodeficiency virus (HIV)/HCV co-infected, and HIV mono-infected veterans within 18 months. We estimated adjusted Cox proportional hazards models comparing statin users and non-users and comparing statin intensity level with non-use; and estimate Cox proportional hazards models utilizing time-dependent coding of statin intensity. Adjusted models included restricted cubic splines of the propensity score as an adjustment variable. Results: From a total of 166,439 patients who met the study criteria, statin initiators were older, had higher values of body mass index, higher values of low-density lipoprotein cholesterol and triglycerides, and lower values of high-density lipoprotein cholesterol. HCV mono-infected and HIV/HCV co-infected cohorts had the highest rates of ALI, and statin users had lower rates across all outcomes of ALI compared with non-users in unadjusted analysis. Statin use is associated with a lower risk of all ALI outcomes compared with non-users. Patients on a high intensity are not associated with a statistically significant increase in risk for any ALI outcome. For each additional 30 days of treatment, there was a reduced risk of any ALI outcome across all cohorts. Conclusions: Statin initiators had a lower risk of any ALI outcome compared with non-users within 18 months regardless of HIV and/or HCV status. [ABSTRACT FROM AUTHOR]

We analyzed data from 2012 to 2016 for patients who were hospitalized or who died after ≥1 dose of isoniazid-rifapentine for treatment of latent Mycobacterium tuberculosis infection. No patients died; 15 were hospitalized. Nine patients experienced hypotension, and 5 had elevated serum aminotransferases, reinforcing the need for vigilant monitoring during treatment. [ABSTRACT FROM AUTHOR]

Iron poisoning was a leading cause of pediatric morbidity and mortality. We sought to assess whether the removal of strict iron packaging requirements in 2003 resulted in an increase in iron-related morbidity and mortality in pediatric exposures. We performed a retrospective cohort study utilizing the National Poison Data System from 2000 to 2017. A total of 4110 exposures met inclusion criteria: 847 from before (2000-2003) and 3263 after removal of unit-dose package regulations (2004-2017). The incidence of any marker of severity (7.2% vs 3.8%; odds ratio = 0.51, 95% confidence interval = 0.37-0.69) and frequency of deferoxamine use were both higher in the early time period (2.6% vs 1.0%; odds ratio = 0.38, 95% confidence interval = 0.22-0.66). There was no difference in the frequency of key serious effects (acidosis, elevated transaminases, hypotension). Despite removal of iron packaging regulations in the United States, there continues to be a decrease in the incidence of severe iron exposures in children. [ABSTRACT FROM AUTHOR]

Oral fostamatinib is an orally administered small molecule spleen tyrosine kinase (SYK) inhibitor approved for the treatment of adults with chronic immune thrombocytopenia (ITP) who have an inadequate response to a previous treatment. Fostamatinib has a unique mechanism of action, whereby its active metabolite targets the SYK-mediated pathway of platelet destruction. In clinical trials, fostamatinib provided durable responses in adults with chronic ITP who had not responded or had relapsed following treatment with one or more prior ITP therapies, including corticosteroids, thrombopoietin receptor agonists, rituximab, and/or splenectomy. Most patients who respond to fostamatinib maintain platelet counts of > 50 × 109/L for periods of ≥ 12 months. The most common adverse events reported with fostamatinib in clinical trials were diarrhea, hypertension, nausea, and increased transaminase levels. [ABSTRACT FROM AUTHOR]

Abstract: Aims: Adolescents with Type 2 diabetes are more likely to have cardiovascular disease (CVD) risk factors but there are few data available among adolescents with prediabetes. We characterized CVD risk factors among adolescents with prediabetes in the USA and compared levels of those risk factors with adolescents with normal glucose. Methods: The 2005–2014 National Health and Nutrition Examination Survey, a nationally representative cross‐sectional survey, included 2843 adolescents aged 12–19 years after excluding those with diabetes. Prediabetes was based on an HbA1c, a fasting plasma glucose or a 2‐h plasma glucose. We determined cardiometabolic risk factors in adolescents using age‐appropriate cut‐off points. We calculated odds ratios (OR) and 95% confidence intervals (CI) of these outcomes associated with having prediabetes compared with normal glucose levels. Results: The weighted prevalence of prediabetes was 17.4%. After adjustment, prediabetes (vs. normal glucose) was associated with obesity (OR 1.86, 95% CI 1.35–2.55), low HDL‐cholesterol (OR 1.62, 95% CI 1.08–2.44), high triglycerides (OR 1.61, 95% CI 1.12–2.30) and elevated liver transaminase (OR 2.09, 95% CI 1.19–3.67), but not with hypertension (OR 1.77, 95% CI 0.88–3.54), elevated total cholesterol (OR 1.30, 95% CI 0.82–2.06), elevated LDL‐cholesterol (OR 1.59, 95% CI 0.88–2.88) or albuminuria (OR 1.24, 95% CI 0.76–2.02). Conclusions: US adolescents with prediabetes are more likely to have obesity, low HDL‐cholesterol, high triglycerides and elevated liver transaminase than adolescents with normal glucose. Addressing prediabetes in youth is important for the prevention of Type 2 diabetes and long‐term comorbidity. [ABSTRACT FROM AUTHOR]

Background: Nonalcoholic fatty liver disease (NAFLD) has been reported to have a negative effect on bone mineral density (BMD) in Asian populations. Whether such an association exists in Western populations is less clear. Methods: This cross-sectional analysis of data from NHANES III, a United States national health survey conducted from 1988 to 1994, included 6089 participants aged 40–75 years, selected after excluding people with hepatitis virus serology, elevated alcohol consumption, decreased renal function, or steroid use, and pregnant females. The main outcome, BMD at the femoral neck, was measured using dual-energy X-ray absorptiometry. The primary exposure, NAFLD, was defined as moderate or severe hepatic steatosis diagnosed using abdominal ultrasonography. Result: After controlling for gender and menopausal status, race/ethnicity, age and body mass index, NAFLD was not significantly associated with BMD (beta coefficient: −0.006, 95%CI: −0.016, 0.003). A secondary analysis categorized participants with NAFLD according to their serum alanine aminotransferase (ALT) levels into high and normal ALT NAFLD groups, and compared these with the non-NAFLD group. NAFLD with higher levels of ALT was associated with lower levels of BMD (beta coefficient: −0.023, 95% CI: −0.044, −0.002). Conclusion: This study showed a relationship between NAFLD with high ALT and lower BMD in the general U.S. population. [ABSTRACT FROM AUTHOR]

Background: Previous studies combining PD-1 checkpoint inhibitors with tyrosine kinase inhibitors of the VEGF pathway have been characterised by excess toxicity, precluding further development. We hypothesised that axitinib, a more selective VEGF inhibitor than others previously tested, could be combined safely with pembrolizumab (anti-PD-1) and yield antitumour activity in patients with treatment-naive advanced renal cell carcinoma.Methods: In this ongoing, open-label, phase 1b study, which was done at ten centres in the USA, we enrolled patients aged 18 years or older who had advanced renal cell carcinoma (predominantly clear cell subtype) with their primary tumour resected, and at least one measureable lesion, Eastern Cooperative Oncology Group performance status 0-1, controlled hypertension, and no previous systemic therapy for renal cell carcinoma. Eligible patients received axitinib plus pembrolizumab in a dose-finding phase to estimate the maximum tolerated dose, and additional patients were enrolled into a dose-expansion phase to further establish safety and determine preliminary efficacy. Axitinib 5 mg was administered orally twice per day with pembrolizumab 2 mg/kg given intravenously every 3 weeks. We assessed safety in all patients who received at least one dose of axitinib or pembrolizumab; antitumour activity was assessed in all patients who received study treatment and had an adequate baseline tumour assessment. The primary endpoint was investigator-assessed dose-limiting toxicity during the first two cycles (6 weeks) to estimate the maximum tolerated dose and recommended phase 2 dose. This study is registered with ClinicalTrials.gov, number NCT02133742.Findings: Between Sept 23, 2014, and March 25, 2015, we enrolled 11 patients with previously untreated advanced renal cell carcinoma to the dose-finding phase and between June 3, 2015, and Oct 13, 2015, we enrolled 41 patients to the dose-expansion phase. All 52 patients were analysed together. No unexpected toxicities were observed. Three dose-limiting toxicities were reported in the 11 patients treated during the 6-week observation period (dose-finding phase): one patient had a transient ischaemic attack and two patients were only able to complete less than 75% of the planned axitinib dose because of treatment-related toxicity. At the data cutoff date (March 31, 2017), 25 (48%) patients were still receiving study treatment. Grade 3 or worse treatment-related adverse events occurred in 34 (65%) patients; the most common included hypertension (n=12 [23%]), diarrhoea (n=5 [10%]), fatigue (n=5 [10%]), and increased alanine aminotransferase concentration (n=4 [8%]). The most common potentially immune-related adverse events (probably related to pembrolizumab) included diarrhoea (n=15 [29%]), increased alanine aminotransferase concentration (n=9 [17%]) or aspartate aminotransferase concentration (n=7 [13%]), hypothyroidism (n=7 [13%]), and fatigue (n=6 [12%]). 28 (54%) patients had treatment-related serious adverse events. At data cutoff, 38 (73%; 95% CI 59·0-84·4) patients achieved an objective response (complete or partial response).Interpretation: The treatment combination of axitinib plus pembrolizumab is tolerable and shows promising antitumour activity in patients with treatment-naive advanced renal cell carcinoma. Whether or not the combination works better than a sequence of VEGF pathway inhibition followed by an anti-PD-1 therapy awaits the completion of a phase 3 trial comparing axitinib plus pembrolizumab with sunitinib monotherapy (NCT02853331).Funding: Pfizer Inc. [ABSTRACT FROM AUTHOR]

Background: Dyslipidemia, typically recognized as high serum triglyceride, high low-density lipoprotein cholesterol (LDL-C) or low high-density lipoprotein cholesterol (HDL-C) levels, are associated with nonalcoholic fatty liver disease (NAFLD). However, low LDL-C levels could result from defects in lipoprotein metabolism or impaired liver synthetic function, and may serve as ab initio markers for unrecognized liver diseases. Whether such relationships exist in the general population has not been investigated. We hypothesized that despite common conception that low LDL-C is desirable, it might be associated with elevated liver enzymes due to metabolic liver diseases. Methods and Findings: We examined the associations between alanine aminotransferase (ALT), aspartate aminotransferase (AST) and major components of serum lipid profiles in a nationally representative sample of 23,073 individuals, who had no chronic viral hepatitis and were not taking lipid-lowering medications, from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2010. ALT and AST exhibited non-linear U-shaped associations with LDL-C and HDL-C, but not with triglyceride. After adjusting for potential confounders, individuals with LDL-C less than 40 and 41–70 mg/dL were associated with 4.2 (95% CI 1.5–11.7, p = 0.007) and 1.6 (95% CI 1.1–2.5, p = 0.03) times higher odds of abnormal liver enzymes respectively, when compared with those with LDL-C values 71–100 mg/dL (reference group). Surprisingly, those with HDL-C levels above 100 mg/dL was associated with 3.2 (95% CI 2.1–5.0, p<0.001) times higher odds of abnormal liver enzymes, compared with HDL-C values of 61–80 mg/dL. Conclusions: Both low LDL-C and high HDL-C, often viewed as desirable, were associated with significantly higher odds of elevated transaminases in the general U.S. adult population. Our findings underscore an underestimated biological link between lipoprotein metabolism and liver diseases, and raise a potential need for liver evaluation among over 10 million people with particularly low LDL-C or high HDL-C in the United States. [ABSTRACT FROM AUTHOR]

Acetaminophen (APAP) overdose is a very common cause of drug overdose and acute liver failure in the US and Europe. Mechanism-based biomarkers of APAP toxicity have the potential to improve the clinical management of patients with large-dose ingestions of APAP. The current approach to the management of APAP toxicity is limited by imprecise and time-constrained risk assessments and late-stage markers of liver injury. A recent study of 'low-risk' APAP overdose patients who all received treatment with N-acetylcysteine found that cell death biomarkers were more sensitive than alanine aminotransferase (ALT) and APAP concentrations in predicting the development of acute liver injury. The data suggest a potential role for new biomarkers to identify 'low-risk' patients following APAP overdose. However, a practical and ethical consideration that complicates predictive biomarker research in this area is the clinical need to deliver antidote treatment within 10 h of APAP overdose. The treatment effect and time-dependent nature of N-acetylcysteine treatment must be considered in future 'predictive' toxicology studies of APAP-induced liver injury. [ABSTRACT FROM AUTHOR]

Abstract: Background: Chronic infection with hepatitis E virus (HEV) has recently been recognized in immunocompromised or immunosuppressed individuals. Case Report: We report a case of concurrent HEV and human herpes virus-6 (HHV-6) infection, documented by serum HEV RNA and HHV-6 DNA, in an orthotopic liver transplant (OLT) recipient in the United States, where HEV genotype 3 infection, although prevalent, is considered to be self-limited and almost always asymptomatic. The coinfection was accompanied by elevated serum aminotransaminases, liver biopsies demonstrating chronic hepatitis, and the presence of HEV RNA in the tissue. After lowering of immunosuppressive therapy and 2 courses of valganciclovir, sequential clearance of the viruses and normalization of the serum aminotransaminases were observed. Conclusions: HEV infection can lead to chronic hepatitis in OLT recipients, and evaluation of this virus should be considered in immunosuppressed individuals with unexplained liver test abnormalities. [Copyright &y& Elsevier]

Background: Low serum levels of vitamin D are associated with metabolic syndrome. Participants in NHANES III with unexplained elevation in ALT levels have high prevalence of metabolic syndrome. We hypothesized that the serum concentrations of vitamin D were inversely associated with unexplained elevation in ALT.Methods: A total of 6,826 fasting subjects underwent morning physical examination and met the inclusion and exclusion criteria. From these participants, we have constructed cases with unexplained elevation in ALT (n = 308) and compared their serum vitamin D concentrations to matched controls with normal ALT (N = 979). We examined the prevalence of unexplained elevation in ALT level across different quartiles of vitamin D levels.Results: Participants with unexplained elevation in ALT had significantly lower serum vitamin D levels compared to controls (61.8 ± 26.0 nmol/l vs. 66.8 ± 27.1 nmol/l, P < 0.01). The unadjusted prevalence of unexplained elevation in ALT in patients with highest to lowest quartiles of serum vitamin D levels were 21.4, 21.4, 25.6, and 31.5%, respectively. Compared to lowest quartile, patients with top two quartiles of serum vitamin D levels had significantly lower prevalence of unexplained elevation in ALT (OR, 95% CI for highest quartile 0.62 [0.43-0.89] and for third quartile 0.61 [0.42-0.86]). This relationship persisted even after controlling for metabolic syndrome, insulin resistance, and serum triglycerides.Conclusions: This study suggests a significant inverse relationship between serum vitamin D levels and unexplained elevation in ALT. Further studies are needed to confirm this observation and to understand the basis for and implications of this observation. [ABSTRACT FROM AUTHOR]

Abstract: Background: Acetaminophen (APAP) toxicity is commonly encountered in the Emergency Department. Until 2004, treatment consisted of either oral N-acetylcysteine (NAC) or filtered oral NAC administered intravenously (i.v.). Intravenous acetylcysteine (Acetadote) is a new Food and Drug Administration-approved i.v. formulation of acetylcysteine manufactured by Cumberland Pharmaceuticals in Nashville, Tennessee. Little post-marketing data exists on the effectiveness and safety of i.v. acetylcysteine. Objectives: We evaluated the clinical presentations and outcomes of patients treated with i.v. acetylcysteine for APAP toxicity. Methods: We performed a retrospective chart review of patients treated with i.v. acetylcysteine for APAP ingestion. The primary outcome measures were: adverse reactions to and effectiveness of i.v. acetylcysteine, as defined by elevation of transaminases, liver failure, renal failure, death, and hospital length of stay (LOS). Data collected included: comorbidities, allergies, intentionality, timing and dosing of i.v. acetylcysteine, hospital LOS, transaminases > 1000 IU/L, development of liver failure requiring transplant, development of renal failure requiring hemodialysis, death, and anaphylactoid reactions. Results: Sixty-four patients met our study criteria. Overall, 16 (25%) patients developed transaminases > 1000 IU/L, 4 (6%) of them died and 2 (3%) received liver transplants. Of the 15 patients (23%) treated within 8 h, none died or developed liver or renal failure, and only 1 developed transient transaminase elevation > 1000 IU/L. In the patients treated outside of 8 h, the median LOS was 3 days, whereas the group treated within 8 h had a median LOS of only 1 day. Six (9%) patients developed anaphylactoid reactions, 2 of whom received the i.v. acetylcysteine bolus over 15 min. Five of these patients were treated pharmacologically and completed treatment, and one had treatment discontinued for undocumented reasons. Conclusion: Intravenous acetylcysteine seemed to be a safe and effective formulation of N-acetylcysteine. [Copyright &y& Elsevier]

Background: We sought to determine the effect of statin therapy on serum AST and ALT levels in a cohort of HCV-infected veterans with well-characterized liver disease.Study: We examined liver biopsy records of consecutive HCV-infected patients and identified 20 patients who were prescribed statins. We matched them on age, stage of fibrosis, and time between HCV diagnosis and statin start dates with up to four HCV-infected patients who did not use statins. ALT and AST values from up to four time points within 1 year of follow-up were abstracted from the medical record. We compared median ALT and AST levels using Wilcoxon-Mann-Whitney tests and assessed changes in ALT and AST over time between the statin and non-statin groups using a non-parametric repeated measures ANOVA model, adjusting for the matching factors, receipt of HCV treatment, BMI, and diabetes.Results: Patients prescribed statins had higher median BMIs, were more likely to have diabetes, and had higher total cholesterol levels. Median baseline ALT levels were higher among those prescribed statins (P = 0.04) while median baseline AST levels were lower among statin users (P = 0.03). From baseline to follow-up, the median decreases in both ALT (-13.5 vs. -4.0) and AST (-4.5 vs. -0.5) were significantly larger among statin users compared to non-statin users (P = 0.03 and P = 0.0007, respectively) even after adjustment.Conclusions: Among HCV-infected patients AST and ALT levels for those prescribed statins decreased over a 6 to 12-month follow-up period compared to patients not taking statins. [ABSTRACT FROM AUTHOR]

Latent tuberculosis infection (LTBI) is a condition in which a person is infected with Mycobacterium tuberculosis, but does not currently have active tuberculosis disease. An estimated 10 to 15 million persons in the United States have LTBI. Because 5 to 10 percent of persons with LTBI are at risk of progressing to active disease, identification and treatment of LTBI are essential for the elimination of tuberculosis. Screening is recommended for high-risk persons, including immigrants; residents and employees of congregate living facilities; and persons infected with human immunodeficiency virus. Targeted tuberculin skin testing remains the most acceptable method of LTBI screening. New tests are being developed, the most promising of which are in vitro interferon-gamma release assays. All screened persons found to have LTBI should be offered treatment, regardless of age. Before initiating treatment, active tuberculosis must be ruled out by patient history, physical examination, and chest radiography. The treatment of choice for LTBI is isoniazid for nine months. Hepatotoxicity is the most severe adverse effect. Isoniazid should be discontinued if transaminase levels are greater than three times the upper limit of normal in symptomatic patients or five times the upper limit of normal in asymptomatic patients. [ABSTRACT FROM AUTHOR]

Acetaminophen overdoses are the number one cause of acute liver failure (ALF) in the United States; they account for 50% of all cases of ALF and carry a 30% mortality. Nevertheless, acetaminophen is a highly successful product with sales easily exceeding a billion dollars annually. A narcotic-containing acetaminophen preparation is the number one generic drug sold in the United States. Historically, a strong association was claimed with alcohol as a co-factor and the accidental nature of ingestions was emphasized but the association with alcohol remains a matter of debate. Recently, a very reliable assay has been developed which detects a byproduct of the toxic reaction, acetaminophen-CYS adducts, protein-acetaminophen compounds that are released from damaged hepatocytes in similar fashion to aminotransferases. The US Acute Liver Failure Study Group is a multi-center network established to gather data prospectively on all forms of acute liver failure, a rare but often fatal condition. The group has data on more than 500 acetaminophen cases and described 275 of them in detail in a recent paper. The clinical pattern of presentation is somewhat different in the US compared with the UK, since nearly half are considered to be unintentional, the result of overuse of acetaminophen-containing compounds for pain relief, without suicidal intent. Despite the relatively good prognosis for acetaminophen overdoses, 30% die once acute liver failure occurs and this is the largest cause of death in the entire ALF registry. [ABSTRACT FROM AUTHOR]

Background: Automatic identification of notifiable diseases from electronic medical records can potentially improve the timeliness and completeness of public health surveillance. We describe the development and implementation of an algorithm for prospective surveillance of patients with acute hepatitis B using electronic medical record data. Methods: Initial algorithms were created by adapting Centers for Disease Control and Prevention diagnostic criteria for acute hepatitis B into electronic terms. The algorithms were tested by applying them to ambulatory electronic medical record data spanning 1990 to May 2006. A physician reviewer classified each case identified as acute or chronic infection. Additional criteria were added to algorithms in serial fashion to improve accuracy. The best algorithm was validated by applying it to prospective electronic medical record data from June 2006 through April 2008. Completeness of case capture was assessed by comparison with state health department records. Findings: A final algorithm including a positive hepatitis B specific test, elevated transaminases and bilirubin, absence of prior positive hepatitis B tests, and absence of an ICD9 code for chronic hepatitis B identified 112/113 patients with acute hepatitis B (sensitivity 97.4%, 95% confidence interval 94-100%; specificity 93.8%, 95% confidence interval 87-100%). Application of this algorithm to prospective electronic medical record data identified 8 cases without false positives. These included 4 patients that had not been reported to the health department. There were no known cases of acute hepatitis B missed by the algorithm. Conclusions: An algorithm using codified electronic medical record data can reliably detect acute hepatitis B. The completeness of public health surveillance may be improved by automatically identifying notifiable diseases from electronic medical record data. [ABSTRACT FROM AUTHOR]

The article investigates the association between increased serum aminotransferase levels and higher risks of obstructive sleep apnea (OSA) among obese children by researchers in the U.S. The results indicate that obese children have higher possibilities of attaining fatty liver disease (FLD) and OSA. However, there are still uncertainties regarding the contribution of OSA on the development of FLD.

Background: Hepatitis C virus (HCV) is the most prevalent chronic viral illness in the United States. Many individuals with virus HCV are opioid dependent requiring treatment with opiate substitution treatment such as buprenorphine. Previous reports in the literature have suggested hepatotoxicity with buprenorphine tempering initial enthusiasm of the safety of buprenorphine in HCV-infected patients.Methods: As part of an ongoing SAMHSA-funded grant to expand opiate substitution therapy with buprenorphine, all opioid-dependent patients seeking treatment with buprenorphine undergo a laboratory evaluation including transaminases (AST/ALT) as well as laboratory evaluation for acute and chronic hepatitis.Results: Of the 121 patients screened for entry into buprenorphine treatment, 4 patients had evidence of acute HCV infection.Conclusions: Despite markedly elevated transaminases in the setting of acute hepatitis C infection, these patients tolerated buprenorphine treatment with improvement in their transaminases during the course of buprenorphine treatment. [ABSTRACT FROM AUTHOR]

Background: Hepatitis C virus (HCV) infects 4 million people in the USA, with a prevalence of 1.4%. The seropositivity rate among potential lung transplant candidates is 1.9%, yet little information is available regarding outcomes of lung transplantation in HCV-positive lung transplant recipients. Our study reports outcomes of lung transplantation in HCV-positive recipients and compares them to HCV-negative controls. Methods: A retrospective analysis of the Cleveland Clinic Foundation’s lung transplant database (465 patients) identified six HCV-positive patients. Demographic data, etiology of HCV infection, HCV viral load pre- and post-transplant, pre-transplant hepatic pathology, serial transaminases, incidence of acute hepatitis, graft function data and patient survival data were obtained by chart extraction. Results: Five HCV-positive recipients had a pre-transplant liver biopsy, none of whom had evidence of cirrhosis pre-transplant. Although HCV RNA levels markedly increased post-transplant, no concomitant increase in transaminases was noted. There was no significant difference in the incidence of acute rejection at 1 year in our HCV-positive cohort compared with the HCV-negative lung transplant recipients from our institution. One patient developed bronchiolitis obliterans syndrome (BOS) during the follow-up period. Two patient deaths occurred, one at 8 months and the other at 2 years post-transplant. No evidence of hepatic dysfunction was noted in either deceased patient. The four surviving patients are alive at a median 3.2 years (range 1 to 6 years). Conclusions: No significant difference in patient or graft survival was noted between the HCV-positive lung transplant recipients and the HCV-negative recipients. [Copyright &y& Elsevier]

OBJECTIVES: The presence of elevated serum aminotransferase activity is a sign of possible underlying liver disease. We aimed to describe the prevalence and associations of elevated serum aminotransferase activity in a recent, nationally representative U.S. survey. METHODS: We described the prevalence and predictors of elevated alanine aminotransferase (ALT >43 IU/L) or elevated aspartate aminotransferase (AST >40 IU/L) activity among 6,823 participants of the National Health and Nutrition Examination Survey (NHANES) conducted between 1999 and 2002. We compared our findings to the results already published based on the NHANES conducted between 1988 and 1994. RESULTS: In NHANES 1999–2002, the prevalences of elevated ALT, AST, or either ALT or AST were 8.9%, 4.9%, and 9.8%, respectively, in the entire population and 7.3%, 3.6%, and 8.1%, respectively, after excluding participants who tested positive for hepatitis C virus (HCV) antibody or reported excessive alcohol consumption. Strong predictors of elevated ALT activity included increasing waist circumference and body mass index, alcohol consumption, male sex, Mexican American ethnicity, decreasing age, and presence of HCV antibody. In NHANES 1988–1994, which employed a different assay methodology, the prevalences of elevated aminotransferases were approximately half of the prevalences we describe in NHANES 1999–2002, but the predictors of elevated ALT activity were similar. CONCLUSIONS: The current prevalence of elevated ALT activity in the United States (8.9%) is more than double that of previously available estimates. This prevalence is very high (7.3%) even among persons without viral hepatitis C or excessive alcohol consumption and is strongly associated with risk factors for nonalcoholic fatty liver disease. [ABSTRACT FROM AUTHOR]

Describes the factors that complicate anti-tuberculosis therapy in a large observational cohort of HIV-infected persons in the United States. Hepatotoxicity; Adverse events; Elevation of the upper limits of normal of aminotransaminases.

The purpose of this study was to assess changes in liver enzyme levels among opioid-dependent patients treated with buprenorphine. Liver enzyme levels were evaluated among 120 individuals before treatment and following a minimum of 40 days of buprenorphine treatment (2, 4, or 8 mg/70 kg/day). Among patients with a history of hepatitis, AST and ALT levels significantly increased (p < .05) with buprenorphine treatment. The odds of observing an increase in AST were determined to be dependent upon buprenorphine dose (p < .05; odds ratio = 1.23 per 1 mg increase in dose). These results suggest that liver enzyme levels should be monitored carefully when patients with hepatitis are treated with buprenorphine. [ABSTRACT FROM AUTHOR]

Background Murine typhus is an arthropod borne disease of worldwide distribution with recent reemergence in the United States of America. There is limited data about the presentation, treatment and outcomes in the pregnant population. We report two cases of murine typhus in pregnancy, as well as a case series based in literature published between 1990 and 2019. Methods A comprehensive search in Pubmed database using words murine typhus, pregnancy, R. typhi and endemic typhus was done. Exclusion criteria were asymptomatic murine typhus in pregnancy and undiagnosed febrile illness in pregnancy. Results Six articles met the criteria of symptomatic pregnant murine typhus infection. Four case reports plus our own 2 case reports, and 2 observational population studies. A total of 35 pregnancy patients were identified. Distribution was worldwide. Gestational age at presentation varied. Patients frequently presented with prolonged duration of fevers prior to presentation, headache, rash, thrombocytopenia and elevated hepatic transaminases. Diagnosis was mainly based on serology. Treatment varied and 8 cases did not receive any treatment at all. Overall pregnancy outcome was favorable, except in an Asian cohort reporting 6 patients with poor pregnancy outcomes. Conclusion The lack of data about murine typhus in pregnancy is of serious concern. Increase awareness of different presentations is needed in this population. Murine typhus infection can mimic other pregnancy-related pathologies that have very different treatments and outcomes. More data are needed about effective treatment and safety of doxycycline use during pregnancy. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Examines the prevalence of abnormal serum alanine aminotransferase levels in obese and type II diabetic patients in the United States. Use of the SUDAAN ans SAS statistical analyses; Comparison between the alanine aminotransferase levels of men and women; Distinction between the serum hepatitis C antibody of diabetic and non-diabetic persons.

The article cites a clinical observation on the acute hepatitis E virus (HEV) infection. It highlights the case of a 45-year-old HIV-positive man who had mildly elevated aminotransferase levels that were asymptomatic. It discusses the nature of HEV and concludes that sporadic HEV infection may occur in U.S. patients who have no history of international travel.

This article reports that nonalcoholic fatty liver disease is linked to the metabolic syndrome. In the U.S., the prevalence and cause of elevated aminotransferase levels, often used to detect liver disease, are unknown. This study analyzed data on 15,676 individuals 17 years of age and older from the Third National Health and Nutrition Examination Survey. The investigators defined an aminotransferase elevation as an aspartate aminotransferase level greater than 37 U/L and an alanine aminotransferase level greater than 42 U/L. The investigators found that 8% of the sample had an aminotransferase elevation.

The article reports that the Food & Drug Administration has approve the adefovir dipivoxil tablets for treating chronic hepatitis B infection who have active viral replication and either histologically active disease or elevated serum alanine aminotransferase or aspartate aminotransferase levels in adults in the U.S. The drug can slacken the progression of the disease by blocking the virus replication.