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BACKGROUND Aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase (ALP) are markers of aggression to hepatocytes and aid in the diagnosis, monitoring and treatment of liver diseases because they reflect the inflammatory activi ty of the liver. The present study aimed to estimate the changes in serum ALT, AST and ALP levels in both pre-dialysis (pre-HD-CKD) and haemodialysis (HD-CKD) patients in comparison to healthy controls, and to find out the association between hepatic enzyme changes and estimated Glomerular Filtration Rate (eGFR), body weight loss, duration of disease and duration of haemodialysis in CKD patients. MATERIALS AND METHODS The present descriptive comparative study conducted on 53 HD-CKD patients, 61 pre-HD-CKD patients and 50 healthy controls. The clinical information and medical history were obtained through the review of patient's medical files and patient's interviews. A face-to-face interview was conducted based on a questionnaire that included variables such as age, sex, date of the diagnosis, cause of the disease, blood pressure, height, weight, duration of haemodialysis and any health problems or prescriptions. Blood samples were collected from all the participants and analysed for urea, creatinine, AST, ALT and ALP using fully automated machines. The data were statistically analysed using SPSS software and p-value less than 0.05 was considered as statistically significant. RESULTS Our results revealed lower AST and ALT levels in HD-CKD patients than both pre-HD-CKD patients and healthy controls. On the contrary, the difference in aminotransferase level between pre-HD-CKD patients and control was statistically non-significant. Moreover, ALP was significantly higher in both groups of CKD patients when compared to healthy controls. In addition, a significant negative correlation has been shown between blood urea and aspartate aminotransferase level in pre-HD-CKD group. CONCLUSION Serum ALT and AST levels tend to be reduced in CKD patients, particularly in those on maintenance haemodialysis treatment, a finding that enforces the urgent need for the establishment of separate reference ranges of liver function tests for CKD patients in order to facilitate the diagnosis, monitoring and treatment of liver diseases, especially hepatitis C infection, an establishment that may play a role in decreasing the mortality in the CKD patients.

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Background Data: Osteoporosis is a systemic skeletal disease characterized by low bone mass and microarchitectural deterioration, with a consequent increase in bone fragility. Moreover, it is a condition that is both preventable and treatable if caught in time. Purpose: Evaluation the different perioperative enhancing factors available that might increase spinal fixation success rate in low bone density postmenopausal women. Study Design: retrospective analysis of a case series. Patients and Methods: Between May 2011 and May 2013, twenty four low bone density post-menopausal women were included in this retrospective study. All of them were admitted at KSMH-Hospital-Tabouk. During that period, they had either thoracic or lumbar implants for two major indications, osteoporotic vertebral compression fractures and osteodegenerative spondylolisthesis. Different techniques and precautions were followed to maximize the outcome. Pre-and postoperative bone densitometry, radiograph, pain and functional outcome assessment were documented. All patients were followed up for at least 12 months. Results: The mean age of the ladies was fifty eight years. 62.5% of the patients were classified as osteoporotic, with a further 37.5%, being osteopenia. Ten surgical fractures and fourteen cases of spondylolisthesis had implants. In densitometry, little postoperative change happened in the fracture series. However, Remarkable improvement was obvious in the spondylolisthesis series. Based on postoperative radiograph control and follow up, no reported cases of implant failures, loosening, pull-out screws or pseudoarthrosis necessitated re-surgery in one hundred twenty inserted screws. Three cases of severely osteoporotic spondylolisthesis were supported with rhBMP-2 that showed adequate fusion before expected. Out Egy Spine J -Volume 10 -April 2014 THE PERIOPERATIVE ENHANCING FACTORS THAT MIGHT HELP THE POSTM E N O PAUS A L WO M E N of twenty two cement injected screws in four spondylolisthesis cases, one screw showed silent extra vertebral leakage and failure of injection in another one. In the fracture series: The Beck's index mean pre-and postoperative was (0.44 versus 0.67, P=0.013). The kyphotic angle mean pre-and postoperative was (13 ∘ versus 8 ∘ , P=0.007). In the spondylolisthesis series: The total pre-and postoperative score of disc height narrowing was (77 versus73, P=0.95). No change in the osteophyte score pre-and postoperatively. Vacuum Sign was positive in 40% of fracture series and 57% of spondylolisthesis series. It did not show any change in the former. However, the latter showed an improvement in 37.5% cases completely and 25% partially. The lumbar lordosis angle mean pre-and postoperative was (25 ∘ versus 29 ∘ , P=0.01). 40% in the fracture series with marked paraparesis and 7% in the spondylolisthesis regained the full power by the end of the year. Pre-and postoperative mean of low back pain rating scale were (115 versus 23, P=0.001). pre-and postoperative mean of walking distance in meters were (22 versus 448, P=0.0...