Dark Yellow Urine Research Articles

Prevalence of glucose-6-phosphate dehydrogenase (G6PD) deficiency among the fulminant hepatitis A virus infection patients.

Hepatitis A is a widespread viral infection with significant public health implications. Assessing glucose 6-phosphate dehydrogenase (G6PD) deficiency in hepatitis A patients is essential for various reasons, including prognosis, disease severity evaluation, encephalopathy risk identification, tailored management, and advancing scientific understanding. This study aimed to investigate the prevalence and clinical implications of G6PD impairment in individuals with fulminant hepatitis A. A cross-sectional descriptive analysis was conducted, involving hospitalized patients with fulminant hepatitis A. Demographic data, prevalence rates, and clinical findings were recorded in a database. The diagnosis of hepatitis A infection was confirmed using an anti-HAV IgM antibody test, and G6PD enzyme activity was measured with a fluorescent spot assay. Out of 81 patients with hepatitis A, 57 (70.4%) were males, and 24 (29.5%) were females, with an average age of 24.6 years. Dark yellow urine and anorexia were the most common clinical symptoms. Notably, 30 (37%) patients lacked G6PD. The group with G6PD deficiency showed significantly higher rates of encephalopathy and mortality (P<0.01), along with elevated bilirubin (P=0.00), abnormal coagulation parameters, and low hemoglobin levels (P=0.00). In light of these findings, the present study proposes the implementation of routine G6PD level assessments and the evaluation of other relevant markers in regions where hepatitis A is endemic. Furthermore, the study underscores the need for vigilant monitoring of hemolysis and encephalopathy in affected patients to optimize clinical management and reduce morbidity and mortality associated with this condition.

A Mouse Model of Chronic Liver Fibrosis for the Study of Biliary Atresia.

Biliary atresia (BA) is a fatal disease involving obstructive jaundice, and it is the most common indication for liver transplantation in children. Due to the complex etiology and unknown pathogenesis, there are still no effective drug treatments. At present, the classic BA mouse model induced by rhesus rotavirus (RRV) is the most commonly used model for studying the pathogenesis of BA. This model is characterized by growth retardation, jaundice of the skin and mucosa, clay stools, and dark yellow urine. The histopathology shows severe liver inflammation and obstruction of the intrahepatic and extrahepatic bile ducts, which are similar to the symptoms of human BA. However, the livers of end-stage mice in this model lack fibrosis and cannot fully simulate the characteristics of liver fibrosis in clinical BA. The presented study developed a novel BA mouse model of chronic liver fibrosis by injecting 5-10 µg of anti-Ly6G antibody four times, with gaps of 2 days after each injection. The results showed that some of the mice successfully formed chronic BA with typical fibrosis after the time lapse, meaning these mice represent a suitable animal model for the virus-induced liver fibrosis mechanistic study of BA and a platform for developing future BA treatments.

Pancreatic tumor with lung tumor: a case report

According to the global cancer observatory (GLOBOCAN), there were 16,485 new cases of pancreatic cancer in Southeast Asia in 2020, with men (9458 cases) having the highest incidence compare to woman (8320 cases). The death rate from 16,485 cases was 16,167 cases (98%). A person's chance of developing pancreatic cancer in addition to other cancers is between 1% to 20%. In this study, we reported a case of pancreatic tumor with lung tumor. A 68 years old woman presented with right quadrant abdominal pain since 1 month ago. The pain occurs randomly, but mostly occur during night. The pain didn’t occur after eat fatty food and during exercise. The pain didn’t relieve by rest. The patient also experienced nausea and vomit. The vomit consist of food and blood. She complains black colored stools and dark yellow urine. She also lost weight from 62 kg to 47 kg. There was history of gastric bleeding in 4 month ago. She was passive smoker. We then did several tests such as complete blood count, blood chemistry, serology, chest x-ray and abdominal CT-scan. The test showed pancreatic tumor with suggestive primary lung tumor. Patient with multiple primary tumor are an extremely rare type of cancer, which need comprehensive approach to both diagnosis and treatment of these numerous primary tumors.

Updates in Diagnosis and Management of Neonatal Cholestasis

Neonatal jaundice refers to the yellow coloration of the skin and sclera of newborn babies that results from hyperbilirubinemia. About 50% of term and 80% of preterm babies develop jaundice in the first week of life. Jaundice is also a common cause of readmission to hospital after early discharge of newborn babies. Jaundice mainly develop due to two factors—the cessation of fetal hemoglobin as it is substituted with adult hemoglobin and the comparatively immature metabolic trails of the liver, which are incapable to conjugate and so expel bilirubin as quickly as an adult. This grounds an accretion of bilirubin in the blood (hyperbilirubinemia), causes the symptoms of jaundice. The typical results in an infant who has cholestasis are prolonged jaundice, scleral icterus, acholic stools, dark yellow urine, and hepatomegaly. Trying of diagnosis of children with jaundice must begin with the classification of serum bilirubin into total bilirubin and direct (or combined) bilirubin. Phototherapy is introduced based on risk influences in the nomogram and serum bilirubin levels. IV immunoglobulin is suggested for cumulative bilirubin levels from isoimmune hemolysis regardless of phototherapyand exchange transfusion is designated if there is a risk of neurologic dysfunction regardless beginning of phototherapy. This review aims to summarize current evidence regarding epidemiology, etiology, diagnosis and management of neonatal cholestasis.

Impact of Papaya (Carica papaya L.) on Breast Milk Production Enhancement of Nursing Mothers at Teling Atas Public Health Center, Wanea Subdistrict, Manado City

BACKGROUND: Papaya fruit which is a type of fruit that has high nutritional content and is rich in health benefits, one of the benefits is to increase breast milk production. Papaya is a fruit that contains galactagogue, a substance that can help increase and improve breast milk production. AIM: This study aimed to determine papaya fruit’s effect on breast milk production in nursing mothers at Teling Atas Public Health Center, Wanea Subdistrict, Manado City, Indonesia. METHODS: The research method was the pre-experimental method using a before and after intervention design to one group. The study population was all breastfeeding mothers whose babies were aged 0–6 months per June 2019 and a sample size of 14 categorized less breastfeeding, namely, babies often cry; restless baby; the color of the feces dark brown; consistency of solid feces; the baby’s mouth and eyes appear dry; dark yellow urine; and baby’s weight decreases. The intervention group, namely, getting 200 g of papaya 3 times a day, and given for 7 days (1 week). Data analysis is the Wilcoxon Test. RESULTS: Most respondents were less breastfeeding before consuming papaya, about 71.43%. Nursing mothers before and after being given papaya for 7 days increased by 4.1. The mean value before the intervention was 2.21, and after the intervention, the level of milk production increase to 6.36. There was a significant difference in the level of milk production before and after papaya intervention (p = 0.001). CONCLUSION: Consuming papaya fruit effectively enhanced breast milk production in nursing mothers.

Development of integrated neonatal cholestasis card for early recognition and referral of neonatal cholestasis.

Delayed referral of neonatal cholestasis (NC) can result in significant morbidity and mortality. In this multi-center study, we aimed to evaluate the reliability of the stool card in the Indian population and develop an integrated NC card with (a) urine color identification and (b) stool color for early referral. Consecutive children with NC were enrolled and divided into two groups (biliary atresia [BA] and non-BA). Normal healthy children at 6-8weeks of age served as controls. Each photograph of stool and urine samples of every child was evaluated by 6 parents, 6 paramedical staff, and 4 trainee doctors using a stool color card as a reference for stool samples. Of 319 children (BA [n = 58], non-BA [n = 62], and controls [n = 199]), parents correctly detected dark yellow urine in all NC. Stool samples of 50 (86%) children with BA were unanimously labeled as pale by all observers. The average inter-item correlation showed good correlation between parents and trainee doctors of 0.77 and 0.64 with paramedical staff. The integrated NC card proposes to recognize neonatal cholestasis at an early stage irrespective of etiology. It is a major step towards public health benefit both at the community as well as physicians' levels to enable early detection and timely referral and management.

2742 A Unique Presentation of Scurvy in the Modern Era

INTRODUCTION: Although rare in modern times, scurvy can present among elderly with malabsorptive syndromes, anorexia, or ESRD requiring hemodialysis. Below is a case of a middle-aged male without typical risk factors who was diagnosed with severe ascorbic acid deficiency. The purpose of this report is to highlight the importance of proper history taking that can aid in the early diagnosis and treatment of nutritional deficiencies, thereby reducing overall cost and length of hospital stay for these patients. CASE DESCRIPTION/METHODS: A 47-year-old male with history of anxiety/depression presented with two weeks of progressively worsening bilateral lower extremity ecchymosis and aches with associated non-specific flank pain and dark yellow urine. Patient denied recent aspirin or NSAID use, trauma, and blood in stool, urine, sputum, or gums. He is an unemployed, former smoker with a penicillin allergy and no family history of bleeding disorders. He was taking bupropion and clonazepam as prescribed by his psychiatrist but was also treating his anxiety with a friend’s clonidine and HCTZ. Urine drug screen was positive for MDMA and benzodiazepine. Initial lab work revealed Hb 4.7, K 2.8, elevated ESR/CRP and D-Dimer. WBC, platelets, iron studies, creatinine kinase, fibrinogen levels, and CT abdomen/pelvis were unremarkable. Patient was transfused multiple units of blood. Extensive hematologic and rheumatologic workup over the next several days was negative. He continued to have lower extremity weakness that finally resolved after starting treatment for a serum vitamin C level of 0.0 µmol/L. Patient then revealed that he had an allergic reaction to fruit as a child. He had since eliminated all fruits and most vegetables from his diet. DISCUSSION: Ascorbic acid has a short half-life and is not stored in the body. Severe Vitamin C deficiency can be seen in extremes of age and can take up to 3 months to develop. Symptoms can range from fatigue in the early stages to anemia, bone pain, gum disease, perifollicular hemorrhages, mood changes, and convulsions in the more advanced stages. Supplementation with 1-2 g of Vitamin C for the first 3 days followed by 500 mg for the next week and 100 mg daily for the next month should result in complete recovery. The case presented is unique due to the patient’s age and lack of typical findings such as corkscrew hair and bleeding gums. Patient had a prolonged hospital course with a costly workup that could have been curtailed with attention to nutritional status on presentation.

HUBUNGAN KADAR ALANINE AMINOTRANSFERASE (ALT) TINGGI TERHADAP HASIL ANTIBODI VIRUS HEPATITIS A PADA PENDERITA DEMAM

Penyakit Hepatitis A disebabkan oleh virus Hepatitis A (HAV) yang merupakan self limiting desease dan memberikan kekebalan seumur hidup. Penderita HAV ditandai dengan demam, mual, muntah, nafsu makan berkurang, urin berwarna kuning tua, feses berwarna pucat, dan hasil Alanine Aminotransferase (ALT) tinggi. Tujuan penelitian ini untuk mengetahui apakah ada hubungan kadar Alanine Aminotransferase (ALT) tinggi terhadap kadar antibodi Hepatitis A Virus (HAV) di Rumah Sakit Islam Jemursari Surabaya. Jenis penelitian ini adalah observasional dengan rancangan Cross-sectional analitik. Teknik pengambilan sampel dilakukan secara purposive sampling dengan kriteria inklusi kadar ALT tinggi. Jumlah sampel penelitian sebanyak 27 responden yang diperiksa IgG HAV dan IgM HAV menggunakan Rapid Test IgG dan IgM HAV merek V Care. Hasil penelitian ini menunjukan tidak terdapat hubungan yang signifikan antara kadar ALT tinggi terhadap kejadian Hepatitis A dengan p= 0,185 (p &gt; 0,05) melalui uji Korelasi Spearman.

Increase in morbidity and mortality in a shipment of red-eared slider turtles (Trachemys scripta elegans).

A cohort of captive-bred red-eared slider turtles, Trachemys scripta, was received from a commercial vendor. Shortly after arrival, several turtles presented as lethargic with subjectively pale skin and multifocal areas of cotton-like tufts in the mouth area and distal extremities. The water was treated with a commercial anti-fungal and anti-bacterial preparation of Victoria Green B and acriflavine. Despite treatment, 10 turtles were euthanized and others demonstrated persistent clinical signs. A live turtle was submitted to a commercial diagnostic laboratory for microbiologic and histologic evaluation. Seven cultures were obtained from this turtle and numerous organisms grew from each culture, including Flavobacterium sp. Blood film analysis demonstrated intracytoplasmic gamonts of Haemogregarina sp. within erythrocytes. On necropsy, internal organs appeared to be slightly more adhered within the coelomic cavity than normal. The urinary bladder was markedly distended with turbid, dark yellow urine. Microscopic evaluation of the tissues revealed significant parasitism with Myxidium sp., Spirorchis sp. and Neopolystoma orbiculare. No fungal organisms were identified on histology or grown in culture. While there are scattered reports of these pathogens in freshwater turtles, none of the cases reported describe such extensive co-infections. It is likely that complicated infection and shipping stress exacerbated clinical signs typically seen with these organisms. Efforts to minimize stress and administration of prophylactic antiparasitic agents during the acclimation period may aid in reducing the consequences of internal parasitism in aquatic turtles.

Chemical clue hints at Indian yellow’s origins

Artists throughout the 1800s prized the pigment Indian yellow for its luminescent gold hue until synthetic pigments took its place on palettes at the beginning of the 20th century. But the pigment’s lore still fascinates. According to an account made by Indian product and resource expert Trailokya Nath Mukharji in 1883, Indian yellow was manufactured in the country’s Monghyr region by a small community who dried the urine of cows fed only mango leaves and water—a diet that produced dark yellow urine. Mukharji, the sole eyewitness to report the unusual manufacturing process, also sent samples of the raw pigment and other items involved in its preparation to the Royal Botanic Gardens, Kew. In the intervening years, scholars have cast doubt on Mukharji’s story, suggesting the pigment is purely plant based. Now, Buffalo State College’s Rebecca Ploeger and Aaron Shugar and researchers at Newfields, which includes the Indianapolis Museum of Art,

Clinical and pathological analysis on Traditional Chinese Medicine syndromes in children with immunoglobulin A nephropathy

ObjectiveTo evaluate the common Traditional Chinese Medicine (TCM) syndromes and analyze their relationship to clinical and pathological manifestations in children with IgA nephropathy. MethodsForty five children diagnosed as having primary IgA nephropathy by renal biopsy for the first time were enrolled in this trial, and their TCM syndromes were evaluated and the distribution of TCM syndromes was observed. All the sick children were growed? according to clinical manifestations and pathological damages, and the differences in TCM syndromes were compared between the groups. ResultsThe first 5 TCM symptoms were common cold, hyperhidrosis, red dry throat, dark yellow urine and lassitude. In the acute nephritis group, edema and aching pain in loin and knees were significant (P=0.021 and P=0.000). In the severe pathological damage group, edema was obvious (P= 0.004), and 24 h urinary protein was positively correlated with edema (P=0.015) while negatively with common cold (P=0,007). The score of mesangial cell proliferation was correlated with edema, red dry throat and common cold (P=0.006, 0.013 and 0.029 respectively). The score of segmental pathological change was positively correlated with edema (P=0.039). ConclusionCommon cold, hyperhidrosis, red dry throat, dark yellow urine, lassitude and other symptoms of qi deficiency of the spleen and lung mainly seen in children with IgA nephropathy may bear a close relationship to clinical manifestations and pathological damages.

Autoimmune hemolytic anemia: a history.

UTOIMMUNE HEMOLYTIC anemia (AIHA) is an acquired immunoIogic disease in which the patient's red blood cells (RBCs) are selectively attacked and destroyed (hemolyzed) by autoantibodies produced by the patient's own immune system. These patients generally display the common symptoms of anemia: weakness, pallor, fatigue, and jaundice. Less obvious is the frequent occurrence of mild splenomegaly. There are 2 major types of AIHA: cold agglutinin disease (CAD) and warm autoimmune hemolytic anemia (WAIHA), which are differentiated by the optimal temperature of reactivity of the autoantibody. A third type of AIHA is the relatively uncommon, but quite distinct, paroxysmal cold hemoglobinuria (PCH). The pathophysiologic mechanisms differ for the different types of AIHA, depending on autoantibody immunoglobulin class and subclass and the ability of the antibody to activate complement. The degree of RBC hemolysis depends, in part at least, on the autoantibody concentration in the patient's blood and on the abifity of the antibody to activate complement. In CAD, the autoantibodies are immunoglobulin M (IgM) immunoglobulins; in WAIHA, the autoantibodies are IgG immunoglobulins. RBCs coated with IgG autoantibody undergo extravascular destruction, primarily in the spleen, whereas RBCs coated with complement (mediated by IgM and some IgG autoantibodies) can be destroyed either intravascularly or extravascularly. Although it may occur in both the warm and cold types of AIHA, intravascular hemolysis is classically more associated with CAD (and with PCH) ,and leads to increased plasma hemoglobin and hemoglobinuria, resulting in red, brown, or tea-colored plasma and urine. Extravascular destruction of the RBC (classic in WAIHA, but also common in CAD) results in increased bilirubin in the plasma and urine urobilin, resulting in jaundice and dark yellow urine. AIHA is further classified into (1) primary or idiopathic, in which no associated disease is identified, and (2) secondary, associated with collagenvascular disorders such as systemic lupus erythematosus (SLE), lymphomas and leukemias, rheumatoid arthritis, ulcerative colitis, lupoid hepatitis, etc. Whereas both secondary WAIHA and CAD have been associated with SLE, lymphomas, and leukemias, secondary CAD is also known to result from infectious mononucleosis and Mycoplasma pneumoniae infections. PCH, which has historically been associated with syphilis, has more recently been more commonly associated with rubella and other virus infections and may be idiopathic in some cases. The main current treatments for WAIHA are corticosteroids, splenectomy, and immunosuppressive drugs, with a wide variety of therapies employed with varying success in cases resistant to the three approaches. CAD is treated by keeping the patient warm, blood transfusions, and plasmapheresis.

Effect of malnutrition on extraintestinal spread of rotavirus and development of hepatitis in mice

The effects of malnutrition on the extramucosal spread and severity of the clinical disease were examined in suckling BALB/c mice infected with heterologous rhesus rotavirus (RRV). Control animals were inoculated with homologous murine rotavirus (MRV). Following oral infection with RRV, 100% of malnourished and 90% of normally nourished mice exhibited watery diarrhea within 48 hours. The clinical symptoms appeared more severe and of longer duration in the malnourished group. At 7 to 14 days post-inoculation, 30 of 79 (38%) malnourished and 19 of 92 (21%) well nourished mice developed icterus, clay-colored feces and dark yellow urine. The mortality rates were 9% and 0%, respectively. Light microscopy revealed an acute hepatitis with foci of necrosis. Rotavirus was detected in liver tissue by cell culture infectivity, immunofluorescence assay and electron microscopy. Homologous MRV infection resulted in diarrhea in all animals and with increased severity in the malnourished group. Significantly, however, none of the control animals developed hepatitis and no virus could be detected in the liver. These results suggest that malnutrition may exert significant influence on the severity of rotavirus infection and on the extent of extramucosal spread of RRV. Since several heterologous rotavirus strains are currently being tested in human vaccine trials, the implications of our observations suggest that special attention should be paid to malnourished infants and that screening of hepatic function should be included in vaccine protocols.

METHYLTESTOSTERONE, RELATED STEROIDS, AND LIVER FUNCTION.

JAUNDICE due to methyltestosterone was first reported by Werner in 1947. 1 Subsequently 42 cases of jaundice during methyltestosterone therapy have been reported. 2 Foss and Simpson 2 summarized reported cases and noted that the duration of therapy to the onset of jaundice ranges from eight days to ten months. Studies of liver function, in addition to elevation of serum direct and indirect bilirubin levels, showed abnormal sulfobromophthalein (Bromsulphalein) sodium (BSP) retention, and normal or a slight elevation of the alkaline phosphatase concentration. The flocculation tests and total serum albumin and globulin concentrations were not altered. In most cases the illness is mild with anorexia, malaise, nausea, vomiting, and upper abdominal pain. Pruritus and jaundice subsequently develop with acholic stools and dark yellow urine. There is no fever. These symptoms are of varying intensity and duration. Withdrawal of methyltestosterone results in remission of hepatocellular dysfunction within a few days to