Blood Bilirubin Levels Research Articles

Predictive Value of Cord Blood Bilirubin for Hyperbilirubinemia in Term Neonates with ABO Incompatibility

Introduction: Jaundice affects 60% of full-term and 80% of preterm neonates. Feto-maternal ABO incompatibilities occur in 20-25% of pregnancies, but severe haemolytic disease develops in only 10%. ABO-incompatible babies have doubled the risk of jaundice requiring treatment and a 5-10 times increased risk of exchange transfusions. Objective: Aim of this study was to determine if cord blood bilirubin (CBB) can predict hyperbilirubinemia in term babies with ABO setup prior to discharge that would help to decrease readmission and subsequently complications due to jaundice. Methods: A hospital-based prospective observational study was conducted at Patan Hospital. Cord blood group and bilirubin levels were collected from newborns of O positive mothers. Babies with A positive and B positive blood groups had their CBB levels measured and were followed daily for 72 hours. Serum bilirubin was tested based on clinical judgment to detect hyperbilirubinemia and treated per NICE guidelines. Data were analysed using SPSS v21.0, Mann-Whitney test, ANOVA, and ROC analysis. Results: Among 66 cases, significant hyperbilirubinemia was seen in 7 neonates (10.6%). It was more common in B positive babies (12.2%) compared to A positive (8%). Mean CBB was 3.45 ± 0.57 in those developing significant hyperbilirubinemia. A CBB of 2.95 mg/dL had the highest sensitivity (86%), specificity (94%), and negative predictive value (98%) for predicting hyperbilirubinemia in ABO setup babies. Conclusion: Term babies with ABO incompatibility and CBB<2.95 mg /dL are unlikely to need further evaluation, while those with cord bilirubin level ≥2.95 mg/dL should have frequent early follow-ups.

Predictors of bleeding from esophagus veins in patients with liver cirrhosis

Aim: to identify clinical and laboratory predictors of bleeding from the esophageal veins in patients with liver cirrhosis and evaluate their practical significance. Materials and methods. The study materials were the results of an examination of 50 patients treated in the gastroenterology department for liver cirrhosis and 160 patients in surgical departments hospitalized for bleeding from esophageal varices due to liver cirrhosis. All patients were subjected to a standard set of general clinical examinations, ultrasound examination of the abdominal organs, and videoesophagogastroduodenoscopy. Results. When comparing patients with cirrhosis of the liver with and without bleeding from the veins of the esophagus, a statistically significant difference was revealed between the groups in the gender and age composition, blood bilirubin level, and de Ritis coefficient. At the same time, no differences were found in the etiology and severity of liver cirrhosis, blood protein levels, the diameter of the portal and splenic veins, and the proportion of patients with ascites. Conclusions. The detection of a de Ritis coefficient equal to or exceeding 1.8 in a patient with liver cirrhosis can be considered a predictor of a high risk of bleeding from the esophageal veins (sensitivity of the parameter 60.87%, specificity 93.94%) and can be recommended for identifying those in need of priority measures primary prevention.

Геронтологические особенности влияния новой коронавирусной инфекции на показатели интерлейкинового профиля, воспаления и эндогенной интоксикации у пациентов зрелого и пожилого возраста с ишемической болезнью сердца

Background: Coronary heart disease (CHD) is considered as an independent risk factor for COVID19, however, the indicators of inflammation and endogenous intoxication in patients with CHD 3-4 weeks after recovery from COVID-19 have not been the subject of scientific research. The aim of the study: Assessment of the gerontological features of the effect of the transferred new coronavirus infection on the indicators of the interleukin profile, inflammation and endogenous intoxication of mature and elderly patients with coronary heart disease in the early stages of recovery. Materials and methods: The study included 58 mature-age patients with coronary heart disease 3-4 weeks after recovery from COVID-19 of moderate severity, who made up the comparison group. The main group of patients was represented by 62 elderly people with coronary heart disease who had suffered a new coronavirus infection and were examined in the same way as the previous group, 3-4 weeks after recovery. The level of C-reactive protein and highly sensitive C-reactive protein in the blood was studied using the Nicomed-reader express analyzer, and antistreptolysin-O was studied using an immunoturbidimetric method on the Cobas 600 analyzer (Switzerland). The blood levels of bilirubin, urea, creatinine and sialic acids were studied using the ROKI biochemical analyzer. The content of systemic cytokines was determined by the Beckton Dickinson FACS Canto 2 (USA). The level of anxiety and depression was studied on the HADS scale. Results: 3-4 weeks after recovery from COVID-19, antistreptolysin-O levels ranged from 120.9 МЕ/ml to 208.1 МЕ/ml. Significant changes among the considered parameters of inflammation and endogenous intoxication in patients with coronary heart disease in old age during recovery from a new coronavirus infection were accompanied by a change in the content of highly sensitive C-reactive protein in peripheral blood. In the early stages of recovery after COVID-19, in elderly patients with coronary heart disease, the concentration of many studied cytokines in blood plasma remained elevated compared with those aged 45-59 years. The excess of reference values in both groups was found for IL-17, TNF-α and IFN-α, and among elderly patients – for IL-3, IL-4, IL-6, IL-7, IL-17. Conclusion: Antistreptolysin-O, highly sensitive C-reactive protein, C-reactive protein can be considered markers of recovery in patients with combined coronary heart disease in the early stages after a new coronavirus infection.

Clinical characteristics and predictors of benign portal vein thrombosis in patients with liver cirrhosis: A retrospective single-center study.

Portal vein thrombosis (PVT) is a common thrombotic complication of cirrhosis. It can lead to variceal bleeding and bowel ischemia and also complicate liver transplantation. Identifying the possible risk factors associated with PVT can aid in identifying patients at high risk, enabling their screening and potentially preventing PVT through the rational use of anticoagulants. This study focuses on examining the clinical characteristics of PVT in cirrhotic patients and identifying the clinical and biochemical factors that are linked to the development of PVT. Consecutive hospitalized cirrhotic patients between 2015 and 2023 were identified through the hospital's computerized medical records based on the Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) coding system and retrospectively analyzed. 928 individuals were included in this study; 783 (84.3%) without PVT and 145 (15.7%) with benign PVT. Hepatitis B virus (HBV) was significantly more common in the PVT group (P-value = .02), while alcohol and primary sclerosing cholangitis (PSC) were less common in this group (P-value = .01 and .02, respectively). Hepatocellular carcinoma (HCC) (P-value < .01), ascites (P-value = .01), and spontaneous bacterial peritonitis (SBP) (P-value = .02) were more common in the PVT group. Patients with PVT had a higher international normalized ratio (INR) level (P-value = .042) and lower plasma albumin (P-value = .01). No differences were identified in white blood cell, hemoglobin, platelet, and bilirubin levels. However, patients with PVT had higher model for end-stage liver disease (MELD) (P-value = .01) and Child-Pugh scores (P-value = .03). This study demonstrated a higher likelihood of PVT presence in cirrhotic patients with advanced age, HBV, and HCC, along with ascites, SBP, splenomegaly, hypoalbuminemia, elevated INR, and a higher MELD score. Nevertheless, additional research endeavors are necessary to accurately ascertain and validate supplementary risk factors within a broader demographic.

What Happens in the Gut during the Formation of Neonatal Jaundice-Underhand Manipulation of Gut Microbiota?

Jaundice is a symptom of high blood bilirubin levels affecting about 80% of neonates. In neonates fed with breast milk, jaundice is particularly prevalent and severe, which is likely multifactorial. With the development of genomics and metagenomics, a deeper understanding of the neonatal gut microbiota has been achieved. We find there are accumulating evidence to indicate the importance of the gut microbiota in the mechanism of jaundice. In this paper, we present new comprehensive insight into the relationship between the microbiota and jaundice. In the new perspective, the gut is a crucial crossroad of bilirubin excretion, and bacteria colonizing the gut could play different roles in the excretion of bilirubin, including Escherichia coli as the main traffic jam causers, some Clostridium and Bacteroides strains as the traffic police, and most probiotic Bifidobacterium and Lactobacillus strains as bystanders with no effect or only a secondary indirect effect on the metabolism of bilirubin. This insight could explain why breast milk jaundice causes a longer duration of blood bilirubin and why most probiotics have limited effects on neonatal jaundice. With the encouragement of breastmilk feeding, our perspective could guide the development of new therapy methods to prevent this side effect of breastfeeding.

Correlation between elevated serum bilirubin levels and coronary artery disease risk - An institutional study

Background and objectives. Coronary artery disease (CAD) is a major public health problem resulting in profound morbidity and mortality. Recent research studies have suggested that bilirubin may play a role in preventing coronary artery disease. The purpose of this study was to determine the association between increased levels of bilirubin in the blood and risk for developing coronary artery disease (CAD). Material and methods. For the course of this study, an observational method was used where 30 participants were enrolled from our department’s general medicine unit. We collected demographic data and patient’s medical history. Moreover, we carried out complete blood count to measure serum levels of bilirubin such as total, direct and indirect, lipid profile, fasting blood glucose, C-reactive protein (CRP). Several statistical analyses were done to find out whether there is any relation between blood bilirubin levels and CAD related risk factors. Results. The current findings showed average serum concentration for bilirubin at 1.5 ± 0.5 mg/dL. In this regard, hypertension was prevalent among 40% of respondents while diabetes took up 20%. This present study indicates that there is strong negative relationship between cardiovascular risks indicator blood-bilirubins. Conclusion. Consequently, this study produces great proof that shows strong support for a negative relationship between the levels of bilirubin in the blood and the likelihood of getting affected by coronary arteries. This might be due to different roles played by bilirubin such as being an antioxidant and having anti-inflammatory properties. These findings suggest that there is a need for more investigations into bilirubin as its importance as a potential biomarker for assessing and mitigating cardiovascular risk has been highlighted.

The Importance of Evaluating Sudomotor Function in the Diagnosis of Cardiac Autonomic Neuropathy.

Cardiac autonomic neuropathy (CAN) is a disorder affecting the autonomic nerves that regulate the cardiovascular system, leading to irregular heart rate and blood pressure control. It is commonly associated with diabetes mellitus but can also result from other conditions such as autoimmune disorders, chronic kidney disease, alcohol abuse, and certain medications. Screening for CAN is essential, particularly in individuals with poor glycemic control, cardiovascular risk factors, or complications. Early identification of CAN is vital for timely intervention to prevent or manage cardiovascular complications effectively. Regular screening helps detect CAN before symptoms emerge, enabling early intervention to slow or halt its progression. This study examined the relationship between sudomotor function and cardiovascular reflex tests. This was a cross-sectional study conducted between June 2019 and June 2020. The study included 271 subjects aged 18 years and above who provided informed consent, were diagnosed with type 2 diabetes mellitus (T2DM), and were overweight or obese. Exclusion criteria encompassed patients with other types of diabetes, pregnant women, those with recent neoplasm diagnoses, stroke sequelae, history of myocardial infarction, or pelvic limb amputations. The assessment of cardiac autonomic neuropathy involved conducting an electrocardiogram and evaluating the QTc interval in the morning before taking medication. Additionally, cardiovascular reflex tests (CART) were conducted, including assessments of heart rate variability during deep breathing, the Valsalva maneuver, and changes in orthostatic position. Simultaneously, the diagnosis of CAN was assessed by performing a sweat test using a Sudoscan assessment (Impeto Medical, Moulineaux, France). Results: More than half of the participants (52%, n=143) were female. Significant differences in statistical measures were noted between females and males regarding age, systolic blood pressure, fasting blood glucose, A1c level, total cholesterol, triglycerides, gamma-glutamyl transferase, and bilirubin levels. Within the CAN-diagnosed group (CAN+), 40.92% were classified as mild cases (n=90), 47.27% as moderate cases (n=104), and 11.81% as severe cases (n=26). Among the CAN+ group, 54% (n=119) were women. Electrochemical skin conductance was lower in the CAN+ group than the CAN- group in hands (67.34±15.51 μS versus 72.38±12.12 μS, p=0.008) and feet (73.37±13.38 μS versus 82.84 ±10.29 μS, p<0.001). The Sudoscan-CAN score significantly correlated with Ewing scores (r= 0.522, p<0.001). In multiple linear regression analysis, the Sudoscan-CAN score remained significantly associated with age, high BMI, long-standing diabetes, and Ewing score. Sudoscan demonstrates potential in identifying patients with an increased risk of CAN. Its integration into clinical practice can improve patient outcomes through early detection, risk stratification, and personalized treatment approaches. Its non-invasive, portable, and user-friendly features render it suitable for utilization in outreach programs or resource-constrained settings as part of screening efforts designed to pinpoint high-risk individuals for additional assessment.

Hubungan Antara Frekuensi Pemberian ASI dengan Kejadian Ikterus Neonatorum Pada Bayi Usia 0-7 Hari di Puskesmas Wangkal

Neonatal jaundice is a clinical condition in infants characterized by yellow discoloration of the skin and sclera due to excessive accumulation of unconjugated bilirubin. Jaundice will clinically appear in newborns when the blood bilirubin level is 5-7 mg/dL. Breast milk contains nutrients, hormones, elements of immunity, growth, allergy, and anti-inflammation. Nutrition in breast milk includes nearly 200 elements of food substances. The purpose of this study was to find out whether there is a Correlation between the frequency of breastfeeding and the incidence of neonatal jaundice in infants aged 0-7 days at the Wangkal Health Center in 2023. The study design used correlation analysis with a cross-sectional approach. The data collection technique used was observation with 90 respondents using accidental sampling techniques. Data collection includes coding, editing and tabulating, then analyzed manually and by computer with the Chi-Square Test. Results of the study 90 respondents Most the frequency of breastfeeding was carried out frequently by 57 respondents (63.3%) and the incidence of neonatal jaundice in infants aged 0-7 days did not occur jaundice by 55 respondents (61%) obtained P Value: 0.000 and α : 0.05, meaning that H0 is rejected and H1 is accepted so that there is a Correlation between the frequency of breastfeeding and the incidence of neonatal jaundice in infants aged 0-7 days at the Wangkal Health Center in Probolinggo in 2023. It is hoped that knowledge about the frequency of breastfeeding with neonatal jaundice is important in infants aged 0-7 days at the Wangkal Health Center, Probolinggo in 2023. Where it can reduce the prevalence of infant jaundice and increase infant immunity.

Carboxyhemoglobin in Cardiac Surgery Patients and Its Association with Risk Factors and Biomarkers of Hemolysis.

Cardiac surgery with cardiopulmonary bypass (CPB) is associated with hemolysis. Yet, there is no easily available and frequently measured marker to monitor this hemolysis. However, carboxyhemoglobin (CO-Hb), formed by the binding of carbon monoxide (a product of heme breakdown) to hemoglobin, may reflect such hemolysis. We hypothesized that CO-Hb might increase after cardiac surgery and show associations with operative risk factors and indirect markers for hemolysis. We conducted a retrospective descriptive cohort study of data from on-pump cardiac surgery patients. We analyzed temporal changes in CO-Hb levels and applied a generalized linear model to assess patient characteristics associated with peak CO-Hb levels. Additionally, we examined their relationship with red blood cell (RBC) transfusion and bilirubin levels. We studied 38,487 CO-Hb measurements in 1735 patients. CO-Hb levels increased significantly after cardiac surgery, reaching a peak CO-Hb level 2.1 times higher than baseline ( P < .001) at a median of 17 hours after the initiation of surgery. Several factors were independently associated with higher peak CO-Hb, including age ( P < .001), preoperative respiratory disease ( P = .001), New York Heart Association Class IV ( P = .019), the number of packed RBC transfused ( P < .001), and the duration of CPB ( P = .002). Peak CO-Hb levels also significantly correlated with postoperative total bilirubin levels (Rho = 0.27, P < .001). CO-Hb may represent a readily obtainable and frequently measured biomarker that has a moderate association with known biomarkers of and risk factors for hemolysis in on-pump cardiac surgery patients. These findings have potential clinical implications and warrant further investigation.

Neonatal Hyperbilirubinemia: Causes, Symptoms, and Management in the Context of Research on Newborns

Hyperbilirubinemia is a medical disorder characterized by elevated blood levels of bilirubin, which can cause jaundice, or a yellowing of the skin, sclera, and nails. A condition known as hyperbilirubinemia frequently affects babies. Neonatal hyperbilirubinemia patients are managed with exchange transfusion and phototherapy. This study aimed to determine the neonatal hyperbilirubinemia therapies at the one private hospital in Azerbaijan. In 2023, data on the condition of hyperbilirubinemia and the kind of therapies received were gathered from medical records. Samples for this study were chosen based on inclusion criteria. Phototherapy was used to treat all 41 neonates with hyperbilirubinemia; 29.26 % of the patients received treatment for less than 24 hours, and 70.73 % received treatment for longer than 24 hours. 100% of patients recovered after treatment. After treatment, 100% patients cured. Hyperbilirubinemia neonates in this hospital were treated with phototherapy and the treatment was successful.

Short-Term Safety Evaluation of Albumin-Bound Paclitaxel in Intraoperative and Postoperative Hyperthermic Intraperitoneal Chemotherapy for Gastric Cancer.

To evaluate the short-term safety of albumin-bound paclitaxel in hyperthermic intraperitoneal chemotherapy (HIPEC) during and after gastric cancer (GC) surgery. A retrospective analysis of clinical data was conducted for GC surgery patients at Zhongnan Hospital of Wuhan University, from January 2020 to September 2022. The study group (n = 120) received HIPEC and the control group (n = 268) did not receive albumin-bound paclitaxel. Short-term safety indicators including intraoperative complications, hematological toxicity, liver and kidney function, and gastrointestinal function recovery were compared between the two groups. There were no statistically significant differences between the two groups regarding intraoperative complications, hematological toxicity, liver and kidney function, and gastrointestinal function recovery time (P > 0.05 for all). In the study group, patients were further divided into subgroups based on dose and timing. Subgroup analysis revealed no significant differences among the different dose subgroups. However, when focusing on timing subgroups, the postoperative subgroup exhibited significantly higher white blood cell counts and bilirubin levels compared to the intraoperative subgroup, while the intraoperative subgroup had significantly higher bilirubin levels compared to both postoperative and intraoperative plus postoperative subgroups. Albumin-bound paclitaxel demonstrates good safety and tolerability in HIPEC during and after GC surgery, without increasing the risk of intraoperative complications.

Fruquintinib combined with sintilimab as a second-line therapy for advanced gastric and gastroesophageal junction adenocarcinoma (GC/GEJC): A phase II, single-arm, prospective study.

332 Background: The KEYNOTE-061 trial showed that anti-PD-1 monotherapy did not improve overall survival compared to chemotherapy in the second-line treatment of advanced GC/GEJC. Preclinical and clinical data have demonstrated the synergistic anti-tumor effect of fruquintinib, a highly selective oral VEGFR 1/2/3 inhibitor, in combination with immune checkpoint inhibitors (ICIs). Additionally, the phase III study (NCT03223376) of fruquintinib combined with paclitaxel in second-line GC/GEJC has yielded positive topline results. This study aims to assess the safety and efficacy of fruquintinib combined with sintilimab (an anti-PD-1 antibody) as a second-line therapy for GC/GEJC. Methods: In this phase II, open-label trial (NCT05625737), patients (pts) aged 18-75 years who were HER2-negative and had failed first-line standard therapy were enrolled. Eligible pts received fruquintinib at 4mg/day orally on days 1-14 and sintilimab at 200 mg intravenously on day 1, with treatment repeated every 3 weeks. The primary endpoint was objective response rate (ORR) per RECIST v1.1. Secondary endpoints included disease control rate (DCR), progression-free survival (PFS), overall survival (OS), and safety. An optimal Simon two-stage design was employed: if more than 1 pt achieved objective responses in the first stage (n = 7), the study would proceed to the second stage and enroll an additional 19 pts; otherwise, the study would be terminated. Results: At data cut-off (August 31, 2023), 7 pts were enrolled in the first stage and additional 7 pts in the second stage. Pts characteristics included: median age 50 (range 33–71); 29% male; 57% with ECOG PS 1; 57% with peritoneal metastasis, and 71% having previously received immunotherapy. Of the 12 pts evaluable for tumor response, 4 achieved partial responses, and 4 had stable disease, resulting in a confirmed ORR of 33.3% (95% CI: 9.9-65.1%) and a DCR of 66.7% (95% CI: 34.9-90.0%). The median PFS was 5.09 months (95% CI: 2.69–NA), while OS results were pending maturity. Grade 1-2 treatment-emergent adverse events (TEAEs) occurred in ≥20% of pts, including decreased white blood cell count (36%), hypertriglyceridemia (29%), abdominal pain (29%), decreased lymphocyte count (21%), and elevated aspartate transaminase and alanine transaminase (21%). Grade 3/4 TEAEs occurred in only one patient, consisting of increased blood bilirubin levels, aspartate transaminase elevation, and alanine transaminase elevation. No treatment-related deaths were reported. Conclusions: The combination of fruquintinib and sintilimab as a second-line therapy has demonstrated promising anti-tumor activity and an acceptable safety profile in pts with advanced GC/GEJC. The trial is ongoing, and further data analysis and reporting are anticipated. Clinical trial information: NCT05625737 .

Comparison of the Changes in Blood Carboxyhemoglobin and Bilirubin Levels and Their Effects on Neonatal Hyperbilirubinemia in Neonates Born by Cesarean Section versus Vaginal Delivery

Aim: The study aimed to investigate whether there are differences in carboxyhemoglobin, bilirubin and hemoglobin values of neonates born by normal spontaneous vaginal birth (NSVD) (without anesthesia) and elective spinal cesarean section (CS) and its effect on neonatal jaundice. Materials and Methods: A total of 110 healthy neonates without any risk factors for neonatal hyperbilirubinemia were included in the study. There were fifty-five neonates in both NVSD and spinal CS groups. COHb, bilirubin and Hb values which were measured from umbilical cord blood (as cord) and capillary blood taken from the heel 4-6 hours after birth (as post cord) were recorded. Results: No statistically significant difference was found between the groups in terms of birthweight, maternal age, APGAR scores, and gender (p&gt;0.05). There was a statistical difference between the groups according to the mean of gestational age, and it was observed that the mean of gestational age in spinal CS group was lower than in NSVD group (38.30±1.2 and 39.16±1.39 respectively) (p=0.001). Umbilical cord COHb levels in spinal CS group were higher than in NSVD group, but there was no statistically significant difference between groups (1.01±0.15 and 0.99±0.20 respectively, p=0.22). Furthermore, the differences between groups in term of mean of bilirubin and Hb levels in cord and post cord were not statistically significant (&gt;0.05). But, it was determined that post cord COHb levels were higher than in NVSD group, and this difference was statistically significant (p=0.028). Additionally, it was found that the mean rank of COHb, bilirubin, and Hb in cord and post cord values were statistically significantly different between the groups (p &lt; 0.05). Conclusion: It should be kept in mind of that the anesthetic agent may also be a factor in bilirubin increases that occurs in neonatal hyperbilirubinemia without an underlying risk factor.

Predictors of hemorrhagic manifestations in dengue: A prospective observational study from the Hadoti region of Rajasthan

Objective: To study the laboratory and clinical predictors of hemorrhagic manifestations in dengue virus-infected patients. Methods: This was a single-center hospital-based prospective observational study. 200 Dengue seropositive patients were included in the study. A detailed clinical examination was done and comprehensive laboratory investigations were done. These parameters were compared between patients with and without hemorrhagic manifestations. Results: Out of the 200 patients, 47 (23.5%) had bleeding. 64.5% Patients were males and 76.0% were under the age of 40 years. The most common presenting symptoms were fever (100.0%) followed by myalgia (77.0%), nausea and vomiting (56.0%). Leukocytosis, neutrophilia, thrombocytopenia, hyperbilirubinemia, transaminitis, decreased serum albumins, and raised D-dimer can serve as hematological, biochemical, and coagulation predictors of hemorrhagic manifestations for dengue. Conclusions: Dengue is a tropical infection with various complications. Bleeding complications are one of them. Laboratory parameters like white blood cells, platelets, bilirubin level, liver enzymes, and D-dimer can help to identify patients at risk for bleeding. Early identification and appropriate management can save a lot of resources and lives.

Bilirubin metabolism &amp; pathophysiology of neonatal jaundice

Jaundice is a visible yellowish color change in skin and sclera, secondary to elevated serum bilirubin which accumulates in the skin. Visibility of jaundice depends upon the age of the patient, color/complexion of the skin and level of bilirubin in blood. It is more easily visible in fair complexioned and new born (particularly, pre term) babies. In the new born, jaundice is visible during the 1 week of life in 60% of full term and 80% preterm infants.

Management of Kamala (Jaundice) with Ayurveda Treatment - A Case Study

Jaundice is a yellowish pigmentation of the skin, sclera, mucous membrane and intestinal fluid due to high bilirubin levels. In Ayurveda, Jaundice and their treatment are very well described under the heading of Kamala Vyadhi. Jaundice can develop in all age of peoples. Clinically sign of jaundice occur when the serum bilirubin level exceeds 2.5 to 3 mg/dl. Level of bilirubin in blood are normally below 1.0 mg/dl. Most of the people have become used to spicy food, fast food, alcohol consumption day by day. This has taken human being far away from nature. Ayurvedic text has mentioned hepatocellular jaundice as Kamala. Kamala due to frequently intake of Pittakara Aahara (Spicy and fast food). Its leads to vitiation of Pitta Dosha. Kamala is such a disease where in the Rakta Dhatu is vitiated primarily by Pitta Dosha. Kam means different type of desire of body and mind desire especially regarding the diet and physical activity of body are minimised in Kamala. In Kamala disease there is loss of desire to do anything. This paper discusses a patient in the OPD of Kayachikitsa department in Dhanwantari Ayurveda Hospital, Ujjain. His chief complaint is yellow discolouration of skin, Icterus, yellow discolouration of urine (Pittamootrata), Anorexia, since 7 days. Here is a case report of 12 years old child was having Kamala who was treated with some Ayurvedic internal medicine and mild purgative, after 15 days we got effective result by Ayurvedic management.

FREQUENCY OF COMMON CAUSES OF SEVERE HYPERBILIRUBINEMIA IN NEONATES LEADING TO EXCHANGE TRANSFUSION

Neonatal often have hyperbilirubinemia, which may become severe if left untreated. Severe hyperbilirubinemia in neonates that necessitates exchange transfusions may lead to "kernicterus," which has a high risk of morbidity. This descriptive cross-sectional research examined the medical records of sixty newborns who had exchange transfusions at HMC Peshawar between March 2021 and March 2022 and weighed more than two kilos. There were 22 (36%) females and 38 (64%) males in the group. With 37.2% of cases, ABO incompatibility was the most common reason for exchange transfusions. Other causes, such as cephalohematoma and Crigler-Najjar syndrome, were followed by unidentified causes (26.5%), Rh incompatibility without immune hydrops (15.2%), sepsis (08.3%), and urinary tract infections (05.2%). Exclusive breastfeeding and vaginal deliveries were associated variables. It was discovered that the average serum bilirubin level was 28.5 mg/dl (SD = 09.02). The objective of our study was to identify and quantify the most frequent reasons babies needing exchange transfusions have severe hyperbilirubinemia. This study was conducted in the Department of Peaderitcs HMC Peshawar between March 2021 and March 2022. The causes of severe hyperbilirubinemia in neonates needing an exchange transfusion were investigated in this research using a descriptive cross-sectional methodology. Medical records from HMC Peshawar served as the primary source of information. In all, 60 infants weighing over two kilograms received exchange transfusions within the allotted period. The primary emphasis of the data extraction method was on variables such as serum bilirubin levels, linked diseases, gender, and the cause of hyperbilirubinemia. The causes included ABO incompatibility, Rh incompatibility without immune hydrops, sepsis, urinary tract infection, and cephalohematoma. Further information was also gathered on the kind of feeding and the mode of delivery. Frequencies, percentages, averages, and standard deviations were computed using statistical techniques, mostly descriptive statistics. The results were then examined about the study's objectives. Twenty-two (36%) and 38 (64%) of the sixty neonates studied for this research were female. ABO incompatibility was shown to be the most common cause of severe hyperbilirubinemia necessitating exchange transfusion, explaining 22 (37.2%) instances. In decreasing order of frequency, the other reasons were: sepsis, 5 (8.3%); urinary tract infection, 3 (5.2%); unidentified causes, 16 (26.5%); Rh incompatibility without immune hydrops, 9 (15.2%); and other causes such as cephalohematoma and Crigler-Najjar syndrome, 2 (3.3%). One interesting finding was that newborns born vaginally and those nursed exclusively were more likely to need an exchange transfusion. The average blood bilirubin level throughout the group was 28.5 mg/dl, with a standard deviation 9.02. This research emphasizes the need to watch for ABO incompatibility in neonates, particularly those delivered vaginally, as it is significantly linked to the requirement for exchange transfusions. The most common reason for exchange transfusions for hyperbilirubinemia was found to be ABO incompatibility. Adolescents who were nursed exclusively, male, and born vaginally were more likely to need an exchange transfusion. Neonatal with ABO incompatibility would need close observation after discharge, particularly if they were vaginally born.

N-acetylcysteine vs placebo as adjunctive treatment in paediatric leukaemia: A single blind, randomized controlled trial

Background: Acute lymphoblastic leukaemia (ALL) accounts for about 25% of all cancer types in children. Many chemotherapeutic agents have been shown to be related to increased oxidative stress and hepatotoxicity which affect the survival rate. N-acetylcysteine (NAC) has been used as adjunctive treatment in malignancy. Objectives: To analyse the effect of NAC administration towards blood oxidant, transaminase enzyme, and bilirubin level in ALL children undergoing induction phase of chemotherapy. Method: This is a single-blind placebo-controlled randomized clinical trial carried out from August to December 2020 in Cipto Mangunkusumo National Hospital, Jakarta, Indonesia. Subjects were randomized consecutively into 2 groups treated with NAC or placebo. Inclusion criteria were newly diagnosed ALL-standard risk (SR) children undergoing chemotherapy induction. Exclusion criteria were subjects contraindicated to NAC, already diagnosed with liver dysfunction, and already taken antioxidants. Data were analysed using SPSS 21. Normality test was conducted followed by data analysis with unpaired t-test. Results: A total of 18 subjects were included in study and 2 of them were excluded. Malondialdehyde levels showed an increase of 0.17nmoL in the NAC group and a decrease of 0.19nmoL in the placebo group. Aspartate transaminase (AST) level increased in mean of 11.40 U/L in the NAC group compared to placebo group 5.67 U/L. Alanine transaminase (ALT) level in the NAC group showed an increase in mean of 23.24 U/L compared to placebo group which showed a decrease in mean of 3.5 U/L. Bilirubin level in the NAC group showed an increase of 0.7 mg/dL compared to placebo group 0.17 mg/dL. There was no significant difference in MDA levels, AST, ALT, and bilirubin levels in the 2 groups (p=0. 186; p=0.638; p=0.164; p=0.352, respectively). Conclusions: Higher malondialdehyde level was shown as a trend in subjects in both groups before chemotherapy was done. N-acetyl cysteine administration showed no significant difference in reducing MDA levels, transaminase enzymes, and bilirubin levels in ALL-SR patients compared to placebo.

SpeCamX: mobile app that turns unmodified smartphones into multispectral imagers.

We present the development of SpeCamX, a mobile application that enables an unmodified smartphone into a multispectral imager. Multispectral imaging provides detailed spectral information about objects or scenes, but its accessibility has been limited due to its specialized requirements for the device. SpeCamX overcomes this limitation by utilizing the RGB photographs captured by smartphones and converting them into multispectral images spanning a range of 420 to 680 nm without a need for internal modifications or external attachments. The app also includes plugin functions for extracting medical information from the resulting multispectral data cube. In a clinical study, SpeCamX was used to implement an augmented smartphone bilirubinometer, predicting blood bilirubin levels (BBL) with superior performance in accuracy, efficiency and stability compared to default smartphone cameras. This innovative technology democratizes multispectral imaging, making it accessible to a wider audience and opening new possibilities for both medical and non-medical applications.

A CASE STUDY ON AYURVEDIC MANAGEMENT OF KAMALA W.S.R. TO JAUNDICE

Jaundice is a yellow pigmentation of the skin, the conjunctival membrane over the sclera and other mucous membrane caused by hyperbilirubinemia (increase level of bilirubin in blood). Today’s lifestyle with unhygienic and poor dietary habit specially in children which are responsible factor to promote hepatic damage which clinically reflect as kamala. This paper discusses patients seen in the OPD of Kaumarbhritya department, Uttaranchal ayurvedic hospital Dehradun. In this case 15-year female patient having kamala who was suffering from yellowish discolouration of skin, icterus, yellowish discolouration of urine, pain in abdomen, weakness, vomiting (3-4 times in a day), anxiety and anorexia in the last 5 days. The patient was treated with shaman chikitsa. Patients got significant results as per the values of bilirubin with symptomatic relief in complaints within 15 days of treatment. Kamala can be successfully managed by shamana chikitsa the effect of ayurvedic treatment was assessed in relation to improvement in overall clinical sign and symptoms &amp; biochemical investigations further study will be needed as per different assessment criteria.