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Liver disease
Published in Catherine Nelson-Piercy, Handbook of Obstetric Medicine, 2020
The usual pattern of abnormal LFTs is as follows: Moderate (less than threefold) elevation in transaminases (ALT is the most sensitive).Raised alkaline phosphatase (beyond normal pregnancy values).Raised gamma-glutamyl transpeptidase (γGT) (about 20% of cases).Mild elevation in bilirubin (less common).Increased serum total bile acid concentration.Primary bile acids (cholic acid and chenodeoxycholic acid) may increase ten to 100-fold.In some instances, an increased concentration of bile acids may be the only biochemical abnormality or raised bile acids may precede other liver function abnormality.Pruritus may precede the derangement of LFTs, or vice versa, and serial measurements are advised in women with persistent typical itching or deranged LFTs.
Biliary Atresia
Published in Gianfranco Alpini, Domenico Alvaro, Marco Marzioni, Gene LeSage, Nicholas LaRusso, The Pathophysiology of Biliary Epithelia, 2020
Laboratory evaluation at presentation is notable for a moderate conjugated hyperbilirubinemia, and mildly to moderately elevated serum transaminases (100–200 units/dl). The conjugated bilirubin level is usually less than 7 mg/dl and is usually 50–80% of the total bilirubin. Levels of gamma glutamyl transpeptidase can be more strikingly elevated. Measures of liver synthetic function, including albumin and prothrombin time, are usually normal, during the initial laboratory evaluation.
Alcohol Pharmacology and Pharmacotherapy of Alcoholism
Published in Sahab Uddin, Rashid Mamunur, Advances in Neuropharmacology, 2020
Aman Upaganlawar, Sindhu Ramesh, Ellery Jones, Vishnu Suppiramaniam, Timothy Moore, Muralikrishnan Dhanasekaran
Topiramate, an anticonvulsant drug has been demonstrated in improving drinking behavior by decreasing heavy drinking episodes as well as maintaining abstinence. Topiramate enhances GABAA-mediated inhibitory action as well as antagonize glutamate receptors. Other mechanisms include inhibition of carbonic anhydrase and inhibition of sodium and calcium channels (Dodgson et al., 2000; White et al., 2000; Zhang et al., 2000). The reinforcing effects seen in alcohol abuse are due to enhanced dopamine release from the nucleus accumbens. This is inhibited through glutamate antagonism mediated by topiramate (Johnson and Ait-Daoud, 2010). The increase in GABA neuronal activity in nucleus accumbens is inhibited by topiramate. Through these mechanisms, topiramate may decrease dopamine activity in the reward pathway with alcohol ingestion and reduce withdrawal symptoms (Paparrigopoulos et al., 2011). Furthermore, decreased craving for alcohol and markedly decrease in serum gamma-glutamyl transpeptidase (GGT) levels (an important biomarker of chronic alcohol abuse) were observed with topiramate (Johnson et al., 2003a). Adverse events include burning sensation of skin (paresthesia), alteration of taste sensation, anorexia, inability to concentrate and focus. Dose-related adverse effects restrict the use of topiramate, thereby, requiring weekly dosage titration to effective doses of 100–300 mg/day. Pharmacotherapy with topiramate in those with alcohol abuse should be accompanied by counseling or psychotherapy for best outcomes.
Evaluating efficacy and safety of loncastuximab tesirine injection for the treatment of adult patients with relapsed or refractory large B-cell lymphoma
Published in Expert Review of Anticancer Therapy, 2021
Nausheen Ahmed, Mehdi Hamadani
Safety data from the 88 patients in part I (dose escalation) and 95 in part II (dose expansion portion) of the study were combined in the final report [17]. The safety and DLT analysis comprised 183 and 73 patients, respectively. Median doses administered was f 2 doses (1–24) of loncastuximab tesirine, with median weight-adjusted dose per cycle of 129.9 µg/kg (range 14.6–204.4 µg/kg) for a median duration of 64 days (range, 22–532 days). Most patients (99%) had a least one TEAE. Hematologic toxicities were common, including thrombocytopenia, neutropenia, and anemia. Common non-hematologic toxicities in the order of frequency included fatigue, nausea, peripheral edema, and increased γ-glutamyltransferase (GGT). Rash occurred in 24.6% of patients, most commonly in sun-exposed skin, edema, or effusion occurred in 47% of patients and generally occurred after 2 cycles. Dexamethasone pre-medication significantly reduced these adverse effects and was introduced in part II (120 µg/kg, 34.6%; 150 µg/kg, 47.8%) vs Part 1 (120 µg/kg, 68.8%; 150 µg/kg, 63.2%)
Clinical and biochemical differences between hantavirus infection and leptospirosis: a retrospective analysis of a patient series in Belgium
Published in Acta Clinica Belgica, 2020
Emma Bakelants, Willy Peetermans, Katrien Lagrou, Wouter Meersseman
Blood results are shown in Table 3. Five patients had normochromic, normocytic anemia, three patients had normal values of hemoglobin. Leukocytosis was observed in five patients. White blood cell differentiation showed a tendency to lymphocytopenia and neutrophilia. Thrombocytopenia was seen in four patients, the other four patients had a normal value of platelets. CRP was highly elevated, median value was 263.2 mg/l and with a range of 80.3 mg/l–374.2 mg/l. Five patients had acute kidney failure with creatinine values above 1.17 mg/dl. Hypoalbuminemia was observed in three patients. Five patients presented with elevated transaminases, they also showed elevated gamma glutamyltransferases (GGT). One patient had normal transaminases but had a cholestatic biochemical pattern and a raised bilirubin level. Total bilirubin was also raised in three other cases. Two patients had normal liver tests without bilirubin elevation. CK’s were elevated in two patients, LDH was also elevated in two patients.
Substance use disorders: diagnosis and management for hospitalists
Published in Journal of Community Hospital Internal Medicine Perspectives, 2020
Ahmed K. Pasha, Arnab Chowdhury, Sanah Sadiq, Jeremiah Fairbanks, Shirshendu Sinha
A comprehensive history, clinical exam and temporal relationship of symptom onset with alcohol cessation or reduction in alcohol consumption are important. No specific laboratory investigation is necessary to make this diagnosis. It is important to make sure there is no other medical or psychiatric cause for the symptoms. It is not uncommon for patients with AWS to not provide information regarding their alcohol use history. By the time patient presents, BAL may be undetectable. Laboratory tests could be obtained which help in confirming alcohol use in those you suspect alcohol withdrawal. These tests have variable sensitivity and specificity and have to be interpreted with caution. Three evidence-based test results that suggest recent alcohol use are elevated Gamma-glutamyl transferase (GGT) (blood), AST:ALT ratio>2 (blood) and elevated ethyl glucuronide (EtG)(urine) [13].