Hypoxic hepatitis with marked elevation of serum ferritin probably due to activation of intrahepatic macrophages: another form of hypoxic hepatitis hitherto not reported?

Background and study aims: Hypoxic hepatitis (HH) is an acute liver injury that develops in patients with underlying diseases, such as heart failure, respiratory failure, septic/toxic shock. However, some patients do not have underlying diseases or episodes which are known to result in HH. Here, we analyzed the clinical characteristics of this particular patient group (called ‘unknown HH’ hereafter) to understand its pathogenesis. Patients and methods: Between October 2010 and January 2016, 157 consecutive patients with acute liver injury were admitted to our hospital. Among these patients, 15 patients were categorized as unknown HH. Medical histories and blood test results of unknown HH were analyzed. Results: Among 15 patients of unknown HH, 11 were habitual drinkers and all experienced one of digestive symptoms which might result in mild hypovolemia such as vomiting, diarrhea, appetite loss, and epigastralgia. All patients of unknown HH presented marked elevation of serum ferritin concentration paralleled with aspartate transaminase (AST), alanine transaminase (ALT), and lactate dehydrogenase (LDH) concentrations. The serum levels of ferritin, ALT, LDH, and prothrombin time-international normalized ratio (PT-INR) were rapidly decreased during hospitalization and all 15 patients of unknown HH recovered without any complication. Conclusions: We found the particular group of HH with marked elevation of serum ferritin probably due to intrahepatic macrophage activation. Anti-inflammatory treatments might be effective for this group of hypoxic hepatitis.

Central precocious puberty after resection of a virilising adrenocortical oncocytic tumour

Adrenocortical oncocytic tumours are a histological subtype of adrenal neoplasms with a distinctive morphological appearance. Since these tumours are composed of cells of the adrenal cortex, they may act as functional tumours with excess hormone production. They may cause Cushing’s syndrome, inappropriate virilisation or precocious puberty. Though rare during childhood, adrenocortical oncocytic tumours should be suspected in a child with peripheral precocious puberty and marked elevation of dehydroepiandrosterone sulfate levels. We describe a 6-year girl who presented with peripheral precocious puberty due to a functional adrenocortical oncocytic tumour. Three months after tumour removal, she developed true central precocious puberty. This report highlights that peripheral precocious puberty may trigger central precocious puberty, particularly after resolution of the underlying cause of the peripheral precocious puberty.

Safety Evaluation of Picralima nitida (Akuamma) Seed Extracton Hepatorenal and Haematological Systems of Rats

Background: Plants like herbs has been extensively used for different kinds of nutritional and medicinal purposes, however, scientific studies has shown that these medicinal plants may have deleterious effects on some vital organs of the body if not taken at the recommended doses. Thus, there is a need for safety evaluation of these plants to ascertain their actions on organ’s physiological functions. This present study evaluates the effects of ethanol seed extract of Picralima nitida on the haematological examines and some enzymes activities in the serum of albino rats. Twenty-five rats were equally randomized into five groups. Group A (control) received distilled water while graded doses (50, 100, 150 and 200 mg/kg body weight) of ethanol seed extract of Picralima nitida were administered to rats in groups B, C, D and E respectively for 14 days. Haematological studies were carried out on the rats’ blood samples while concentrations of total protein, albumin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), urea, and creatinine were measured in the serum. Results: Result obtained revealed that treatment of rats with various graded doses of ethanol seed extract of Picralima nitida caused marked increase in urea and creatine compared to the control. Rats treated with 150 and 200mg/kg bw of the extract showed marked elevation in serum levels of the enzymes suggesting that the extract may have adverse effects at this dose. There was also a marked elevation in serum electrolytes of rats treated with 150 and 200mg/kg bw of the extract. Rats treated with low concentrations (50 and 100 mg/kg bw) of the extract demonstrated no marked differences or alteration in haematological parameters, protein profile and enzyme activities in the serum. Conclusion: The results of this study indicated that consumption of ethanol seed extract of Picralima nitida as a therapeutic treatment is nontoxic at lower dose. However, if taken at high doses, the extract might be detrimental to some vital organs and systems.