Morning (First) Urine Copper Concentration: a New Approach for the Diagnosis of Wilson's Disease

Evaluation of Possible Human Health Risk of Heavy Metals from the Consumption of Two Marine Fish Species Tenualosa ilisha and Dorosoma cepedianum

In order to study the effects of contaminants on human health, fish is considered as a powerful model among all available species for risk-benefit assessments. Tenualosa ilisha and Dorosoma cepedianum are two fish species of great economic importance as they are found in undeveloped, developing and developed countries. Concentrations of heavy metals lead (Pb), cadmium (Cd), chromium (Cr), arsenic (As) and mercury (Hg) were determined using validated and accredited test methods in order to assess the potential human health risk from the dietary intake of these two selected fish species. The estimated daily intake (EDI) of all the five heavy metals was measured from the consumption of the two species considering the mean fish consumption of 61 g person^-1 day^-1 defined for European population. The EDI indicates that no risk to people's health with respect to the EDI of Pb, Cd, Cr, As and Hg through the consumption of the two fish species. The estimation of target hazard quotient (THQ) demonstrating the non-carcinogenic risk indicates that intake of Pb, Cd, Cr and Hg through the consumption of two fish species is safe for human health, whereas, consumption of As suggests potential risk to consumers. The estimation of carcinogenic risk of Cd, Cr and As due to the consumption of two selected fish species indicates that consumers remain at risk of cancer. Thus, these fish species should not be considered safe for human consumption.

High Prevalence of Wilson's Diseases with Low Prevalence of Kayser-Fleischer Rings among Patients with Cryptogenic Chronic Liver Diseases in Bangladesh

Background

Chronic liver disease (CLD) is common in Bangladesh; however, a major bulk remains as cryptogenic CLD as they remain devoid of known pathological agents leading to have a check of Kayser-Fleischer (K-F) rings for possible Wilson's disease (WD) and many of these patients develop complications such as cirrhosis of liver and hepatocellular carcinoma. However, there remains considerable proportions of CLD patients with undefined etiology (cryptogenic CLD) and these patients cannot be provided effective therapy based on etiological factors. Here, the proportion of WD among cryptogenic CLD patients in Bangladesh has been evaluated to improve the management of CLD and reduce complications.

Materials and methods

A total of 941 patients with cryptogenic CLD [negative for hepatitis viruses, alcohol, nonalcoholic fatty liver disease (NAFLD), drug, and autoimmunity] were enrolled in the study. To assess if they have been suffering from WD, the levels of copper in 24-hour urine were evaluated. Definitive WD was diagnosed when 24-hour urinary copper output was >100 μg and strongly indicative WD patients excreted >40 μg of copper in 24 hours.

Results

Out of 941 patients with cryptogenic CLD, 212 patients were diagnosed as definitive WD and 239 patients as strongly indicative WD on the basis of 24-hours copper excretion. The age distribution ranging of the patients varied from 1 year to 90 years. There was a male predominance. Considerable numbers of WD patients had previous history of jaundice. Kayser-Fleischer rings were mostly uncommon and detected in five patients with WD only.

Discussion

Wilson's disease is not a rare entity in Bangladesh; rather, it seems to be fairly common among CLD patients. A country-wide epidemiological survey should be conducted for diagnosis of WD in Bangladesh to provide a proper management strategy for these huge numbers of WD patients. In fact, most of the WD patients are unaware of their diagnosis and the general physicians are equally unaware of diagnosis and management of WD.

How to cite this article

Choudhury N, Quraishi SB, Atiqullah AKM, et al. High Prevalence of Wilson's Diseases with Low Prevalence of Kayser-Fleischer Rings among Patients with Cryptogenic Chronic Liver Diseases in Bangladesh. Euroasian J Hepato-Gastroenterol 2019;9(2):67-70.