Bilirubin Production Research Articles

Novel extracorporeal treatment for severe neonatal jaundice: a mathematical modelling study of allo-hemodialysis

Severe Neonatal Jaundice (SNJ) causes long-term neurocognitive impairment, cerebral palsy, auditory neuropathy, deafness, or death. We developed a mathematical model for allo-hemodialysis as a potential blood purification method for the treatment of SNJ in term or near-term infants. With allo-hemodialysis (allo-HD), the neonate’s blood flows through hollow fibers of a miniature 0.075 m2 hemodialyzer, while the blood of a healthy adult (“buddy”) flows counter-currently through the dialysate compartment. We simulated the kinetics of unconjugated bilirubin in allo-hemodialysis with neonate blood flow rates of 12.5 and 15 mL/min (for a 2.5 kg and 3.5 kg neonate, respectively), and 30 mL/min for the buddy. Bilirubin production rates in neonate and buddy were set to 6 and 3 mg/kg/day, respectively. Buddy bilirubin conjugation rate was calculated to obtain normal steady-state bilirubin levels. Albumin levels were set to 1.1, 2.1, 3.1 g/dL for the neonate and 3.3 g/dL for the buddy. Model simulations suggest that a 6-h allo-hemodialysis session could reduce neonatal bilirubin levels by > 35% and that this modality would be particularly effective with low neonatal serum albumin levels. Due to the high bilirubin conjugation capacity of an adult’s healthy liver and the larger distribution volume, the buddy’s bilirubin level increases only transiently during allo-hemodialysis. Our modelling suggests that a single allo-hemodialysis session may lower neonatal unconjugated bilirubin levels effectively. If corroborated in ex-vivo, animal, and clinical studies, this bilirubin reduction could lower the risks associated with SNJ, especially kernicterus, and possibly avoiding the morbidity associated with exchange transfusions.

Association of elevated baseline bilirubin caused by preadmission statin use with cardiovascular prognosis in patients undergoing elective percutaneous coronary intervention

Bilirubin is widely recognized to possess antioxidant and anti-inflammatory characteristics. However, the relationship between bilirubin and coronary artery disease (CAD) remains controversial, particularly in individuals receiving Percutaneous Coronary Intervention (PCI). Given that statins may enhance the production of heme oxygenase-1 (HO-1) and bilirubin, we investigated the long-term cardiovascular prognostic role of bilirubin levels elevated by statin use in patients undergoing PCI. Data of 6945 subjects undergoing PCI were enrolled in this study. We divided the patients into two groups based on serum total bilirubin (TB) levels detected prior to PCI. The high TB group consisted of patients with serum TB values > 8.4 μmmol/L, while the low TB group consisted of patients with serum TB values ≤ 8.4 μmmol/L. The median follow-up time was 836 days. Cox proportional hazards models were performed to evaluate the hazard ratios (HRs) and 95% confidence interval (CI) for the incidence of major adverse cardiovascular event (MACE) associated with bilirubin levels. The association between TB levels and risk of MACE was significant [adjusted HR = 0.557, 95% CI (0.59–0.96), p = 0.020). Linear analysis was performed to determine the association between preadmission usage of statin and bilirubin level. The preadmission usage of statin independently linearly increases TB [adjusted-β = 0.371, 95% CI (0.134–0.608), p = 0.002] and direct bilirubin (DB) [adjusted-β = 0.411, 95% CI (0.300–0.522), p < 0.001). Mediation analysis demonstrated a direct protective role of preadmission statins treatment (β = − 0.024, p < 0.01), TB (β = − 0.003, p < 0.05) and DB (β = − 0.009, p < 0.05). Furthermore, it was found that TB (4.0%) and DB (12.0%) mediated the relationship between preadmission statins therapy and MACE. Bilirubin has a protective effect against MACE. In patients with normal bilirubin level undergoing elective PCI, preadmission statin use elevated bilirubin levels, which were independently associated with a lower incidence of MACE over the long-term follow-up period.

Cholelithiasis Diagnosis and Management in Thalassemia

Background: Cholelithiasis, while infrequently found in children, carries a significant risk for those with underlying conditions like thalassemia compared to the general population. This study aimed to described the manifestations of cholelithiasis in thalassemic children. Case: A 12-year-old girl with beta-thalassemia major presented with recurrent right upper quadrant abdominal pain and vomiting. Imaging revealed cholelithiasis and choledocholithiasis. Due to complications related to her thalassemia, she underwent endoscopic retrograde cholangiopancreatography (ERCP) for gallstone removal followed by laparoscopic cholecystectomy. Post-operative management addressed post-ERCP pancreatitis and bleeding concerns. The patient recovered well and is scheduled for follow-up. Discussion: Increased bilirubin production, iron overload, and altered bile properties in beta-thalassemia contribute to cholelithiasis risk. The patient presented with typical symptoms and underwent successful laparoscopic cholecystectomy after initial management with ERCP, which led to post-ERCP pancreatitis. Conclusion: This case underscores the elevated risk of cholelithiasis in thalassemic children and the importance of early diagnosis and intervention for optimal outcomes.

Prophylactic efficacy of aqueous extract of unripe pawpaw (Carica papaya) fruit on hematological and biochemical parameters in induced hyperbilirubinemia Wistar rats

This research offers a comprehensive examination of hyperbilirubinaemia, characterized by elevated levels of bilirubin in the bloodstream leading to jaundice. It presents a prevalent challenge during the neonatal phase, as bilirubin can accumulate in various body parts resulting in potential neurotoxicity. The discussion encompasses factors influencing bilirubin production, conjugation, and elimination in the organism, along with an overview of the causes and symptoms of hyperbilirubinaemia. The study delves into the potential advantages of utilizing Carica papaya, a tropical fruit, for the prevention of hyperbilirubinaemia. Traditional medical approaches for managing this condition are linked to numerous adverse effects, hence the necessity to develop more affordable, easily accessible, and efficacious drugs with minimal or no side effects. Blood samples were procured and subjected to full blood cell count analysis via an automated hematologic analyzer, while serum samples were utilized for quantifying liver enzymes and bilirubin employing a spectrophotometric technique. Additionally, the weight of visceral organs was determined using a Mettler weighing balance. The outcomes of an experimental study conducted on rodents revealed that pretreatment with Carica papaya extract notably decreased bilirubin and liver enzyme levels in the subjects. This highlights the potential role of Carica papaya in the preventive management of hyperbilirubinaemia, underscoring the imperative for further investigation in this domain. In essence, this research serves as a valuable repository of knowledge for healthcare practitioners and researchers keen on addressing hyperbilirubinaemia.

Cytoprotective mechanism of cerebro-cognitive reserve

IntroductionConsideration of the reserve problem would be incomplete without an analysis of the cytoprotective mechanism. The predominant molecular hallmark of aging and degeneration is the accumulation of altered gene products. Moreover, several conditions, including protein, lipid, or glucose oxidation, disrupt redox homeostasis and lead to the accumulation of unfolded or misfolded proteins in the aging brain in case of AD, and other neurodegenerative diseases that have as a common denominator abnormal protein production, mitochondrial dysfunction and oxidative stress. Some authors classify aging, pathological aging, and neurodegeneration as “protein conformational diseases”.Objectivesscientific publicationsMethodsanalytical reviewResults The central nervous system has evolved a conserved unfolded protein response mechanism to cope with the accumulation of misfolded proteins. As one of the main intracellular redox systems involved in neuroprotection, the vitagene system becomes a potential neurohormetic target for novel cytoprotective interventions. Vitagens encode the cytoprotective heat shock proteins (Hsp) Hsp70 and heme oxygenase-1, as well as thioredoxin reductase and sirtuins. The cellular stress response is the ability of a cell to withstand stressful conditions, including the heat shock response. The production of heat shock proteins, including protein chaperones, is necessary for the folding and repair of damaged proteins, which promotes cell survival to avoid apoptosis.«Molecular chaperone» are proteins that function as part of an ancient defense system in our cells. They promote cell survival by sequestering damaged proteins and preventing their aggregation. Chaperone complexes are involved in the regulation of mitochondrial functions, assembly of the cytoplasmic proteolytic system of brain cells. The cellular response to stress requires the activation of survival pathways that are under the control of protective genes called vitagens. Vitagens are involved in the production of heat-shock protein molecules, glutathione, and bilirubin. They have antioxidant and anti-apoptotic activity and provide protection against oxidative stress.Conclusions Studies have shown that the heat shock response contributes to the maintenance of cellular homeostasis, the establishment of a cytoprotective state in a wide range of human diseases, including inflammation, cancer, aging, and neurodegenerative disorders. Endogenous proteins can be manipulated by food or pharmacological compounds, which represents an innovative approach to therapeutic intervention in neurodegenerative disorders, actually influencing reserve mechanisms and adaptive capacity.Disclosure of InterestNone Declared

Otras enfermedades hepáticas de causa genética, metabólica y endocrinológica

Liver diseases of genetic origin comprise a series of diseases that manifest as abnormalities in liver structure and/or function due to genetic mutations. This update will discuss some of them, such as alpha-1 antitrypsin deficiency (A1AT), Wilson's disease, lysosomal acid lipase deficiency (LAL-D), and other congenital diseases related to bile acid and bilirubin metabolism.Alpha-1 antitrypsin deficiency is an autosomal codominant condition characterized by a decrease in secretion of alpha-1 antitrypsin protein, which acts as an inhibitor of neutrophil elastase. This results in liver and lung damage due to an accumulation of misfolded protein in hepatocytes and uncontrolled elastase activity. On the other hand, in Wilson's disease, an autosomal recessive disorder, mutations in the ATP7B gene impair copper metabolism. This results in an accumulation of toxic copper in the liver and other organs, causing hepatitis, cirrhosis, and neuropsychiatric manifestations. Lysosomal acid lipase deficiency is an autosomal recessive disorder caused by mutations in the LIPA gene. This results in the accumulation of cholesterol and triglyceride esters in lysosomes, leading to hepatomegaly, hyperlipidemia, and premature atherosclerosis. Finally, the set of diseases related to bilirubin and bile acid metabolism involve abnormalities in the production, transport, and excretion of bilirubin and bile acids. They are associated with cholestasis and hepatocellular damage, which can lead to liver failure and death.

Bilirubin Distribution in Plants at the Subcellular and Tissue Levels.

In heterotrophs, heme degradation produces bilirubin, a tetrapyrrole compound that has antioxidant activity. In plants, heme is degraded in plastids and is believed to be converted to phytochromobilin rather than bilirubin. Recently, we used the bilirubin-inducible fluorescent protein UnaG to reveal that plants produce bilirubin via a non-enzymatic reaction with NADPH. In the present study, we used an UnaG-based live imaging system to visualize bilirubin accumulation in Arabidopsis thaliana and Nicotiana benthamiana at the organelle and tissue levels. In chloroplasts, bilirubin preferentially accumulated in the stroma, and the stromal bilirubin level increased upon dark treatment. Investigation of intracellular bilirubin distribution in leaves and roots showed that it accumulated mostly in plastids, with low levels detected in the cytosol and other organelles, such as peroxisomes, mitochondria and the endoplasmic reticulum. A treatment that increased bilirubin production in chloroplasts decreased the bilirubin level in peroxisomes, implying that a bilirubin precursor is transported between the two organelles. At the cell and tissue levels, bilirubin showed substantial accumulation in the root elongation region but little or none in the root cap and guard cells. Intermediate bilirubin accumulation was observed in other shoot and root tissues, with lower levels in shoot tissues. Our data revealed the distribution of bilirubin in plants, which has implications for the transport and physiological function of tetrapyrroles.

Production of bilirubin via whole-cell transformation utilizing recombinant Corynebacterium glutamicum expressing a β-glucuronidase from Staphylococcus sp. RLH1.

Bilirubin, a key active ingredient of bezoars with extensive clinical applications in China, is produced through a chemical process. However, this method suffers from inefficiency and adverse environmental impacts. To address this challenge, we present a novel and efficient approach for bilirubin production via whole-cell transformation. In this study, we employed Corynebacterium glutamicum ATCC13032 to express a β-glucuronidase (StGUS), an enzyme from Staphylococcus sp. RLH1 that effectively hydrolyzes conjugated bilirubin to bilirubin. Following the optimization of the biotransformation conditions, a remarkable conversion rate of 79.7% in the generation of bilirubin was obtained at temperate 40°C, pH 7.0, 1mMMg2+ and 6mM antioxidant NaHSO3 after 12h. These findings hold significant potential for establishing an industrially viable platform for large-scale bilirubin production.

Altered trace elements, antioxidant vitamin C, and malondialdehyde levels are associated with the pathophysiology and development of pre-hepatic jaundice: A case-control study.

Pre-hepatic jaundice results from an imbalance between bilirubin production and clearance, often linked to hemoglobinopathies. Antioxidant vitamin C, malondialdehyde, and trace elements play roles in jaundice, yet their specific associations remain unclear. The objective is to assess and compare these biomarkers in pre-hepatic jaundice patients and healthy controls, aiming to identify potential diagnostic markers and understand distinctive characteristics related to the disease's pathogenesis. This case-control study enrolled 50 pre-hepatic jaundice patients and 50 healthy controls, utilizing advanced techniques for biomarker quantification. We completed blood sample collection from study participants between 1 September 2023 and 31 December 2023. This study investigates the correlation between various biomarkers and pre-hepatic jaundice using serum samples with a focus on antioxidant vitamin C, malondialdehyde, and trace elements. This study demonstrates elevated concentrations of malondialdehyde in patients with pre-hepatic jaundice, suggesting alterations in bilirubin metabolism and increased oxidative stress. We found that the serum levels of malondialdehyde were significantly higher in pre-hepatic jaundice patients compared to healthy controls. Our observations revealed a notable decrease in the average serum vitamin C levels in patients with pre-hepatic jaundice compared to healthy controls. The patients had lower serum Zn levels and higher serum Cu and Mn levels compared to the healthy controls. The correlation study demonstrates robust positive correlations among these biomarkers in pre-hepatic jaundice. As the levels of vitamin C rise, the levels of the other criteria often fall, and vice versa. There is an inverse relationship between higher levels of vitamin C and lower levels of malondialdehyde. The current investigation identifies possible changes in antioxidant vitamins, malondialdehyde levels, and trace elements, which provide significant insights for targeted interventions. The present research highlights the integrated significance of vitamin C, malondialdehyde, and trace elements in the progression of the disease.

Development of Terbium based luminescent platform as a “Turn-off” sensor for the detection of bilirubin

The sensitive and selective fluorescent probes for biomolecule detection have significant application in clinical diagnosis and bioanalysis. Hyperbilirubinemia is a disease condition in which the excessive or less production of bilirubin in blood resulting in jaundice. In this work, we have synthesised Terbium based bright green, fluorescent lanthanide complex (Tb-DPA) with emission atλem = 544 nm for the detection of Bilirubin. A one-step synthesis approach was adopted with2,6-pyridine dicarboxylic acid (DPA) as ligand and Sodium dodecyl sulphate (SDS) as surfactant. The green fluorescence of Tb-DPA was quenched with the addition of bilirubin due to the inner filter effect mechanism. The fluorescence intensity of Tb-DPA decreases as bilirubin concentration increases and a linear “turn-off” response is obtained. Even in presence of other coexisting biomolecules and ions, the Tb-DPA probe exhibited good selectivity and sensitivity for the detection of bilirubin. The limit of detection (LOD) of 2.6 mg/dL was obtained. Furthermore, the proposed fluorescent probe was applied in Human serum and urine samples with satisfactory recoveries in the range of 92–122 %. Based on the result obtained, it has probability to be used as a rapid detection method for bilirubin in biological samples at bedside.

An Overview on Neonatal Jaundice

A significant proportion of term and preterm infants develop neonatal jaundice. Jaundice in a healthy term infant is the most common reason for readmission to hospital. Jaundice is caused by a significant increase in serum bilirubin levels, largely due to the breakdown of red blood cells. Bilirubin is transported in the blood as 'unconjugated' bilirubin, largely bound to albumin. The bilirubin is converted into a conjugated form by the liver, which is excreted in the bile. Very high levels of unconjugated bilirubin led to neurotoxicity. In most infants, severe hyperbilirubinemia is caused due to an increase in bilirubin production (e.g., due to haemolysis) and thus reducing bilirubin production is a rational approach for its management. The situation can become critical in infants with an associated impaired bilirubin elimination mechanism as a result of a genetic deficiency and polymorphism. The simplest way to reduce bilirubin levels is by phototherapy. Current management of jaundice in the UK is guided by the NICE guideline.1

Prevalence and management of neonatal jaundice in a hospital, Jos-Nigeria

Neonatal jaundice (hyperbilirubinemia) is one of the most common conditions that require medical attention in neonates. The medical condition is because of the imbalance between bilirubin production and its excretion. The accumulation of serum bilirubin in excess, elevates the values of bilirubin in neonates up to a high concentration as noted in the medical laboratory assay causing the yellowish colouration of skin and the eye. A retrospective study was carried out in OLA hospital from 2019 t0 2021 for neonates delivered within the period. The incidence of neonatal jaundice (hyperbilirubinemia) in this study was 11.7%. The most common risk factor associated with neonatal jaundice (hyperbilirubinemia) is ABO incompatibility, Preterm gestation and low birth weight (&lt;2.5kg). Neonatal jaundice (hyperbilirubinemia) is a common problem encountered in Neonatal Intensive Care Units of hospitals as seen in OLA Hospital in Jos. The recommended strategies that is involve in the prevention and control of neonatal jaundice include; health education on neonatal jaundice, identification of risk factors, early detection of neonatal jaundice, proper assessment of babies with neonatal jaundice and early referral for good medical management.

Bilirubin and Redox Stress in Age-Related Brain Diseases.

Cellular redox status has a crucial role in brain physiology, as well as in pathologic conditions. Physiologic senescence, by dysregulating cellular redox homeostasis and decreasing antioxidant defenses, enhances the central nervous system's susceptibility to diseases. The reduction of free radical accumulation through lifestyle changes, and the supplementation of antioxidants as a prophylactic and therapeutic approach to increase brain health, are strongly suggested. Bilirubin is a powerful endogenous antioxidant, with more and more recognized roles as a biomarker of disease resistance, a predictor of all-cause mortality, and a molecule that may promote health in adults. The alteration of the expression and activity of the enzymes involved in bilirubin production, as well as an altered blood bilirubin level, are often reported in neurologic conditions and neurodegenerative diseases (together denoted NCDs) in aging. These changes may predict or contribute both positively and negatively to the diseases. Understanding the role of bilirubin in the onset and progression of NCDs will be functional to consider the benefits vs. the drawbacks and to hypothesize the best strategies for its manipulation for therapeutic purposes.

An Evolution of Bilirubin Physiology and Analysis

Abstract: Bilirubin is a yellow tetrapyrrole molecule found in the gastrointestinal system, and it is produced when hemoglobin (Hb) is degraded. For treating various liver disorders like jaundice, serum bilirubin in the body is a testing marker. Jaundice develops when the serum bilirubin level is more significant than 2.0 to 2.5 mg/dl. Examining different forms of bilirubin, i.e., conjugated (direct) bilirubin, unconjugated (indirect) bilirubin, and total bilirubin, helps the physician identify the cause and metabolic disorder of jaundice. Inconsistent bilirubin production and removal results in lasting neurologic consequences (kernicterus). In this paper, we have presented a brief introduction to jaundice, the physiological mechanism of bilirubin, its types and causes, clinical approaches toward patients having jaundice, i.e., the conventional method being practiced in clinical laboratories, and various non-invasive systems in the point-of-care settings along with their advantages and disadvantages. Information on bilirubin production and elimination with tracking of bilirubin levels may help to guide the proper clinical management of jaundice. The primary focus is on the progression of established methodologies and techniques to newer ones capable of measuring bilirubin in biological materials.

#4080 NOVEL EXTRACORPOREAL TREATMENT FOR SEVERE NEONATAL JAUNDICE: A MATHEMATICAL MODELING STUDY WITH ALLO-HEMODIALYSIS

Abstract Background and Aims Neonate hyperbilirubinemia usually resolves within 3–5 days without complications however, severe neonatal jaundice (SNJ) is associated with long-term neurocognitive impairment, cerebral palsy, auditory neuropathy, deafness, or death. Globally, at least 481,000 term/near-term neonates are affected by SNJ annually, with 114,000 neonates dying and an additional 63,000 neonates surviving with kernicterus [1,2]. Phototherapy and exchange transfusions prevent/treat SNJ, but these modalities are scarce in some low and lower-middle income countries, where SNJ prevalence is increased due to higher prevalence of glucose-6-phosphate dehydrogenase deficiency, blood group incompatibilities, late referrals, and delayed diagnosis. We aimed to explore a model for allo-hemodialysis (alloHD), a novel potential modality to treat SNJ rapidly and effectively in neonates, possibly avoiding exchange transfusions. Method With alloHD, the neonate's blood flows through hollow fibers of a 0.075 m2 miniature low flux hemodialyzer (pore size 1.2 to 2.2 nm), while the blood of a healthy adult (“buddy”) flows counter-currently through the dialyzer, thus serving as the “dialysate”. Our mathematical model simulates the bilirubin kinetics in alloHD, with neonate and buddy blood flow rates at 15 and 30 mL/min, respectively. In the neonate model, bilirubin conjugation was assumed to be zero, resulting in excess unconjugated bilirubin that binds to albumin and causes SNJ. Bilirubin production rate in neonate and buddy were set to 6 and 3 mg/kg/day, respectively [3]. Buddy bilirubin conjugation rate was calculated to obtain normal steady state bilirubin levels. We only simulated unconjugated bilirubin because the conjugated form is easily excreted. Simulations are performed with neonate and buddy albumin levels of 31 g/L and 43 g/L, respectively. Results Model simulations suggest that 3- to 6-hour alloHD session can reduce neonatal bilirubin levels by &amp;gt;30% (Fig. 1, left panel). Due to the high bilirubin conjugation capacity of an adult's healthy liver, the buddy's bilirubin level increases only transiently during the alloHD session (Fig. 1, right panel). Conclusion Our modeling suggests that a single alloHD session can lower neonatal bilirubin levels effectively. In principle, this bilirubin reduction should lower the risks associated with SNJ, especially kernicterus and possibly avoiding exchange transfusions. Future modeling scenarios will incorporate the improved neonatal liver function over time and additional alloHD schedules.

Bilirubin is produced nonenzymatically in plants to maintain chloroplast redox status.

Bilirubin, a potent antioxidant, is a product of heme catabolism in heterotrophs. Heterotrophs mitigate oxidative stress resulting from free heme by catabolism into bilirubin via biliverdin. Although plants also convert heme to biliverdin, they are generally thought to be incapable of producing bilirubin because they lack biliverdin reductase, the enzyme responsible for bilirubin biosynthesis in heterotrophs. Here, we demonstrate that bilirubin is produced in plant chloroplasts. Live-cell imaging using the bilirubin-dependent fluorescent protein UnaG revealed that bilirubin accumulated in chloroplasts. In vitro, bilirubin was produced nonenzymatically through a reaction between biliverdin and reduced form of nicotinamide adenine dinucleotide phosphate at concentrations comparable to those in chloroplasts. In addition, increased bilirubin production led to lower reactive oxygen species levels in chloroplasts. Our data refute the generally accepted pathway of heme degradation in plants and suggest that bilirubin contributes to the maintenance of redox status in chloroplasts.

First report on the toxicity of SARS-CoV-2, alone and in combination with polyethylene microplastics in neotropical fish

The COVID-19 pandemic has caused unprecedented negative impacts in the modern era, including economic, social, and public health losses. On the other hand, the potential effects that the input of SARS-CoV-2 in the aquatic environment from sewage may represent on non-target organisms are not well known. In addition, it is not yet known whether the association of SARS-CoV-2 with other pollutants, such as microplastics (MPs), may further impact the aquatic biota. Thus, we aimed to evaluate the possible ecotoxicological effects of exposure of male adults Poecilia reticulata, for 15 days, to inactivated SARS-CoV-2 (0.742 pg/L; isolated SARS.CoV2/SP02.2020.HIAE.Br) and polyethylene MP (PE MPs) (7.1 × 104 particles/L), alone and in combination, from multiple biomarkers. Our data suggest that exposure to SARS-CoV-2 induced behavioral changes (in the open field test), nephrotoxic effect (inferred by the increase in creatinine), hepatotoxic effect (inferred by the increase in bilirubin production), imbalance in the homeostasis of Fe, Ca, and Mg, as well as an anticholinesterase effect in the animals [marked by the reduction of acetylcholinesterase (AChE) and butyrylcholinesterase (BChE) activity]. On the other hand, exposure to PE MPs induced a genotoxic effect (assessed by the comet assay), as well as an increase in enzyme activity alpha-amylase, alkaline phosphatase, and carboxylesterases. However, we did not show synergistic, antagonistic, or additive effects caused by the combined exposure of P. reticulata to SARS-CoV-2 and PE MPs. Principal component analysis (PCA) and values from the “Integrated Biomarker Response” index indicate that exposure to SARS-CoV-2 was determinant for a more prominent effect in the evaluated animals. Therefore, our study sheds light on the ecotoxicity of the new coronavirus in non-target organisms and ratifies the need for more attention to the impacts of COVID-19 on aquatic biota.

Design and Characterization of Nanoflowers-based Biosensor for Estimation of Bilirubin in Jaundice.

Nanoflowers (NFs) are flower-shaped nanoparticulate systems with a higher surface-to-volume ratio and good surface adsorption. Jaundice indicates yellow discoloration of skin, sclera, and mucus membrane and is a clinical indication of bilirubin accumulation in the blood which occurs as a consequence of the incapability of the liver to excrete bilirubin in the biliary tree or conjugate bilirubin and higher production of bilirubin in the body. Several methods have been developed so far for bilirubin estimation in jaundice like the spectrophotometric method, chemiluminescence method, etc., but biosensing methods provide advantages over traditional methods concerning the surface area, adsorption, particle size, and functional characteristics. The primary objective of the present research project was to formulate and examine the adsorbent nanoflowers-based biosensor for accurate, precise, and sensitive detection of bilirubin in jaundice. The particle size of adsorbent nanoflowers was found to be in the range of 300-600nm with the surface charge (zeta potential) in the range of -1.12 to -15.42 mV. Transmission electron microscopy and scanning electron microscopy images confirmed the flower-like morphological structure of adsorbent NFs. The adsorption efficiency of NFs for bilirubin adsorption was maximum at 94.13%. Comparative studies of bilirubin estimation in the pathological sample with adsorbent NFs and diagnostic kit displayed bilirubin concentration to be 1.0 mg/dL in adsorbent nanoflowers and 1.1 mg/dL with diagnostic kit indicating effective detection of bilirubin with adsorbent NFs. The nanoflower-based biosensor acts as a smart approach to elevate adsorption efficiency on the surface of nanoflower due to a higher surface-to-volume (SV) ratio. Graphical Abstract.

STUDY OF LABORATORY PARAMETERS IN NEONATAL JAUNDICE

Introduction: Neonatal hyperbilirubinemia with a total serum bilirubin level above 5mg/dL is one of the most vexing situations in neonates thereby becoming a concern for pediatricians. It is observed during the rst week of life in full-term infants and preterm infants. It results from a predisposition to the production of bilirubin in newborns infants and reects the immature excretory pathway of bilirubin by the liver. Preterm infants have higher rates of bilirubin production. This retrospective study considered 150 cases of term and pre-term neonates w Materials And Methods: ith jaundice within one week of diagnosis of neonatal jaundice (NNJ). The blood group of the mother and baby, Serum bilirubin, Complete blood count with peripheral smear examination, Reticulocyte count, Direct coomb's test, and C-reactive protein of the baby were done. The mean age of the neonates was 2 days. 76 (50.66 %) were male while 74 Results: (49.33) were females. Percentage of Preterm babies was 30%. Neonates having low birth weight were 31 %. Physiological jaundice constitutes to 58 % of cases followed by ABO incompatibility Septicaemia, Rh incompatibility. Highest level of serum bilirubin was found in septicemia and Rh incompatibility. Direct Coomb's test and Indirect Coomb's test were found to be positive in all cases in Rh incompatibility while they were positive in 27 % of cases of ABO incompatibility. In cases of septicemia CRP was found to be positive in 100% of cases. Most of the cases were due to physiological jaundice. To rule out hemolys Conclusion: is, causes of hyperbilirubinemia should be enquired widely to avoid complications

Clinical profile of term neonates requiring intervention for hyperbilirubinemia

ABSTRACT Introduction: Neonatal jaundice is the imbalance between bilirubin production and conjugation, resulting in increased serum bilirubin levels. It is visible in the skin and eyes, only when the total serum bilirubin level exceeds 5–7 mg/dl. Sixty percent of the term and almost 80% of the preterm babies develop neonatal jaundice. Objectives: To identify the etiology of neonatal hyperbilirubinemia in term neonates and to determine short-term outcomes in terms of rebound hyperbilirubinemia during hospital stay and other modalities of intervention in these babies. Methods: We did a cross-sectional, descriptive, and retrospective chart-based study. The clinical profile of term neonates treated for hyperbilirubinemia was procured from the inpatient medical records and neonatal intensive care unit (NICU) discharge summaries over 5 years from January 2017 to December 2021. Short-term outcomes, such as duration of hospital stay, rebound hyperbilirubinemia, and other modalities of treatment used, were noted. Results: A total of 252 term babies who fulfilled the inclusion criteria were included in the study. Two hundred and thirty-four babies were delivered vaginally, 10 by cesarean section, and 8 extracted by instrumental delivery. Ninety-eight babies had ABO incompatibility and 19 Rh incompatibility. Twelve babies had elevated cord thyroid-stimulating hormone levels. Seventy-one babies had signs of bilirubin encephalopathy. Thirty-nine babies had sepsis. Fifty-three of them had significant weight loss suggestive of improper feeding. Thirty-three babies had cephalhematoma. Nine babies were born to mothers with gestational diabetes mellitus. All 252 babies underwent phototherapy. Thirty-two babies required a prolonged hospital stay of more than 1 week and seven had rebound hyperbilirubinemia. Nine babies required exchange transfusion. Two received intravenous immunoglobulin. Conclusions: The most common risk factor associated was ABO incompatibility, followed by inadequate breastfeeding. As only nine neonates required exchange transfusion, early and prompt initiation of phototherapy remains the best modality of treatment. Emphasis on proper feeding technique can go a long way in preventing admission to NICU, as it is the second-most common preventable cause of hyperbilirubinemia.