Serum Bilirubin Concentration Research Articles

The Impact of Renal Function on Liver Cirrhosis among Patients in Wasit Governorate, Iraq

In Al-Kut city's AL-Zahraa general hospital, this study was carried out.for individuals with liver cirrhosis to evaluate their serum levels of ALT, AST, GGT, ALP, urea, creatinine, T.Protien, Albumin, and Bilirubin. The 50 patients ranged in age from 20 to 60, with 29 male and 21 female individuals.Based on the patient's medical history and physical examination, liver cirrhosis was determined to affect both sexes of the patient. The 30 control groups were drawn from the medical personnel and family of those who did not exhibit any indications or symptoms of renal liver disease or kidney diseases. With ages ranging from 22 to 66, there were 20 men and 10 women. Eight to fourteen hours following the patients' overnight fasts, blood samples were obtained. The research reveals the following. Serum ALT, AST and GGT concentrations in liver cirrhosis patients were found to be significantly increased compared with control group (P<0.01).Serum Bilirubin (Total) and direct Bilirubin concentrations in liver cirrhosis patients were found to be significantly high compared with control group (P<0.5), (P<0.01) respectively. Serum Albumin concentrations in liver cirrhosis patients were found to be no significantly lower compared with control group (P>0.5). Serum Total protein concentrations in liver cirrhosis patients were found to be no significantly lower compared with control group (P≤0.5).Serum Alkaline phosphatase (ALP) concentrations in liver cirrhosis patients were found to be significantly increased compared with control group (P<0.01).Serum urea, creatinine, Uric acid and ammonia level concentrations in liver cirrhosis patients were found to be significantly high compared with control group (P<0.01).

Effect of bilirubin and Gilbert syndrome on health: cohort analysis of observational, genetic, and Mendelian randomisation associations

ObjectivesTo compare associations between the Gilbert syndrome genotype in European populations, measured bilirubin concentrations, genetically predicted bilirubin using this genotype, and a wide range of health outcomes in a large...

Validating a novel three-times-weekly post-hemodialysis ceftriaxone regimen in infected Indigenous Australian patients-a population pharmacokinetic study.

To describe the total and unbound population pharmacokinetics of a 2 g three-times-weekly post-dialysis ceftriaxone regimen in Indigenous Australian patients requiring hemodialysis. A pharmacokinetic study was carried out in the dialysis unit of a remote Australian hospital. Adult Indigenous patients on intermittent hemodialysis (using a high-flux dialyzer) and treated with a 2 g three-times-weekly ceftriaxone regimen were recruited. Plasma samples were serially collected over two dosing intervals and assayed using validated methodology. Population pharmacokinetic analysis and Monte Carlo simulations were performed using Pmetrics in R. The probability of pharmacokinetic/pharmacodynamic target attainment (unbound trough concentrations ≥1 mg/L) and toxicity [trough concentrations (total) ≥100 mg/L] were simulated for various dosing strategies. Total and unbound concentrations were measured in 122 plasma samples collected from 16 patients (13 female) with median age 57 years. A two-compartment model including protein-binding adequately described the data, with serum bilirubin concentrations associated (inversely) with ceftriaxone clearance. The 2 g three-times-weekly regimen achieved 98% probability to maintain unbound ceftriaxone concentrations ≥1 mg/L for a serum bilirubin of 5 µmol/L. Incremental accumulation of ceftriaxone was observed in those with bilirubin concentrations >5 µmol/L. Three-times-weekly regimens were less probable to achieve toxic exposures compared with once-daily regimens. Ceftriaxone clearance was increased by >10-fold during dialysis. A novel 2 g three-times-weekly post-dialysis ceftriaxone regimen can be recommended for a bacterial infection with an MIC ≤1 mg/L. A 1 g three-times-weekly post-dialysis regimen is recommended for those with serum bilirubin ≥10 µmol/L. Administration of ceftriaxone during dialysis is not recommended.

Association of Low Serum Bilirubin Concentrations and Promoter Variations in the UGT1A1 and HMOX1 Genes with Type 2 Diabetes Mellitus in the Czech Population.

Bilirubin has potent biological beneficial effects, protecting against atherosclerosis, obesity, and metabolic syndrome. The aim of this study was to assess serum bilirubin concentrations and (TA)n and (GT)n microsatellite variations in the promoter regions of the UGT1A1 and HMOX1 genes, respectively, in patients with type 2 diabetes mellitus (T2DM). The study was carried out in 220 patients with T2DM and 231 healthy control subjects, in whom standard biochemical tests were performed. The (TA)n and (GT)n dinucleotide variations were determined by means of fragment (size-based) analysis using an automated capillary DNA sequencer. Compared to controls, both male and female patients with T2DM had lower serum bilirubin concentrations (9.9 vs. 12.9 μmol/L, and 9.0 vs. 10.6 μmol/L, in men and women, respectively, p < 0.001). Phenotypic Gilbert syndrome was much less prevalent in T2DM patients, as was the frequency of the (TA)7/7UGT1A1 genotype in male T2DM patients. (GT)nHMOX1 genetic variations did not differ between diabetic patients and controls. Our results demonstrate that the manifestation of T2DM is associated with lower serum bilirubin concentrations. Consumption of bilirubin due to increased oxidative stress associated with T2DM seems to be the main explanation, although (TA)n repeat variations in UGT1A1 partially contribute to this phenomenon.

A sensitive “turn-off-on” fluorescence platform for bilirubin detection based on conjugated polymer nanoparticles and ferric ions

Bilirubin is an important biomarker of jaundice, and the quantitative detection of bilirubin is of great significance in the diagnosis and prevention of early jaundice. In this paper, Fe3+ quenched conjugated polymer nanoparticles were used as a "turn-off-on" fluorescence platform to detect bilirubin for the first time. The CPNsPBMC-COOH were prepared through a nanoprecipitation method based on polystyrene maleic anhydride and PBMC, a conjugated polymer synthesized by our research group. The fluorescence of CPNsPBMC-COOH can be efficiently quenched closely to 95% by Fe3+. The optimized fluorescence platform was obtained (CPNsPBMC-COOH: 10 μg/mL, Fe3+: 4.5 μM). The platform to detect bilirubin has a higher sensitivity with a 5 nM of LOD. The detection range was in the 1.32–26.68 μM, which can cover the concentration of bilirubin in normal adult serum (<25 μM). Moreover, the stoichiometries and binding constants of CPNsPBMC-COOH, bilirubin, and Fe3+ are obtained. The binding ability is better for bilirubin and Fe3+. The static quenching mode is found by the absorption spectra and the fluorescence lifetimes. Lastly, this method has obtained satisfactory results in real biological samples (mouse serum and mouse plasma). This work can be used for daily rapid clinical bilirubin detection.

Serum bilirubin is associated with a reduced risk of subsequent recurrent wheezing following acute respiratory syncytial virus bronchiolitis.

Bilirubin is a potent antioxidant and anti-inflammatory molecule that has been shown to ameliorate airway inflammation. We aimed to study whether serum bilirubin is protective and can predict the development of subsequent recurrent wheezing in infants with severe respiratory syncytial virus (RSV) bronchiolitis. The medical records of 188 infants who were hospitalized during an initial episode of severe RSV bronchiolitis at 6 months of age or less were retrospectively reviewed. Our main outcome of interest was the development of subsequent recurrent wheezing by the age of 3years. Each infant's serum bilirubin concentration was extracted from their blood biochemical results. Seventy-one (37.8%) infants developed recurrent wheezing by the age of 3 and 117 (62.2%) did not. The serum total bilirubin, unconjugated bilirubin, and conjugated bilirubin levels at hospital admission were lower in infants who developed recurrent wheezing as compared to those who did not (p ＜ 0.001). The area under the receiver-operating characteristic curve of serum total bilirubin, unconjugated bilirubin, and conjugated bilirubin for the prediction of subsequent recurrent wheezing were 0.71 (95% confidence interval [CI], 0.64-0.78), 0.70 (95% CI, 0.63-0.78), and 0.67 (95% CI, 0.59-0.75), respectively. Higher admission serum total bilirubin levels were independently associated with a lower risk of development of subsequent recurrent wheezing (adjusted OR 0.17, p ＜ 0.001). During the first episode of severe RSV bronchiolitis in infants <6 months of age, moderately higher levels of serum bilirubin are associated with a reduced risk of developing subsequent recurrent wheezing by 3 years of age.

Magnetic Resonance Imaging for Monitoring of Hepatic Disease Induced by Ebola Virus: a Nonhuman Primate Proof-of-Concept Study.

Severe liver impairment is a well-known hallmark of Ebola virus disease (EVD). However, the role of hepatic involvement in EVD progression is understudied. Medical imaging in established animal models of EVD (e.g., nonhuman primates [NHPs]) can be a strong complement to traditional assays to better investigate this pathophysiological process in vivo and noninvasively. In this proof-of-concept study, we used longitudinal multiparametric magnetic resonance imaging (MRI) to characterize liver morphology and function in nine rhesus monkeys after exposure to Ebola virus (EBOV). Starting 5 days postexposure, MRI assessments of liver appearance, morphology, and size were consistently compatible with the presence of hepatic edema, inflammation, and congestion, leading to significant hepatomegaly at necropsy. MRI performed after injection of a hepatobiliary contrast agent demonstrated decreased liver signal on the day of euthanasia, suggesting progressive hepatocellular dysfunction and hepatic secretory impairment associated with EBOV infection. Importantly, MRI-assessed deterioration of biliary function was acute and progressed faster than changes in serum bilirubin concentrations. These findings suggest that longitudinal quantitative in vivo imaging may be a useful addition to standard biological assays to gain additional knowledge about organ pathophysiology in animal models of EVD. IMPORTANCE Severe liver impairment is a well-known hallmark of Ebola virus disease (EVD), but the contribution of hepatic pathophysiology to EVD progression is not fully understood. Noninvasive medical imaging of liver structure and function in well-established animal models of disease may shed light on this important aspect of EVD. In this proof-of-concept study, we used longitudinal magnetic resonance imaging (MRI) to characterize liver abnormalities and dysfunction in rhesus monkeys exposed to Ebola virus. The results indicate that in vivo MRI may be used as a noninvasive readout of organ pathophysiology in EVD and may be used in future animal studies to further characterize organ-specific damage of this condition, in addition to standard biological assays.

Intrahepatic Cholestasis in Non-Alcoholic Fatty Liver Disease: Pathogenesis and Role of Ademetionine in Treatment

Aim: to evaluate features of intrahepatic cholestasis (IHC) pathogenesis in non-alcoholic fatty liver disease (NAFLD), as well as role of ademetionine in treatment of this condition.Key statements. NAFLD is the most frequent chronic diffuse liver disease. Increase in proportion of people with excess weight, obesity, and metabolic dysregulation leads to higher rates of NAFLD. Concomitant IHC is present in 30 % of NAFLD patients, while it is associated with more active disease course and possible worsening of prognosis. Impairment of adipocyte and hepatocyte metabolism, gut dysbiosis, and inherent factors are recognized as significant factors for NAFLD development. In NAFLD patients most of IHC cases are related to functional cholestasis. IHC in NAFLD is associated with increased risks of fibrosis and all-cause death. Ademetionine may restore transmethylation and improve rheologic properties of hepatocyte membranes in liver disease. In IHC patients treatment with ademetionine led to decreased serum bilirubin concentrations, as well as lowering of the liver transaminases' and alkaline phosphatase activities. At the same time improvement of symptoms severity, including itching, was noted. Taking into account the efficacy of ademetionine in IHC in NAFLD patients, its' use was included in the national clinical guidelines.Conclusion. Use of ademetionine in NAFLD with concomitant IHC is feasible from pathogenesis perspective and may be effective in clinical practice.

Comparison of Two Lipid Emulsions on the Incidence of Parenteral Nutrition Associated Cholestasis in Neonates.

Lipid emulsion contributes to parenteral nutrition associated cholestasis (PNAC). For decades, soybean oil-based intravenous lipid emulsion (SO-ILE) was the predominant product. Recently, a multicomponent lipid emulsion containing soybean oil, medium-chain triglycerides, olive oil and fish oil (SMOF-ILE) has been used off-label in neonatal care. This study evaluates the incidence of PNAC in neonates who received SMOF-ILE or SO-ILE. This was a retrospective review of neonates who received SMOF-ILE or SO-ILE for at least 14 days. Patients receiving SMOF-ILE were matched based on gestational age (GA) and birth weight to a historical cohort receiving SO-ILE. The primary outcomes were the incidences of PNAC among all patients and patients without intestinal failure. The secondary outcomes were clinical outcomes and incidence of PNAC stratified by GA. Clinical outcomes included liver function tests, growth parameters, and development of retinopathy of prematurity and intraventricular hemorrhage. Forty-three neonates who received SMOF-ILE were matched to 43 neonates who received SOILE. There were no significant differences in baseline characteristics. The incidence of PNAC in the total population was 12% in the SMOF-ILE cohort and 23% in the SO-ILE cohort (p = 0.26). The lipid dosage of SMOF-ILE was significantly higher at time of peak direct serum bilirubin concentration compared with SO-ILE cohort (p = 0.05). Clinically significant differences were noted in laboratory endpoints in several subgroups. There was no significant difference in the incidence of PNAC among neonates in a SMOFILE cohort compared with a historical SO-ILE cohort.

Treatment for cholangiohepatitis in cats

Acute bacterial cholangiohepatitis of cats is a common disease associated with the inflammation of bile ducts and liver parenchyma, characterized by development of a pronounced hepatodepressive syndrome (hypoalbuminemia), cytolysis (increase in serum activity of alanine and asparagine transaminase), cholestasis (increase in serum concentration of bilirubin, cholesterol, activity of alkaline phosphatase and gamma-glutamyltranspeptidase), intoxication, dehydration, mesenchymal-inflammatory and pain syndromes. The aim of the research was to study the effectiveness of treatment for acute bacterial cholangiohepatitis in cats with average severity of the pathology course. According to inclusion and exclusion criteria, the study included a cohort of cats (n = 12) with acute bacterial cholangiohepatitis. Clinical, hematological, ultrasonographic, statistical methods of investigation were used in this work. For sick cats with medium severity form of cholangiohepatitis, when administered as a complex therapy the combination of marbofloxacin, metronidazole, ursodeoxycholic acid, cyancobolamine, tocopherol acetate, infusion therapy also had a good therapeutic effect, which was accompanied by improved clinical and laboratory performance. In the blood of cats with cholangiohepatitis, in the background of intensive therapy, there was a significant decrease in white blood cell count, erythrocyte sedimentation rate, and in serum, there was an increase in albumin concentration, reduction of creatinine, aminotransferase activity, alkaline phosphatase, gamma-glutamyltranspeptidase, lipase.

Serum bilirubin levels are negatively associated with atherogenic lipids in Saudi subjects with type 2 diabetes: A pilot study

&lt;b&gt;Background: &lt;/b&gt;Recent research has demonstrated the possible relevance of bilirubin in metabolic and cardiovascular disorders. Lipid abnormalities are a major problem that is related with an increased risk of cardiovascular disease in diabetics. This study examined the relationship between serum bilirubin and direct bilirubin concentrations and atherogenic lipids in patients with type 2 diabetes (T2DM).&lt;br /&gt; &lt;b&gt;Methods&lt;/b&gt;: This cross-sectional included 67 patients with type 2 diabetes and 39 matched healthy control. The lipid profile, including total cholesterol, HDL-C, and TG levels, fasting blood glucose, total bilirubin, direct bilirubin, ALT, AST, and ALP were measured using a dimension EXL clinical chemistry analyzer (Siemens Healthcare Diagnostics). Cholesterol in VLDL, LDL, and sdLDL were calculated from standard lipid assay results by the equations of Sampson et al.&lt;br /&gt; &lt;b&gt;Results&lt;/b&gt;: Serum bilirubin was lower in non T2DM subjects nearly significant (p=0.0.51) whereas direct bilirubin concentrations were lower in T2DM (p=0.008). ALT, AST, and ALP levels were higher in T2DM groups. The mean values of LDL-C, sdLDL-C, non HDL-C and VLDL-C were significantly increased in T2DM group and lower HDL-C. An inverse relationship could be observed with increase in serum total bilirubin and serum levels of LDL-C (r&lt;sup&gt;2&lt;/sup&gt;=0.139, p&amp;lt;0.005), sdLDL-C (r&lt;sup&gt;2&lt;/sup&gt;=0.137, p&amp;lt;0.005), VLDL-C (r&lt;sup&gt;2&lt;/sup&gt;=0.074, p&amp;lt;0.044), and non HDL-C (r&lt;sup&gt;2&lt;/sup&gt;=0.166, p&amp;lt;0.002) in T2DM group. The same inverse relationship was observed with serum direct bilirubin and serum levels of LDL-C (r&lt;sup&gt;2&lt;/sup&gt;=0.133, p&amp;lt;0.006), sdLDL-C (r&lt;sup&gt;2&lt;/sup&gt;=0.172, p&amp;lt;0.001), VLDL-C (r&lt;sup&gt;2&lt;/sup&gt;=0.118, p&amp;lt;0.01), and non HDL-C (r&lt;sup&gt;2&lt;/sup&gt;=0.182, p&amp;lt;0.001) in T2DM group.&lt;br /&gt; &lt;b&gt;Conclusions&lt;/b&gt;: A significant negative association was found between serum bilirubin levels and direct serum bilirubin with atherogenic lipids, suggesting that serum bilirubin may protect T2DM patients from development of cardiovascular disease. These findings indicate the need for additional research in a large cohort.

Hematological Abnormalities Beyond Lymphocytosis During Infectious Mononucleosis: Epstein-Barr Virus-Induced Thrombocytopenia.

Thrombocytopenia during Epstein-Barr virus mononucleosis is well-known; however, no recent series have investigated its frequency, associated factors, and evolution. The present study aimed to investigate platelet count characteristics in adult patients with infectious mononucleosis. We reviewed the clinical records of 400 patients admitted to the hospital with infectious mononucleosis (52.0% male; median age, 19 years [range, 15-87 years]), focusing on blood platelet counts, thrombocytopenia prevalence and outcomes. Thrombocytopenia (platelet count ≤150 ×109/L) was present in 119 (29.7%) patients. Thirty-two (8.0%) patients showed platelet counts lower than 100 ×109/L. Thrombocytopenia was severe (platelets <50 ×109/L) in 6 (1.5%) patients. Thrombocytopenia was associated with a lower frequency of typical mononucleosis symptoms such as sore throat and lymphadenopathy, lower frequency of positive heterophil antibodies, higher serum bilirubin concentration and prothrombin time, lower blood leukocyte and lymphocyte count, lower concentration of serum immunoglobulin G and immunoglobulin A concentrations, and larger spleen size. Thrombocytopenia normalized quickly during follow-up. Only 2 cases required specific therapy. Platelet counts significantly increased during follow-up, even in cases without baseline thrombocytopenia. There were no significant hemorrhagic complications. Transient thrombocytopenia is common during infectious mononucleosis in adult patients. Patients with thrombocytopenia have distinct clinical and biological features; it is typically mild during infectious mononucleosis. Cases of severe thrombocytopenia are rare and were not associated with hemorrhagic complications in this series.

Risk of Acute Respiratory Distress Syndrome in Community-Acquired Pneumonia Patients: Use of an Artificial Neural Network Model.

This study aimed to explore the independent risk factors for community-acquired pneumonia (CAP) complicated with acute respiratory distress syndrome (ARDS) and to predict and evaluate the risk of ARDS in CAP patients based on artificial neural network models (ANNs). We retrospectively analyzed eligible 989 CAP patients (632 men and 357 women) who met the criteria from the comprehensive intensive care unit (ICU) and the respiratory and critical care medicine department of Changzhou Second People's Hospital, Jiangsu Provincial People's Hospital, Nanjing Military Region General Hospital, and Wuxi Fifth People's Hospital between February 2018 and February 2021. The best predictors to model the ANNs were selected from 51 variables measured within 24 h after admission. By using this model, patients were divided into a training group (n = 701) and a testing group (n = 288 patients). Results showed that in 989 CAP patients, 22 important variables were identified as risk factors. The sensitivity, specificity, and accuracy of the ANNs model training group were 88.9%, 90.1%, and 89.7%, respectively. When ANNs were used in the test group, their sensitivity, specificity, and accuracy were 85.0%, 87.3%, and 86.5%, respectively; when ANNs were used to predict ARDS, the area under the receiver operating characteristic (ROC) curve was 0.943 (95% confidence interval (0.918-0.968)). The nine most important independent variables affecting the ANNs models were lactate dehydrogenase (100%), activated partial thromboplastin time (84.6%), procalcitonin (83.8%), age (77.9%), maximum respiratory rate (76.0%), neutrophil (75.9%), source of admission (68.9%), concentration of total serum kalium (61.3%), and concentration of total serum bilirubin (50.4%) (all important >50%). The ANNs model and the logistic regression models were significantly different in predicting and evaluating ARDS in CAP patients. Thus, the ANNs model has a good predictive value in predicting and evaluating ARDS in CAP patients, and its performance is better than that of the logistic regression model in predicting the incidence of ARDS patients.

Assessment of serum and drain fluid bilirubin concentrations in liver transplantation patients

Bile leakage is a major complication after liver transplantation and remains as a significant source of morbidity and mortality. In 2011, the International Study Group of Liver Surgery (ISGLS) defined bile leakage as a drain/serum bilirubin ratio ≥3. However, to our knowledge there is no literature assessing serum and drain bilirubin concentrations after liver transplantation. The aim of this study was to describe the natural postoperative changes in serum and drain fluid bilirubin concentrations in patients after liver transplantation. We included 32 patients who underwent liver transplantation at Kobe University Hospital from January 2007 to December 2020. We enrolled 34 living donors who had no complications as the control group. The recipient serum total/direct bilirubin concentration were higher compared with the donors from postoperative day (POD) 1 to 5 with a statistical difference (P < .05). The recipient drain/serum total bilirubin ratio was lower than donors on POD 3 (0.89 ± 0.07 vs 1.53 ± 0.07: P < .0001), which was also confirmed by the recipient drain/serum direct bilirubin ratio (0.64 ± 0.10 vs 1.18 ± 0.09: P < .0001). On POD 3, the drain fluid volume (647.38 ± 89.47 vs 113.43 ± 86.8 mL: P < .001) and serum total bilirubin concentration (6.73 ± 0.61 vs 1.23 ± 0.60 mg/dL: P < .001) was higher in the recipients than in donors. Categorized in 2 groups, the higher drain fluid volume and bilirubin concentration recipients showed lower drain/serum total bilirubin ratio compared with the other group (P=.03) CONCLUSION: The drain/serum bilirubin ratio in the transplanted patients could be calculated lower compared with the hepatectomy patients because of high drain fluid volume and hyperbilirubinemia. Great care should be taken when assessing the bile leakage in liver transplant recipients using the ISGLS definition.

The influence of steroid therapy of complications of infectious mononucleosis on the course of Epstein-Barr virus hepatitis.

The purpose of the study was to characterize the differences in the course of Epstein-Barr virus (EBV) primary infection-induced hepatitis between patients treated with steroids due to complications of infectious mononucleosis (IM) and those not receiving such therapy. We analyzed the changes in the activity of liver enzymes and differences in abdominal ultrasound results. The study was based on reviewing the medical records of children hospitalized for primary EBV infection at the Department of Children's Infectious Diseases, Medical University of Warsaw, Regional Hospital of Infectious Diseases in Warsaw, between August 2017 and March 2023. The study population was divided into two groups: patients treated with steroids (Group 1) and children not receiving steroids (Group 2). Significant differences were obtained for alanine aminotransferase activity only in the first week of IM (205.34 ±115.40 vs. 288.82 ±170.16 IU/l for Group 1 and 2, respectively; p = 0.024), and for aspartate aminotransferase in the first (170.63 ±159.47 vs. 218.85 ±128.22 IU/l for Group 1 and 2, respectively; p = 0.009) and the third week (151.09 ±138.57 vs. 235.50 ±170.27 IU/l for Group 1 and 2, respectively; p = 0.016). The analysis of the results of laboratory tests for the diagnosis of cholestasis (γ-glutamyl transferase and total serum bilirubin concentrations with fractions) did not show significant differences between the groups. Our results indicated that the two cohorts of patients may differ in the course of hepatitis associated with primary EBV infection, especially at the beginning of the disease, when the laboratory features of hepatitis were less pronounced in children treated with steroids.

Jaundice in relation to immune activation during Epstein-Barr virus-induced infectious mononucleosis

BackgroundLiver involvement during infectious mononucleosis is common, but jaundice is considered rare. This study aimed to investigate serum bilirubin concentrations in patients with infectious mononucleosis and immune abnormalities associated with jaundice. MethodsWe report on an adult patient with monoclonal B lymphocytosis and IgM-lambda gammopathy who developed a severe icteric hepatitis during infectious mononucleosis. We then reviewed the clinical records of 389 patients admitted to the hospital with infectious mononucleosis between 1995 and 2018 (51.7% male patients; median age, 19 years; range, 15-87 years) with focus on liver abnormalities and associated factors. ResultsFifty-nine patients (15.1%) had serum bilirubin concentrations between 1.5 and 3 mg/dL, and 47 patients (12.0%) had serum bilirubin >3 mg/dL. Patients with increased bilirubin concentrations had a distinct clinical presentation, with more frequent abdominal pain, nausea and vomiting, and less frequent sore throat than patients with normal bilirubin. Age and sex were not significantly different for the patients with increased and normal serum bilirubin concentrations. The patients with increased serum bilirubin concentrations showed higher levels of immune activation markers than the patients with normal bilirubin, including blood lymphocyte counts, serum IgM, and β2-microglobulin concentrations. Heterophile antibody-positive patients (88.6%) showed similar bilirubin concentrations but higher aspartate aminotransferase and alkaline phosphatase levels than their heterophile-negative counterparts. Serum bilirubin elevations normalized quickly during follow-up. ConclusionsTransient hyperbilirubinemia is common during severe (in-hospital) infectious mononucleosis in adult patients. Patients with hyperbilirubinemia have less frequent pharyngitis symptoms and more frequent abdominal symptoms. Hyperbilirubinemia during infectious mononucleosis is associated with immune activation markers.

Hepatorenal function of Wistar rats treated with Alamo and Jekomo, an alcoholic herbal bitters in Nigeria

Increased demand for herbal remedies and natural quest for alcohol consumption has positioned alcoholic herbal bitters an acclaimed blood detoxifying and liver cleansing potential as an ideal drink without scientific validation. This study assessed the hepatorenal effect of Alomo and Jekomo, commonly consumed alcoholic bitters in male Wistar rat. Thirty male Wistar rats weighing 110 to 130 g were divided into six groups of five animals each and treated with distilled water, ethanol, Alomo and Jekomo Alcoholic Bitters at 2.68 mL/kg body weight respectively for 28 days. The serum and kidney homogenate were used to determine biochemical parameters such as total protein, albumin, creatinine, urea and bilirubin following standard methods. There was a significant increase (p &lt; 0.05) in serum and kidney levels of total protein and albumin in alcohol treated groups. A significant increase (p &lt; 0.05) in serum creatinine levels of ethanol and kidney homogenate of Jekomo bitters treated group when compared with control. A significant increase (p &lt; 0.05) in serum and kidney urea and bilirubin concentration was also observed in all alcohol treated groups when compared with control. A combined elevation in urea and creatinine and bilirubin suggest a moderate to severe form of kidney and liver damage induced by the alcoholic herbal bitters. As essential markers of kidney function, the recorded elevation of urea and creatinine shows a potential exposure to renal dysfunction. Prolonged and increased consumption of these alcoholic herbal bitters should be discouraged to prevent hepatocellular injury or damage.

Effect of Sodium Fluoride on Glycemic Index and Liver Functions in Rats

From a health standpoint, fluoride (F) is a vital element for humans. It had harmful effects on numerous organs when consumed in high dosages. Fluoride poisoning has been linked to liver damage. The purpose of this study was to see how sodium fluoride (Naf) affected liver function and the glycemic index in adult male albino rats. Fourteen (14) adult male Wistar albino rats were randomly and evenly divided into two groups and given the following treatments for thirty (30) days: G1 Group (Control group), were given distilled water and fed a balanced diet, G2 rats were administered water that contained 100 ppm Naf. The animals were fasted for 8-12 hours before being anesthetized and blood samples were taken by heart puncture technique at zero day (zero time) and (30) day. The following parameters were measured using the serum. The glycemic index contains (glucose, insulin, and insulin resistance), as well as liver function tests such as serum activity of alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma glutamyl transferase (GGT), as well as direct, indirect and total bilirubin concentration. The livers and pancreas were quickly delivered, meticulously dissected out, prepped, and viewed under a light microscope. The results demonstrated that 30 days of exposure to Naf in drinking water produced liver damage manifested by significant increases in blood ALT, AST, and GGT activity as well as significant elevation in serum bilirubin (direct, indirect and total) concentration compared to control group. A significant rise in blood glucose levels and a fall in blood insulin levels and IR were detected at the end of the experiments in Naf treated group when compared to the control. Histopathological changes in Naf treated group was observed in hepatic and pancreatic tissue manifested by generalised degeneration and necrosis of hepatocytes, in addition, to severe degeneration of acinar and pancreatic islet cells. In conclusion, the findings of this investigation revealed Naf therapy-induced liver damage and a change in the glycemic index in adult male rats.

Evaluation of a Point-of-Care Test for Bilirubin in Malawi.

BiliSpec is a low-cost spectrophotometric reader and disposable paper-based strip to quantify total serum bilirubin from several blood drops. This study was a prospective evaluation of BiliSpec in 2 neonatal wards in Malawi compared with a reference standard bilirubinometer over a large range of bilirubin and hematocrit levels. The accuracy of BiliSpec and a transcutaneous bilirubinometer were compared with the reference standard of spectrophotometry for 475 blood samples collected from 375 subjects across a range of total serum bilirubin concentrations from 0.0 to 33.7 mg/dL. The development of error grids to assess the clinical effects of measurement differences is reported. BiliSpec was found to have a mean bias of -0.48 mg/dL and 95% limits of agreement of -5.09 mg/dL to +4.12 mg/dL. Results show 90.7% of BiliSpec measurements would have resulted in the same clinical decision as the reference standard, whereas 55.0% of transcutaneous bilirubin measurements would have resulted in the same clinical decision as the reference standard. This evaluation supports use of BiliSpec to provide accurate, low-cost, point-of-care bilirubin measurements in low-resource hospitals. Future work is needed to evaluate BiliSpec among a larger number of users.

Effect of Common Chicory Essence and Phototherapy on Serum Bilirubin Levels in Preterm Infants Admitted to Neonatal Intensive Care Unit: An In Vitro Study

: Jaundice is a common neonatal disorder that occurs in most term and preterm infants. Chicory or dandelion flower has long been used in the treatment of jaundice. This study aimed to investigate the effect of common chicory essence and phototherapy on serum bilirubin levels in preterm infants admitted to the neonatal intensive care unit (NICU) of Valiasr Hospital in Birjand, Iran. This in vitro study was conducted on preterm infants with gestational age of less than 37 weeks and weight less than 2500 g. Bilirubin levels in blood samples from 21 infants were measured before and after the addition of chicory essence or distilled water. Then, phototherapy was performed, and bilirubin levels were measured again. Data were analyzed using SPSS (version 21). The mean weight of infants was 1542.8 ± 453.5 g. In the chicory essence group, the mean total serum bilirubin was 5.29 ± 1.55 and 0.18 ± 0.07 mg/dL before and after the intervention, respectively (P &lt; 0.001). The mean indirect serum bilirubin was 4.96 ± 1.59 and 0.18 ± 0.07 mg/dL before and after the intervention, respectively (P &lt; 0.001). The mean changes in total bilirubin in the distilled water and chicory groups were 5.15 ± 1.70 and 5.43 ± 1.99 mg/dL, respectively (P = 0.62). The results showed that both distilled water and chicory essence decreased direct and total serum bilirubin concentrations. The indirect bilirubin changes were not significant, and there was no difference in the total bilirubin changes between the two groups. Totally, the chicory essence had no effect on reducing the serum bilirubin level in preterm infants.