Serum Bilirubin Concentration Research Articles

Liver Pathology in Children with Diagnosed Inflammatory Bowel Disease-A Single Center Experience.

Background: Inflammatory bowel disease (IBD) in children is frequently associated with liver pathology manifested as transient elevation of liver enzymes or specified liver diseases. The aim of the study was to evaluate the prevalence and the type of liver pathology in children with IBD within 2 years’ follow-up after the IBD diagnosis. Methods: We retrospectively reviewed records of children with IBD. Liver pathology was defined as elevated activity of liver enzymes (alanine transaminase (ALT) and/or gamma-glutamyl transpeptidase (GGT)) and bilirubin concentration in serum and/or as pathological changes of the organ on imaging tests (abdominal ultrasound and/or magnetic resonance cholangiopancreatography) or on liver histology performed when indicated. Results: Liver pathology was detected in 21 from 119 children (18%), including 7 (17%) with Crohn’s disease (CD) and 14 (18%) with ulcerative colitis (UC). Specified diagnosis for liver abnormality was found in 14 of 21 children (67%), including primary sclerosing cholangitis (PSC, 19%), non-alcoholic fatty liver disease (NAFLD, 19%), autoimmune sclerosing cholangitis (ASC, 5%), autoimmune hepatitis (AIH, 5%), cholelithiasis (5%), drug-induced liver disease (9%) and viral infection (herpes simplex virus, 5%). Most patients manifested mild IBD or were in clinical remission at the time of liver pathology diagnosis. 14% of patients with liver disease (including only cases with PSC) were diagnosed before IBD, 33% at the same time, and 52% in the later period. Patients with the specified diagnosis of liver pathology were younger, had higher ALT activity and more often demonstrated liver abnormalities on imaging tests. UC patients with idiopathic elevation of liver enzymes had higher pediatric ulcerative colitis activity index scores compared to children with specified liver disease. Conclusions: Liver pathology was observed in a significant percentage of children with IBD in our study. The majority of cases of hepatobiliary abnormalities were detected after diagnosis of IBD; therefore, children with IBD should undergo routine monitoring of liver enzymes.

Jaundice in a Preterm Infant Twelve Hours After Birth.

Jaundice in a Preterm Infant Twelve Hours After Birth.

Etiology of Juandice and Associated Liver Diseases Among Hiv Patients

Background and Aim: Jaundice and associated liver disease are frequently diagnosed in patients with acquired immunodeficiency syndrome (AIDS). The assessment of jaundice causes, etiology, and outcomes in human immunodeficiency virus (HIV)-infected patients with liver disease have not been addressed. The present study aimed to evaluate jaundice and associated liver disease in human immunodeficiency virus (HIV)-infected patients. Materials and Methods: This cross-sectional study was conducted on 272 human immunodeficiency virus(HIV)-infected patients with liver disease at the Department of Gastroenterology AK CMH/ Sheikh Khalifa bin Zayad Al Nahyan Hospital Rawalakot, Medicine Medical Unit A, Hayatabad Medical Complex, Peshawar and department of Medicine, Fauji Foundation Hospital Rawalpindi for duration between 5th January 2020 and 5th December 2020. Jaundice was defined as a serum bilirubin concentration of 3 mg/dL or higher. The etiology of jaundice was determined using a pattern of liver disease biochemistry test, radiographic studies, liver biopsy and clinical follow-up. Results: About 272 HIV-infected patients were evaluated liver disease; the prevalence of jaundice was 46 (16.9%). Drug-induced hepatitis was the more prevalent cause in Jaundice 19 (41.3%) followed by neoplasms in 14 (30.4%) patients. Out of 14 neoplasms, the extrahepatic and intrahepatic disease was present in 8 and 6 patients respectively. Alcoholic liver disease was present in 5 (10.9%). Various potential causes were present in three patients. The use of abdominal ultrasonography and CT was beneficial in determining the fundamental cause of the infection. five of these patients died as a result of liver disease. Conclusion: Jaundice is rare and can be caused by a number of opportunistic and non-opportunistic etiologies in AIDS. The most common cause is drug-induced hepatitis, which can be fatal. Long-term survival was dismal. Keywords: Jaundice, Liver Disease, Human immunodeficiency virus (HIV)

Pharmacokinetics of 2 oral paracetamol formulations in hospitalized octogenarians.

It is currently unclear how paracetamol should be dosed in order to increase its efficacy while warranting safety in very old adults. The objective was to evaluate the pharmacokinetics of 2 oral paracetamol formulations and its metabolites in hospitalized octogenarians. Geriatric inpatients aged 80 years and older received a 1000-mg paracetamol tablet or granulate at 08.00, 14.00 and 20.00. After at least 4 consecutive gifts, plasma samples were collected around the 08.00 dose (trough, +0.5, +1, +2, +4, +5 and +6h). Plasma concentrations of paracetamol and its metabolites were determined and individual pharmacokinetic parameters were derived. The Edmonton Frail Scale was used to assess frailty. An analgesic plasma target was defined as an average plasma concentration (Cavg ) of 10mg/L. The mean (±standard deviation) age was 86.78 (±4.20) years. The majority (n =26/36, 72%) received the tablet, 10 (28%) the granulate. Thirty patients (85%) were classified with moderate to severe frailty. Seven (21%) patients had a Cavg above 10mg/L. The median [interquartile range] time to reach the peak concentration was 50.5 [31.50-92.50] and 42.50 [33.75-106.75] min for the tablet and granulate, respectively. The coefficient of variation was 95% for time to reach the peak concentration and 30% for Cavg of paracetamol. A correlation of Cavg of paracetamol was observed with female sex and total serum bilirubin. Large interindividual differences were found for pharmacokinetic parameters of oral paracetamol in frail inpatients after multiple dosing. Female sex and higher total serum bilirubin concentrations were associated with paracetamol exposure. No significant differences were observed between the tablet and granulate.

Effect of leaf extracts of Carica papaya (Paw paw) and Pakia biglobosa (African locust bean) on some biochemical parameters of albino rats

In spite of the advances made in orthodox medicine, there has been an increasing interest in herbal medicine. The leaves of Carica papaya and Pakia biglobosa have been reported to contain lots of beneficial medicinal compounds, hence their use in the traditional prevention, management and treatment of ailments/diseases. In this study, the effect of varied concentrations of the ethanol leaf extract of the plants on some biochemical parameters of albino rats was assessed. The phytochemical compositions of the leaves were determined using established standard laboratory methods. Fifty four male Albino rats weighing between 150g-200g were randomly distributed into nine groups of six animals each. A daily single dose of 500mg/kg, 1000mg/kg, 1500mg/kg and 2000mg/kg body weight of either of the extracts was respectively, administered to the eight test groups for fourteen days. The control group was given only feed and water. Biochemical parameters such as the serum activities of Aspartate Aminotransferase, Alanine Aminotranferase and Alkaline phosphatase as well as the serum concentrations of Bilirubin, Albumin, HCO3-, Urea, Creatinine and Na+ were assessed. Result of the analyses showed that the administration of the extracts did not significantly raise the serum activity of ALT. The decreases in serum concentrations of Urea and increase in the concentration of HCO3- were directly proportional to the concentration of the extracts. It can be deduced from this study, that 500mg, 1000mg 1500mg and 2000mg/kg bw of either C. papaya or P. biglobosa did not elicit any marked hepatotoxicological or renotoxicological effect on the experimental animals

Effect of garlic supplementation on zootechnical performance and hepato-renal functions in nitrate-treated rabbits

The effect of garlic supplementation on zootechnical performance and hepato-renal functions of rabbits exposed to experimental nitrate poisoning was evaluated. Adult male 6-8 week-old albino rabbits (n= 24) were randomly divided into four groups (A - D) and subjected to nitrate intoxication through the oral administration of sodium nitrate solution at 2 ml/kg bodyweight per day for 40 days. Group A was a control that received no treatment except sodium nitrate. Rabbits in groups B and C were treated with 1% methylene blue solution (2 mg/kg bodyweight per day) and aqueous garlic extract (500 mg/kg bodyweight per day) through intraperitoneal and oral routes, respectively. Rabbits in group D were treated with both 1% methylene blue solution (2 mg/kg bodyweight per day, intraperitoneally) and aqueous garlic extract (500 mg/kg bodyweight per day, orally). On completion of the treatment period, the groups were compared in growth performance, biochemical profile and histopathological changes of hepato-renal tissues. Although the total feed consumption of the groups remained comparable, Group C showed relatively better weight gain and feed conversion ratio (FCR). Likewise, garlic extract significantly increased the serum bilirubin concentration and reduced the level of other biochemical attributes in comparison with control animals. The hepatic and renal tissues of Groups C and D remained normal, whereas those of the control group exhibited distinct histopathological alterations. It was concluded that garlic supplementation ameliorated the deleterious effects of nitrate intoxication on production performance and hepato-renal functions of rabbits.

Evaluation of serum histone concentrations and their associations with hemostasis, markers of inflammation, and outcome in dogs with naturally occurring acute pancreatitis.

To compare serum concentrations of histones and inflammatory markers in dogs with acute pancreatitis and healthy control dogs, investigate associations of these variables with coagulation test results and survival (vs nonsurvival) to hospital discharge, and examine the prognostic utility of clinical findings and routine laboratory and coagulation tests in affected dogs. 36 dogs. Dogs with findings consistent with acute pancreatitis (n = 29) and healthy control dogs (7) were enrolled in a prospective, observational study. Serum concentrations of histones, interleukin (IL)-6, and tumor-necrosis factor-α were assessed for all dogs. Clinical (including ultrasonographic) findings, relevant history, routine laboratory and coagulation test results, and outcomes were recorded for dogs with pancreatitis. Variables were assessed to determine an association with outcome for affected dogs and hospitalization time for survivors; histone concentrations and markers of inflammation were compared among survivors, nonsurvivors, and controls. Correlation between quantitative variables was investigated. Serum histone and IL-6 concentrations did not differentiate survivors (n = 23) from nonsurvivors (6); IL-6 concentrations in affected dogs were correlated with 1,2-o-dilauryl-rac-glycero glutaric acid-(6'-methylresorufin) ester lipase activity (rS = 0.436) and hospitalization time (rS = 0.528). Pancreatitis-associated peritoneal fluid, obtundation, and jaundice were more common, and serum bilirubin concentration, serum alanine aminotransferase and aspartate aminotransferase activities, and prothrombin and activated partial thromboplastin times were greater in nonsurvivors than in survivors. Thromboelastometric changes consistent with hypercoagulability were detected in survivors; hypocoagulability was detected in 2 nonsurvivors. Serum histone concentrations were not associated with presence of acute pancreatitis or outcome for affected dogs. Further research is needed to investigate the clinical and therapeutic implications of hypocoagulability, hepatocellular injury, and pancreatitis-associated peritoneal fluid in affected dogs.

Effect Sleep Deprivation On Some Liver Enzymes For Adult's Males

The current study was designed for two groups, each group contain (20) nonsmokers healthy persons males, first group was get (more than 7 hours sleep / day) , while the second group did not get enough sleep hours (less than 7 hours sleep / day). The results showed a significant increase in the level of body mass index (BMI) , the activity of glutamic pyruvic transaminase enzyme (GPT), glutamic oxaloacetic transaminase enzyme (GOT) and concentration of total serum bilirubin (TSB) at probability level (P≤0.049 , P≤0.047 , P≤0.032 , P≤0.035) Respectively in Persons with second group compared to Persons with first group, as well as the study showed a positive correlation between the studied parameters , with increase of all parameters in the second group with each other as a result of the same reason.

Primary hepatic sarcoidosis presenting with cholestatic liver disease and mimicking primary biliary cholangitis: a case report

Sarcoidosis often involves the liver. However, primary hepatic sarcoidosis confined to the liver without evidence of systemic involvement is rare. We report the case of a 37-year-old man with hepatic sarcoidosis who initially presented with elevated liver enzymes and suspicious cirrhotic nodules on computed tomography. The patient had cirrhosis but did not have portal hypertension. Based on the initial histopathologic finding of chronic granulomatous inflammation and the common clinical characteristics of sarcoidosis, he was initially diagnosed with primary biliary cholangitis, and his daily dosage of ursodeoxycholic acid was increased to 900 mg. After 14 months of treatment, his total serum bilirubin concentration was 10.9 mg/dL (upper normal limit, 1.2 mg/dL). Additionally, a transjugular liver biopsy revealed multiple noncaseating granulomas. He was diagnosed with primary hepatic sarcoidosis involving the lungs, heart, spleen, kidneys, and skin. Treatment with methylprednisolone was initiated. Two weeks later, he was started on azathioprine, and the dose of steroid was simultaneously reduced. These findings indicate the importance of including hepatic sarcoidosis as a possible diagnosis in patients with elevated liver enzymes or cryptogenic cirrhosis.

Hyperbilirubinemia as an Indicator of Perforated Acute Appendicitis in Pediatric Population: A Prospective Study.

Background: This prospective cohort study aimed to investigate the association of hyperbilirubinemia with perforated appendicitis in the pediatric population. Patients and Methods: A total of 284 children in whom the diagnosis of acute appendicitis was established were included in this study. The patients were allocated in study groups in regard to operative findings. The first study group included patients who had perforated appendicitis (n = 64; 22.5%) whereas the patients in the second group had simple appendicitis (n = 220; 77.5%). Blood samples for serum bilirubin levels and acute inflammatory markers were taken before the patients underwent surgery. The primary outcome of the study was to investigate whether the level of serum bilirubin should be used to distinguish between simple and perforated appendicitis. Results: The median level of serum bilirubin in children with perforated appendicitis was 27 mcmol/L whereas the patients with simple appendicitis had lower median levels of serum bilirubin (10 μmol/L; p < 0.001). An area under the receiver operating characteristic (ROC) curve for total serum bilirubin was 0.876 (95% confidence interval [CI], 0.820-0.929) in the patients who had a perforated appendicitis. An ROC analysis showed the best sensitivity (92%) and specificity (77.3%) for a cutoff value of 15.5 mcmol/L for total serum bilirubin (p < 0.001). Hyperbilirubinemia at admission was found in 35 patients (54.7%) with complicated appendicitis and in 14 patients (6.4%) with non-perforated appendicitis (p < 0.001). The modeling of collected data by multivariable logistic regression identified serum bilirubin concentration (odss ratio [OR] = 1.12; 95% CI, 1.07-1.18; p < 0.001), serum sodium concentration (OR = 0.64; 95% CI, 0.51-0.81; p < 0.001), body temperature (OR = 2.48; 95% CI, 1.05-0.84; p < 0.001), and duration of symptoms (OR = 1.06; 95% CI, 1.02-1.09; p < 0.001) as risk factors for perforated appendicitis. Conclusion: Elevateds level of total serum bilirubin may be useful as an indicator of perforated appendicitis in children. Levels of bilirubin in serum is an inexpensive, simple, and available laboratory marker and should therefore be recommended in the initial evaluation for acute appendicitis in pediatric patients.

Biomimetic point-of-care testing of trace free bilirubin in serum by using glucose selective capture and surface-enhanced Raman spectroscopy

The concentration of bilirubin in serum is a key indicator for liver function, because excess bilirubin accumulation may lead to serious health problems like Jaundice. It is known that in comparison with total bilirubin, the concentration of hydrophobic free bilirubin is more closely associated with Jaundice because of its capability to cross the capillary walls and even blood-brain barrier. However, it is not easy to detect the low concentration of free bilirubin (∼ nM) in the presence of large amount of protein-bound bilirubin (> 150 μM), and no point-of-care detection tool is available. In the present work, direct detection of free bilirubin was realized by using surface enhanced Raman spectroscopy (SERS). By mimicking the in vivo chemical interaction between glucuronic acid and bilirubin, glucose functionalized Au nanoparticles were synthesized for selective capture and detection of free bilirubin. By developing a convenient detection procedure of using robust Au array chip and internal standard calibration method, the sensitive detection of free bilirubin with detection limit down to 0.1 nM was achieved on a handhold Raman spectrometer by monitoring its fingerprint spectra. The clinical applicability was demonstrated with analyzing the spiked and real blood samples. As a proof of concept, the binding constant between bilirubin and human serum albumin (HSA) was determined with the present method. The influence of the binding capacity of the HSA for bilirubin in the presence of competing molecule salicylate sodium was also quantitatively measured, which demonstrated the importance of detection of free bilirubin instead of total bilirubin for warning the risk of bilirubin encephalopathy.

Macroporous cellulose/carbon nanotube microspheres prepared by surfactant micelle swelling strategy for rapid and high-capacity adsorption of bilirubin

It remains a formidable challenge to construct high-performance haemoperfusion adsorbents with fast adsorption kinetic and high adsorption capacity for efficiently removing bilirubin from human blood. In this work, we report a facile yet efficient strategy to manufacture lysine-modified macroporous cellulose/carbon nanotube microspheres (LMCMs) by surfactant micelles swelling strategy followed by modification with lysine. The macroporous structure not only provides wide channels for fast mass transfer, but also shortens the diffusion path into meso/micropores, increasing the accessibility of mesopores and micropores. Experimental results reveal that LMCMs can remove bilirubin with fast adsorption kinetic (> 90% of its equilibrium uptake within 2 h) and high adsorption capacity of 338.14 mg/g. More importantly, the adsorbent can remove about 79% of bilirubin in rabbit serum, and the bilirubin concentration in rabbit serum decreases from 213.36 to 45.78 mg/L within 2 h, indicating a very appealing application prospect.

Analysis of Blood Serum Bilirubin Concentration among Moderate Intensity Exercise Performers; A Randomized Control Trails

Purpose: A randomized control trails were conducted to evaluate the effects of moderate intensity exercise on blood serum bilirubin level.&#x0D; Methods: A participants of the study were divided in two groups i.e. experimental group (EG= 10) and control group (CG=10). 5ml blood were taken from all the subjects and each blood sample was marked with separate identification code. Twelve weeks exercise (moderate intensity exercise) protocols was employed on the selected subjects. The collected blood samples were tested and thus the collected results were processed through Statistical Package for Social Sciences (SPSS, Version, 24) by applying Mean and Standard deviation etc.&#x0D; Result: Based on analysis the researcher concluded that moderate intensity exercise has significant impact on Serum Bilirubin Concentration of the subjects. In addition significant difference was found in pre and post test result of experimental group (t4= 1.000, Sig. = .374 &gt; α= 0.05).

Effect of Silymarin Treatment on Circulating Bilirubin and Cardiovascular Disease Risk Factors in Healthy Men: A Single-Blind, Randomized Crossover Trial.

This clinical trial (ACTRN12619001296123) investigated the impact of silymarin (Legalon®) on circulating bilirubin concentration, lipid status, systemic inflammation, and antioxidant status. The study design was a randomized, placebo-controlled, single-blind crossover trial of healthy men (18-65 years), conducted at Griffith University, Gold Coast, Australia. Participants were recruited from Griffith University and were randomized to silymarin (140 mg silymarin capsules thrice daily) or placebo (3 capsules containing mannitol taken daily) for 14 days followed by a ≥4-week washout and crossover to the other arm. The main outcomes were whether silymarin treatment would increase serum bilirubin concentration by >0.29 mg/dL, change serum lipid status (cholesterol and triglycerides), inflammation (c-reactive protein), and antioxidant capacity (ferric reducing ability of plasma) compared with baseline. Silymarin consumption (n = 17) did not affect serum concentrations of unconjugated bilirubin (0.73 versus 0.67 mg/dL, P = .79), cholesterol (185 versus 189 mg/dL, P = .19), triglycerides (94.2 versus 92.3 mg/dL, P = .79), c-reactive protein (0.17 versus 0.09 mg/dL, P = .23), or antioxidant status (6.61 versus 6.67 mg Fe2+ /dL, P = .40). These findings challenge previous reports and manufacturer claims of hyperbilirubinemia following silymarin treatment and are critical to guiding researchers toward an effective means to mildly elevate bilirubin, which evidence suggests could protect from cardiovascular disease.

Factors Associated with Exchange Transfusion among Severe Neonatal Jaundice in Malaysia

Background Neonatal jaundice may lead to a severe level if it is not well monitored. The long-term consequences of severe neonatal jaundice may result in devastating neurologic sequelae, including bilirubin encephalopathy and kernicterus. Exchange transfusion has remained the most effective modality for lowering serum bilirubin concentration. The present study aimed to determine the proportion and factors associated with exchange transfusion procedure among neonates with severe jaundice in Kelantan from 2015 to 2017.Methods This cross-sectional study was carried out among neonates with severe jaundice in Kelantan between 2015 and 2017 using jaundice surveillance data from Kelantan Health State Department.Result Out of the study subjects, 45 (19.7%) neonates had severe jaundice requiring an exchange transfusion procedure. From 2015 to 2017, the prevalence of severe neonatal jaundice requiring exchange transfusion raised from 17.0%-23.7%. The significant factors associated with exchange transfusion were neonatal infection, low birth weight, ABO blood group incompatibility, and maternal blood type O.Conclusion As evidenced by the obtained results, exchange transfusion among severe neonatal jaundice in Kelantan followed an increasing trend within the study period. Associated factors leading to exchange transfusion among severe neonatal jaundice were neonatal infection, low birth weight, ABO incompatibility, and maternal blood type O. The recognition of these factors would be of great help in developing effective strategies aimed at the prevention of exchange transfusion procedure and its subsequent complications.

The Determination of Total Serum Bilirubin Concentration in Type 2 Diabetes patients

Bilirubin represent a natural end-product of heme metabolism and is used as as a marker in diagnosis off hepatobiliary diseases. Recent studies demonstrated that serum bilirubin levels are related to the risk of Type 2 diabetes mellitus (T2D) development and subsequent complications. The aim of this study was to analyzed serum total bilirubin concentrations and its relationship with biochemical and clinical characteristics in T2D patients. Total of 109 participants were included in this study, 54 controls and 55 diabetic patients, both gender, while ages ranged from 35 to 70 years. Biochemical parameters were analyzed by standard IFCC methods while serum total bilirubin concentrations was determined by the method of Jendrassik/Gróf. All analyses and measurements were provided by using the chemical analyzer VITROS 350. Results showed a significant difference in concentrations of glucose, glycated hemoglobin (HbA1c), lipid profile (total cholesterol, triglycerides, HDL cholesterol, LDL cholesterol) and bilirubin between T2D patients and controls (p&lt;0.05). Also, significant association was found between bilirubin and glucose concentrations in two investigated populations (p&lt;0.05). It appears that elevated concentration of bilirubin and biochemical characteristics are associated with the progression development of Type 2 diabetes and its related vascular complications. Therefore, total serum bilirubin concentrations could be used as potential T2D biomarker and therefore, as new therapeutic target.

Association of Serum Bilirubin Level with Metabolic Syndrome and Non-Alcoholic Fatty Liver Disease: A Cross-Sectional Study of 1672 Obese Children

As in adults, obesity also plays a central role in the development of metabolic syndrome (MS) in children. Non-alcoholic fatty liver disease (NAFLD) is considered a manifestation of MS. Not only MS but also NAFLD seem to be inversely associated with serum bilirubin concentrations, an important endogenous tissue protector when only mild elevated. The aim of the study was to evaluate the association between serum bilirubin levels and the prevalence of MS and NAFLD in Italian obese children and adolescents. A retrospective cross-sectional study was performed in 1672 patients aged from 5 to 18 years. Clinical and laboratory parameters were assessed. NAFLD was measured by liver ultrasonography. The study was approved by the Ethical Committee of the Istituto Auxologico Italiano (research project code 1C021_2020, acronym BILOB). MS was present in 24% and fatty liver (FL) in 38% of this population. Bilirubin was not associated with FL and MS as a whole, but it was inversely associated only with selected components of MS, i.e., large WC, high blood pressure and high triglycerides. Our data suggest that bilirubin is not protective against MS and NAFLD in the presence of severe obesity.

An Inverse Relation between Hyperglycemia and Skeletal Muscle Mass Predicted by Using a Machine Learning Approach in Middle-Aged and Older Adults in Large Cohorts.

Background: Skeletal muscle mass (SMM) and fat mass (FM) are essentially required for health and quality of life in older adults. Objective: To generate the best SMM and FM prediction models using machine learning models incorporating socioeconomic, lifestyle, and biochemical parameters and the urban hospital-based Ansan/Ansung cohort, and to determine relations between SMM and FM and metabolic syndrome and its components in this cohort. Methods: SMM and FM data measured using an Inbody 4.0 unit in 90% of Ansan/Ansung cohort participants were used to train seven machine learning algorithms. The ten most essential predictors from 1411 variables were selected by: (1) Manually filtering out 48 variables, (2) generating best models by random grid mode in a training set, and (3) comparing the accuracy of the models in a test set. The seven trained models’ accuracy was evaluated using mean-square errors (MSE), mean absolute errors (MAE), and R² values in 10% of the test set. SMM and FM of the 31,025 participants in the Ansan/Ansung cohort were predicted using the best prediction models (XGBoost for SMM and artificial neural network for FM). Metabolic syndrome and its components were compared between four groups categorized by 50 percentiles of predicted SMM and FM values in the cohort. Results: The best prediction models for SMM and FM were constructed using XGBoost (R2 = 0.82) and artificial neural network (ANN; R2 = 0.89) algorithms, respectively; both models had a low MSE. Serum platelet concentrations and GFR were identified as new biomarkers of SMM, and serum platelet and bilirubin concentrations were found to predict FM. Predicted SMM and FM values were significantly and positively correlated with grip strength (r = 0.726) and BMI (r = 0.915, p < 0.05), respectively. Grip strengths in the high-SMM groups of both genders were significantly higher than in low-SMM groups (p < 0.05), and blood glucose and hemoglobin A1c in high-FM groups were higher than in low-FM groups for both genders (p < 0.05). Conclusion: The models generated by XGBoost and ANN algorithms exhibited good accuracy for estimating SMM and FM, respectively. The prediction models take into account the actual clinical use since they included a small number of required features, and the features can be obtained in outpatients. SMM and FM predicted using the two models well represented the risk of low SMM and high fat in a clinical setting.

A randomized controlled clinical trial on peripartum effects of delayed versus immediate umbilical cord clamping on term newborns

ObjectivesTo compare the hemoglobin and serum bilirubin concentration of term newborn following delayed and immediate umbilical cord clamping. MethodsA randomized controlled trial of eligible parturients with singleton pregnancy delivered between July 1, 2019 and September 30, 2020 were randomly assigned (1:1 ratio) to either delayed clamping of umbilical cord (60 s after delivery) or immediate clamping (0−15 s) was done. The primary outcome measures included hemoglobin and bilirubin levels of the newborn measured at birth and 48 h of life. Intention-to-treat principle was applied to analysis (www.pactr.org: PACTR201906668876480). ResultsOne hundred and two newborns were randomized into each group and none was lost to follow-up. Participants in both groups had similar socio-demographic and clinical characteristics. At 0 h of birth, cord blood hemoglobin concentration and total bilirubin values were not significantly different between the two groups (p > 0.05). At 48 h of birth, mean hemoglobin concentration was significantly higher in delayed clamping group than immediate clamping group (16.51 ± 1.71 g/dl vs 15.16 ± 2.27 g/dl; p < 0.001) but total mean bilirubin concentration was not significantly different (3.88 ± 1.54 mg/dl vs 3.71 ± 1.20 mg/dl; p = 0.380). There was no significant difference in postpartum hemorrhage (p = 0.653), neonatal jaundice (p = 0.856), and need for phototherapy (p = 0.561) while respiratory symptoms, polycythemia and anemia were not reported. ConclusionDelayed cord clamping at childbirth is more advantageous for term infants in terms of more hemoglobin concentration compared to traditional immediate cord clamping. The maternal and perinatal complications were either not significantly different or absent.

A novel deletion mutation (c.749 del C) in the UGT1A1 gene as a cause of Crigler-Najjar syndrome type 1: A case report

Crigler-Najjar syndrome type I (CNS-1) is a rare inherited disorder, which can lead to kernicterus. Mutations within the UGT1A1 gene that cause the absence of functional UGT1A1 protein/enzyme are the leading cause of CNS-1. UGT1A1 converts unconjugated bilirubin to conjugated form, making it able to be water-soluble and excreted. CNS-1 has a poor prognosis, and timely diagnosis of the disease is necessary to the prevention of kernicterus and successful management of the disease. We identified a novel single nucleotide deletion mutation (c.749 del C) within the first exon of the UGT1A1 gene in a 9-month-old male infant. The patient had total serum bilirubin concentration peaked at 26.8 mg/dL on the 9th day of birth and didn't respond to phototherapy and Phenobarbital and await for the curative liver transplantation. The identified frameshift mutation disrupted the reading frame result in the formation of a premature stop codon. Accordingly, the c.749 del C mutation is a pathogenic mutation that leads to CNS-1.