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Not surprising

Mbogua is an internal medicine/pediatric specialist in Houston, Texas and is affiliated with multiple hospitals in the area, including HCA Houston Healthcare Medical Center and a clinical trails group in the greater Houston area

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Increased ALT activity (more than three times the upper limit of normal, but can be as high as 100 times the upper limit), suggests hepatocellular injury (often necrosis), and is of more concern than an isolated increase in ALP activity (reflecting cholestasis), although mixed patterns commonly occur

It can serve as an alternative delivery method, but it is not a direct replacement