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Assessment of interleukin 17 and transforming growth factor-beta 1 in hepatitis C patients with disease progression

Elbanan WK, Fathy SA, Ibrahim RA, Hegazy MGA

Trop Biomed, 2020 Dec 01;37(4):1093-1104.
PMID: 33612761 DOI: 10.47665/tb.37.4.1093

Hepatitis C virus (HCV) infection in Egypt is the most serious health problem. Identifying HCV-positive persons at high risk of early complications can help prioritize treatment decisions. Recently, attention has been directed to non-invasive, accurate alternatives using serum biochemical markers. The transforming growth factor β 1/interleukins pathway plays an important role in the process of cell injury and inflammation. Thus, TGF-β1 and IL-17 were assessed in serum of chronic HCV patients with correlation to hepatic inflammatory and fibrotic status. The quantitative serum levels of TGF-β1 and IL-17 were analyzed among chronic hepatitis C (CHC) patients (n=75) and normal control (NC) subjects (n=15). Disease severity in patients was assessed using the Child-Pugh scores and METAVIR. Serum levels of TGF-β1 and IL-17 were significantly increased in HCV patients compared to control group. Furthermore, the levels of TGF-β1 and Il-17 were positively correlated to serum transaminases and alpha-fetoprotein and they were negatively correlated with serum albumin and platelets. Additionally, the serum levels of TGF-β1 and Il-17 were associated with inflammation grades and stages of liver fibrosis. TGF-β1 and IL-17 may be hopeful serum biomarkers concerned in the progression of liver inflammation and fibrosis accompanying chronic HCV infection. Therefore, they could be used in the future as targets for anti-fibrotic therapy of chronic HCV to ameliorate the disease progress.
The silvered leaf-monkey of Malaysia, Presbytis cristatus: disease model for human scrub typhus

Walker JS, Cadigan FC, Vosdingh RA, Chye CT

J Infect Dis, 1973 Aug;128(2):223-6.
PMID: 4198721
Seroprevalence and risk factors of Trypanosoma evansi infection in horses in Peninsular Malaysia

Elshafie EI, Sani RA, Hassan L, Sharma R, Bashir A, Abubakar IA

Res Vet Sci, 2013 Apr;94(2):285-9.
PMID: 23021152 DOI: 10.1016/j.rvsc.2012.09.004

A cross-sectional study was designed to assess the seroprevalence and risk factors associated with Trypanosoma evansi infection among horses, using a total of 527 blood samples obtained from eight states in Peninsular Malaysia. A structured questionnaire was used to collect data on risk factors associated with T. evansi seroprevalence. The overall seroprevalence detected by card agglutination test for T. evansi (CATT/T. evansi) was 13.90% (73/527, CI: 11.2-17.1%). Female and exogenous horses showed a higher risk in association with the disease seroprevalence compared to other groups. The majority of the horse owners were not familiar with surra (85.30%). However, most of them were very cautious with the health of their animals. In conclusion, this study showed that T. evansi occurred in low frequency among horses in Peninsular Malaysia, and the good management system adopted by horse owners was probably responsible for the low T. evansi occurrence.
The role of concurrent haemonchosis in the development of pneumonic pasteurellosis in goats

Zamri-Saad M, Subramaniam P, Sheikh-Omar AR, Sani RA, Rasedee A

Vet Res Commun, 1994;18(2):119-22.
PMID: 7975196
Complicated urinary tract infection caused by Corynebacterium urealyticum - A pathogen that should not be forgotten

Mohd Khairul IO, Nurzam SCH, Hamat RA

Med J Malaysia, 2022 Jan;77(1):110-112.
PMID: 35087008

Although Corynebacterium urealyticum has rarely been isolated in diagnostic laboratories, this bacterium can be a significant uropathogen causing significant complications. It causes cystitis and alkaline encrusted cystitis, commonly involved in patients who need prolonged hospitalization and bladder catheterisation. We report here a case of a 19-yearold young man who was diagnosed with N-Methyl Daspartate receptor (NMDAR) encephalitis that requires hospitalization for optimization of rehabilitation treatment in Hospital Kuala Lumpur, Malaysia. His urine culture isolated slow growing gram-positive pleomorphic rods subsequently identified as C. urealyticum. Based on the risk factors, the isolation of C. urealyticum could not be simply dismissed as contaminants. The patient was treated successfully with vancomycin for two weeks.
Vitiligo: symptoms, pathogenesis and treatment

Ghafourian A, Ghafourian S, Sadeghifard N, Mohebi R, Shokoohini Y, Nezamoleslami S, et al.

Int J Immunopathol Pharmacol, 2015 1 13;27(4):485-9.
PMID: 25572727

Vitiligo is an acquired cutaneous disorder of pigmentation, with an incidence of 0.5% to 2% worldwide. There are three major hypotheses for the pathogenesis of vitiligo that are not exclusive of each other: biochemical/cytotoxic, neural and autoimmune. Recent data provide strong evidence supporting an autoimmune pathogenesis of vitiligo. As vitiligo can have a major effect on quality of life, treatment can be considered and should preferably begin early when then disease is active. Current treatment modalities are directed towards stopping progression of the disease and achieving repigmentation. Therapies include corticosteroids, topical immunomodulators, photo(chemo)therapy, surgery, combination therapies and depigmentation of normally pigmented skin. It seems that traditional Chinese medicine could be more effective than the current treatment for vitligo.
Fulltext A pilot study on development and feasibility of the 'MyEducation: CABG application' for patients undergoing coronary artery bypass graft (CABG) surgery

Noor Hanita Z, Khatijah LA, Kamaruzzaman S, Karuthan C, Raja Mokhtar RA

BMC Nurs, 2022 Feb 04;21(1):40.
PMID: 35120517 DOI: 10.1186/s12912-022-00814-4

BACKGROUND: Patients scheduled for coronary artery bypass graft (CABG) surgery tend to have persistent symptoms of anxiety and depression. Course of hospital stay post-CABG procedure has become increasingly shorter over the last few decades. This pilot study was conducted to develop and test feasibility of MyEducation: CABG application as a learning tool to reduce anxiety and depression levels among patients undergoing CABG Surgery.
METHODS: This study was quasi-experimental in design. Forty-five patients scheduled for CABG surgery were recruited via consecutive sampling from a Tertiary Referral Centre at Kuala Lumpur, Malaysia. MyEducation:CABG application (Web-based education application) was administered among the intervention group (N = 23); while the control group (N = 22) underwent standard care. Web-based education application were implemented by nurses at admission and prior to discharge. Patients were assisted in terms of queries and concerns, upon which corresponding information and support was provided. Sociodemographic data were obtained from patients, prior to administration of Hospital Anxiety and Depression Scale which was used to measure levels of anxiety and depression. The educational application was used to obtain satisfaction rating among intervention group. These measures were administered upon admission, on discharge and one-month post-discharge.
RESULTS: Mean anxiety and depression scores among the intervention group were lower compared to the control. This was significant for anxiety upon admission, on discharge and one-month post-discharge (p
Gastrointestinal: Solitary fibrous tumor from lesser omentum: An elderly from Malaysia with an unusual huge painful intra-abdominal mass

Ng CS, Luqman M, Wong ZQ, Ngiu CS, Raja Affendi RA

J Gastroenterol Hepatol, 2017 Oct;32(10):1664.
PMID: 28948703 DOI: 10.1111/jgh.13721
Fulltext Staggering the dose of sugammadex lowers risks for severe emergence cough: a randomized control trial

P S L, Miskan MM, Y Z C, Zaki RA

BMC Anesthesiol, 2017 Oct 11;17(1):137.
PMID: 29020936 DOI: 10.1186/s12871-017-0430-3

BACKGROUND: Cough on emergence has been reported as a common adverse reaction with sugammadex reversal. We investigated if staggering the dose of sugammadex will reduce emergence cough in a single-center, randomized, double-blinded study.
METHODS: A hundred and twenty ASA 1-3 adults were randomly reversed with 1 mg/kg sugammadex prior to extubation followed by another 1 mg/kg immediately after extubation (staggered group), single dose of 2 mg/kg sugammadex (single bolus group) or neostigmine 0.02 mg/kg with glycopyrrolate (neostigmine group).
RESULTS: We found 70% of patients (n = 28) reversed with single boluses of sugammadex had Grade 3 emergence cough compared to 12.5% (n = 5) in the staggered sugammadex group and 17.5% (n = 7) in the neostigmine group (p
Capacitated vehicle-routing problem model for scheduled solid waste collection and route optimization using PSO algorithm

Hannan MA, Akhtar M, Begum RA, Basri H, Hussain A, Scavino E

Waste Manag, 2018 Jan;71:31-41.
PMID: 29079284 DOI: 10.1016/j.wasman.2017.10.019

Waste collection widely depends on the route optimization problem that involves a large amount of expenditure in terms of capital, labor, and variable operational costs. Thus, the more waste collection route is optimized, the more reduction in different costs and environmental effect will be. This study proposes a modified particle swarm optimization (PSO) algorithm in a capacitated vehicle-routing problem (CVRP) model to determine the best waste collection and route optimization solutions. In this study, threshold waste level (TWL) and scheduling concepts are applied in the PSO-based CVRP model under different datasets. The obtained results from different datasets show that the proposed algorithmic CVRP model provides the best waste collection and route optimization in terms of travel distance, total waste, waste collection efficiency, and tightness at 70-75% of TWL. The obtained results for 1 week scheduling show that 70% of TWL performs better than all node consideration in terms of collected waste, distance, tightness, efficiency, fuel consumption, and cost. The proposed optimized model can serve as a valuable tool for waste collection and route optimization toward reducing socioeconomic and environmental impacts.
Fulltext Pyrolysis of polypropylene plastic waste into carbonaceous char: Priority of plastic waste management amidst COVID-19 pandemic

Harussani MM, Sapuan SM, Rashid U, Khalina A, Ilyas RA

Sci Total Environ, 2022 Jan 10;803:149911.
PMID: 34525745 DOI: 10.1016/j.scitotenv.2021.149911

COVID-19 global pandemic, originated from Wuhan, resulted in a massive increase in the output of polypropylene (PP)-based personal protective equipment (PPE) for healthcare workers. The continuous demand of PPE across the world caused the PP based plastic wastes accumulation. Some alternative approaches that have been practiced apart from collecting the plastic waste in the landfills are incineration approach and open burning. However, there were many drawbacks of these practices, which promote the release of chemical additives and greenhouse gases into the environment. Therefore, a proper approach in treating the plastic wastes, which introduces conversion of plastic wastes into renewable energy is paramount. Along the way of extensive research and studies, the recovery of PP plastic to fuel-like liquid oil and solid char through thermal decomposition of pyrolysis process, helps in reducing the number of PP plastic wastes and produces good quality pyrolysis liquid oil and solid char to be used in fuel applications. This paper summarizes the pyrolysis process for massively produced PP plastic wastes, type of pyrolysis used and the main pyrolysis parameters affecting the product yields. Literature studies of pyrolysis of PP plastic and several key points to optimize solid char production for PP were thoroughly elaborated in this review paper.
Fulltext A rare presentation of a gastric volvulus in an adult Bochdalek hernia: a case report

Azhar A, Karim ZRA, Aripin YM, Abid Amir M

J Surg Case Rep, 2023 Sep;2023(9):rjad540.
PMID: 37790291 DOI: 10.1093/jscr/rjad540

A Bochdalek hernia is a common congenital diaphragmatic defect in infants. A late presentation during adulthood is rare with misleading signs and symptoms, resulting in misdiagnosis and errors in treatment. We describe a 30-year-old man who presented with abdominal pain and chronic choking sensation, which was previously treated as peptic ulcer disease. During the present admission, radiological imaging performed revealed loops of bowel and a gastric volvulus in the left hemithorax. The patient underwent a successful emergency surgery and repair of a Bochdalek hernia. Due to its rarity and ambiguous presentation, a symptomatic Bochdalek hernia in an adult is commonly misdiagnosed. A comprehensive evaluation is pertinent for early diagnosis and treatment, to prevent complications arising from obstruction and strangulation of herniated intraabdominal contents.
Fulltext Recent Trends and Developments in Conducting Polymer Nanocomposites for Multifunctional Applications

Sharma S, Sudhakara P, Omran AAB, Singh J, Ilyas RA

Polymers (Basel), 2021 Aug 28;13(17).
PMID: 34502938 DOI: 10.3390/polym13172898

Electrically-conducting polymers (CPs) were first developed as a revolutionary class of organic compounds that possess optical and electrical properties comparable to that of metals as well as inorganic semiconductors and display the commendable properties correlated with traditional polymers, like the ease of manufacture along with resilience in processing. Polymer nanocomposites are designed and manufactured to ensure excellent promising properties for anti-static (electrically conducting), anti-corrosion, actuators, sensors, shape memory alloys, biomedical, flexible electronics, solar cells, fuel cells, supercapacitors, LEDs, and adhesive applications with desired-appealing and cost-effective, functional surface coatings. The distinctive properties of nanocomposite materials involve significantly improved mechanical characteristics, barrier-properties, weight-reduction, and increased, long-lasting performance in terms of heat, wear, and scratch-resistant. Constraint in availability of power due to continuous depletion in the reservoirs of fossil fuels has affected the performance and functioning of electronic and energy storage appliances. For such reasons, efforts to modify the performance of such appliances are under way through blending design engineering with organic electronics. Unlike conventional inorganic semiconductors, organic electronic materials are developed from conducting polymers (CPs), dyes and charge transfer complexes. However, the conductive polymers are perhaps more bio-compatible rather than conventional metals or semi-conductive materials. Such characteristics make it more fascinating for bio-engineering investigators to conduct research on polymers possessing antistatic properties for various applications. An extensive overview of different techniques of synthesis and the applications of polymer bio-nanocomposites in various fields of sensors, actuators, shape memory polymers, flexible electronics, optical limiting, electrical properties (batteries, solar cells, fuel cells, supercapacitors, LEDs), corrosion-protection and biomedical application are well-summarized from the findings all across the world in more than 150 references, exclusively from the past four years. This paper also presents recent advancements in composites of rare-earth oxides based on conducting polymer composites. Across a variety of biological and medical applications, the fact that numerous tissues were receptive to electric fields and stimuli made CPs more enticing.
Fulltext The Effects of Silver Nanoparticles Compositions on the Mechanical, Physiochemical, Antibacterial, and Morphology Properties of Sugar Palm Starch Biocomposites for Antibacterial Coating

Rozilah A, Jaafar CNA, Sapuan SM, Zainol I, Ilyas RA

Polymers (Basel), 2020 Nov 06;12(11).
PMID: 33171913 DOI: 10.3390/polym12112605

Antibacterial sugar palm starch biopolymer composite films were developed and derived from renewable sources and inorganic silver nanoparticles (AgNPs) as main ingredients for antibacterial coatings. The composite films were produced by solution casting method and the mechanical and physicochemical properties were determined by tensile test, Fourier Transform Infrared (FTIR) analysis, thermal gravimetric analysis (TGA), antibacterial screening test and field emission scanning electron microscopy (FESEM) images. It was found that mechanical and antibacterial properties of biocomposite films were improved after the addition of AgNPs compared with the film without active metals. The weakness of neat biocomposite films was improved by incorporating inorganic AgNPs as a nanofiller in the films' matrix to avoid bacterial growth. The results showed that the tensile strength ranged between 8 kPa and 408 kPa and the elasticity modulus was between 5.72 kPa and 9.86 kPa. The addition of AgNPs in FTIR analysis decreased the transmittance value, caused small changes in the chemical structure, caused small differences in the intensity peaks, and produced longer wavelengths. These active films increased the degradation weight and decomposition temperature due to the more heat-stable AgNPs. Meanwhile, the average inhibited areas measured were between 7.66 and 7.83 mm (Escherichia coli), 7.5 and 8.0 mm (Salmonella cholerasuis), and 0.1 and 0.5 mm for Staphylococcus aureus. From the microscopic analysis, it was observed that the average size of all microbes for 1 wt% and 4 wt% AgNPs ranged from 0.57 to 2.90 mm. Overall, 3 wt% AgNP nanofiller was found to be the best composition that fulfilled all the mechanical properties and had better antimicrobial properties. Thus, the development of an organic-inorganic hybrid of antibacterial biopolymer composite films is suitable for antibacterial coatings.
Evaluation of the Efficacy of Probiotics (MCP® BCMC® Strains) Treating Constipation in Elderly Patients with Multiple Chronic Co-Morbidities: A Randomized Control Trial

Ghafar MYA, Yaakup H, Ali RAR, Shah SA

J Nutr Health Aging, 2020;24(10):1066-1072.
PMID: 33244562 DOI: 10.1007/s12603-020-1494-1

OBJECTIVES: To evaluate the impact of a microbial cell preparation (MCP®) (Hexbio®; comprising MCP® BCMC® strains) on stool frequency, consistency, and constipation-related symptoms in elderly patients with multiple chronic medical conditions.
DESIGN: Randomised control trial.
SETTING: Medical outpatient and medical/surgical in-patient unit in single tertiary center.
PARTICIPANT: Patients aged ≥ 60 years who experience constipation and have multiple chronic medical conditions.
METHODS: Participants with constipation were blindly randomized into either a treatment (MCP® BCMC® strains) or a placebo group. The treatment was administered twice daily.
MEASUREMENT: Gastrointestinal symptoms and stool habits were assessed over a week during the intervention via the use of a questionnaire and stool diary.
RESULTS: Stool frequency was seen to be higher and the improvement in stool consistency was more significant in the treatment group than in the placebo group (p =<0.001). A significant improvement in symptoms was demonstrated in patients who received MCP® BCMC® strains,specifically with respect to straining (p = < 0.001) and a sensation of incomplete evacuation (p = < 0.001). reduction in anorectal blockage symptoms and the need for manual stool evacuation was also demonstrated, but this finding was not statistically significant. Significant adverse events were not observed.
CONCLUSIONS: An improvement in stool frequency and consistency was reported in elderly patients with chronic medical conditions following the administration of MCP® BCMC® strains.
Midface hypoplasia in syndromic craniosynostosis: predicting craniofacial growth via a novel regression model from anatomical morphometric analysis

Hariri F, Malek RA, Abdullah NA, Hassan SF

Int J Oral Maxillofac Surg, 2024 Apr;53(4):293-300.
PMID: 37739816 DOI: 10.1016/j.ijom.2023.08.009

Midface hypoplasia in syndromic craniosynostosis (SC) may lead to serious respiratory issues. The aim of this study was to analyse the morphometric correlation between midface and cranial base parameters in paediatric SC patients in order to formulate predictive regression models. The computed tomography scans of 18 SC patients and 20 control were imported into Materialise Mimics Medical version 21.0 software for the measurement of multiple craniofacial landmarks and correlation analysis. The results showed a strong correlation of anterior cranial base (SN), posterior cranial base (SBa), and total cranial base (NBa) (r = 0.935) to maxilla length and width (ZMR-ZML) (r = 0.864). The model of NBa = - 1.554 + 1.021(SN) + 0.753(SBa) with R2 = 0.875 is proposed to demonstrate the development of the cranial base that causes a certain degree of midface hypoplasia in SC patients. The formula is supported using a prediction model of ZMR-ZML = 5.762 + 0.920(NBa), with R2 = 0.746. The mean absolute difference and standard deviation between the predicted and true NBa and ZMR-ZML were 2.08 ± 1.50 mm and 3.11 ± 2.32 mm, respectively. The skeletal growth estimation models provide valuable foundation for further analysis and potential clinical application.
Fulltext Innovative ionic liquid pretreatment followed by wet disk milling treatment provides enhanced properties of sugar palm nano-fibrillated cellulose

Norfarhana AS, Ilyas RA, Ngadi N, Dzarfan Othman MH

Heliyon, 2024 Mar 30;10(6):e27715.
PMID: 38509963 DOI: 10.1016/j.heliyon.2024.e27715

In order to accommodate the increased demand for innovative materials, intensive research has focused on natural resources. In pursuit of advanced substances that exhibit functionality, sustainability, recyclability, and cost-effectiveness, the present work attempted an alternative study on cellulose nanofibers derived from sugar palm fiber. Leveraging an innovative approach involving ionic liquid (IL) pre-treatment, bleaching, and wet disc mill technique, nano-fibrillated cellulose (NFC) was successfully obtained from the sugar palm fiber source. Remarkably, 96.89% of nanofibers were extracted from the sugar palm fiber, demonstrating the process's efficacy and scalability. Further investigation revealed that the sugar palm nano-fibrillated cellulose (SPNFC) exhibited a surface area of 3.46 m2/g, indicating a significant interface for enhanced functionality. Additionally, the analysis unveiled an average pore size of 4.47 nm, affirming its suitability for various applications that necessitate precise filtration. Moreover, the surface charge densities of SPNFC were found to be -32.1 mV, offering opportunities for surface modification and enhanced interactions with various materials. The SPNFC exhibit remarkable thermal stability, enduring temperatures of up to 360.5 °C. Additionally, the isolation process is evident in a significant rise in the crystallinity index, escalating from 50.97% in raw fibers to 61.62% in SPNFC. These findings shed light on the vast potential and distinct features of SPNFC, opening the path for its application in a wide array of industries, including but not limited to advanced materials, biomedicine, and environmental engineering.
Fulltext The impact of vitamin D deficiency on caries, periodontitis, and oral cancer: A systematic review

Hussein AS, Rosli RA, Ramle RS, Khor GH

Saudi Dent J, 2024 Jul;36(7):970-979.
PMID: 39035557 DOI: 10.1016/j.sdentj.2024.04.012

BACKGROUND: The relationship between vitamin D deficiency with dental caries, periodontitis and oral cancer is controversial.
OBJECTIVES: This review aimed to systematically evaluate the published literature and summarise the available evidence about the impact of vitamin D deficiency (VDD) on the oral diseases mentioned above.
METHODS: PubMed, Web of Science, Scopus and ScienceDirect databases were used. The search terms included were vitamin D, caries, periodontitis, and oral cancer. All papers published between January 2017 and November 2022 were included. The PRISMA process was used for the screening and selection studies.
RESULTS: Initially, 3001 studies were identified. However, after evaluating 46 full-text articles that explored the link between VDD and caries, periodontitis, and oral cancer, only 32 studies met the inclusion criteria for this systematic review. Among these, 15 studies focused on caries, 16 on periodontitis, and only one on oral cancer. Regarding study quality and risk of bias, 25 out of the 32 studies were deemed to have low risk. A total of 12 studies on periodontitis showed the impact of VDD.
CONCLUSION: The review highlights that most evidence suggests an association between VDD and periodontitis. However, findings concerning the association between VDD and dental caries were controversial. Thus, further research is required to clarify the impacts of VDD on caries and oral cancer.
Fulltext A highly sensitive, nested polymerase chain reaction based method using simple dna extraction to detect malaria sporozoites in mosquitos

Vythilingam I, Nitiavathy K, Yi P, Bakotee B, Hugo B, Singh B, et al.

Southeast Asian J Trop Med Public Health, 1999 Dec;30(4):631-5.
PMID: 10928352

Dried Anopheles farauti mosquitos caught in Solomon Islands in 1990 were examined for malaria sporozoites by ELISA and nested polymerase chain reaction (PCR). Only heads and thoraces were used. Plasmodium genus-specific nested PCR amplifications were carried out on all samples. Of the 402 pools of mosquitos that were processed, 30 were positive for malaria. Nest 1 products of positive samples were subjected to further PCR amplifications with species-specific primers for P. falciparum and P. vivax. Twenty pools were positive for P. vivax by PCR while only 7 were positive by ELISA. For P. falciparum 2 pools were positive by both ELISA and PCR, and one of these was a pool which was positive for P. vivax by PCR and ELISA. Thus the sensitivity of PCR for P. vivax was 100% while the specificity was 96.7%. For P. falciparum the sensitivity and specificity were 100%. The PCR technique is highly sensitive and can be used on dried mosquitos which makes it a valuable tool for determining sporozoite rates of mosquitos, even in remote areas.
A comparison of the pattern of liver involvement in dengue hemorrhagic fever with classic dengue fever

Wahid SF, Sanusi S, Zawawi MM, Ali RA

Southeast Asian J Trop Med Public Health, 2000 Jun;31(2):259-63.
PMID: 11127322

The impact of dengue on liver function was studied on fifty serologically confirmed dengue cases admitted to Hospital Universiti Kebangsaan Malaysia (HUKM). Twenty-five of these patients had classic dengue fever (DF) and 25 had grade 1 or 2 dengue hemorrhagic fever (DHF). There were more (60%) DHF patients with hepatomegaly compared to DF (40%) but the difference was not statistically significant. Analysis of the liver profile showed that liver dysfunction was commoner in DHF compared to DF, indicating that the degree of liver impairment may be related to the severity of DHF. Hyperbilirubinemia was noted in 3 (12%) DHF and 2 (8%) DF patients. The mean (range) serum bilirubin was higher in DHF [14.2(5-50) micromol/l] compared to DF [10.9(5-30) micromol/l)] (p > 0.05). Elevated levels of serum alanine aminotransferase (ALT) and alkaline phosphatase (ALP) were observed more frequently in DHF (20 and 12 patients respectively) compared to DF (16 and 8 patients respectively). Nine (36%) DHF and 6 (24%) DF patients had concomitant elevation of ALT and ALP levels. The mean (range) serum ALT levels were 109.3(23-325) U/l in DHF and 90.8(13-352) U/l in DF (p > 0.05). The mean (range) serum ALP levels were 102.2(15-319) U/l in DHF and 93.3(34-258) U/l in DF (p > 0.05). The ALT and ALP levels were significantly higher in DHF patients with spontaneous bleeding than those without bleeding (p < 0.05) None of the patients developed fulminant hepatitis. The immunoregulatory cells, which include the T (CD3), B (CD 19), CD4, CD8, CD5 and natural killer (NK) cells were significantly lower in DHF compared to DF patients (p < 0.05). However, the reduction in these cell counts did not correlate with the liver dysfunction seen in DHF patients. In conclusion, hepatomegaly and liver dysfunction were commoner in DHF compared to DF.

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