Diagnosis Of Jaundice Research Articles

An Invisible Dermal Nanotattoo-Based Smart Wearable Sensor for eDiagnostics of Jaundice.

Despite substantial progress in the diagnosis of jaundice/hyperbilirubinemia as the most common disease and cause of hospitalization of newborns, on the eve of Industry/Healthcare 5.0, the development of accurate and reliable wearable diagnostic sensors for noninvasive smart monitoring of bilirubin (BIL) is still in high demand. Aiming to fabricate a smart wearable sensor for early diagnosis of neonatal jaundice and its therapeutic monitoring, we here report a fluorescent dermal nanotattoo that further coupled with an IoT-integrated wearable optoelectronic reader for minimally invasive, continuous, and real-time monitoring of BIL in interstitial fluid. Selective recovery of quenched fluorescence of the dermal tattoo sensor, composed of biocompatible dissolving/hydrogel microneedles loaded with fluorescent carbon quantum dots, upon blue light exposure used for jaundice phototherapy was utilized for highly selective BIL sensing. The fascinating features of our developed smart wearable tattoo sensor and its successful results with high correlation with blood BIL results make it a highly promising sensor for easy, minimally invasive, reliable, and smart eDiagnostics and continuous therapeutic eMonitoring of jaundice and other BIL-induced diseases at the point of care. We envision that the developed nanotattoo sensing bioplatform will inspire the development of future smart tattoo sensors in various diagnostic and monitoring scenarios.

Correlation of Clinical Assessment of Jaundice with Total Serum Bilirubin in Neonates: Hospital-Based Cross-Sectional Study

Introduction: Neonatal jaundice is a common cause of admission in the neonatal period. Early diagnosis and treatment of neonatal jaundice prevent the bilirubin encephalopathy. There are various methods for the estimation of neonatal jaundice. Clinical assessment of neonatal jaundice can aid in the diagnosis of neonatal jaundice in low-resource settings and refer to the higher center for those who require treatment. This study aims to understand the relation between clinical assessment of jaundice and total serum bilirubin in neonates and to know the risk factors of neonatal jaundice.  Methods: The Clinical assessment of jaundice by Kramers scale can be used to assess the level of jaundice and know the progression of jaundice.  Results: This shows a significant positive relation between clinical assessment of jaundice and serum bilirubin level.  Conclusions: The study findings showed that clinical assessment of jaundice was comparable with the serum bilirubin. Clinical assessment of jaundice by Kramer‟ 's scale can be used to assess the level of jaundice and know the progression of jaundice.

Community health worker knowledge and perceptions of neonatal jaundice in Kumasi, Ghana.

This study sought to understand community health workers' (CHW) knowledge and perceptions of community beliefs surrounding neonatal jaundice (NNJ), a treatable but potentially fatal condition prevalent in sub-Saharan Africa. In this cross-sectional qualitative study, CHWs in Kumasi, Ghana, completed in-depth interviews with trained research assistants using a semi-structured interview guide. Interviews were audiotaped, transcribed verbatim, and analyzed using grounded theory methodology. Knowledge of NNJ varied widely among the 23 respondents: 74% knew NNJ could cause death, 57% knew how to screen for NNJ. 35% of CHWs favored home treatment (sunlight therapy or watchful waiting). Three main themes emerged: CHWs perceived that caregivers prefer home treatment, equating hospital care with death; sunlight and herbs are the most common home treatments; and caregivers attribute NNJ to supernatural causes, delaying jaundice diagnosis. Incomplete understanding of NNJ among trained CHWs and local communities will require improved education among both groups to improve outcomes.

Spicy Recipe for At-Home Diagnostics: Smart Salivary Sensors for Point-of-Care Diagnosis of Jaundice.

Even though significant advances have been made, there is still a lack of reliable sensors capable of noninvasively monitoring bilirubin and diagnosing jaundice as the most common neonatal disease, particularly at the point-of-care (POC) where blood sampling from infants is accompanied by serious challenges and concerns. Herein, for the first time, using an easy-to-fabricate/use assay, we demonstrate the capability of curcumin embedded within paper for noninvasive optical monitoring of bilirubin in saliva. The highly selective sensing of the developed sensor toward bilirubin is attributed to bilirubin photoisomerization under blue light exposure, which can selectively restore the bilirubin-induced quenched fluorescence of curcumin. We also fabricated an IoT-enabled hand-held optoelectronic reader to measure and quantify the fluorescence and color signals of our sensor. Clinical analysis on the saliva of 18 jaundiced infants by using our developed smart salivary sensor proved that it is amenable to be widely exploited in POC applications for bilirubin monitoring as there are good correlations between its results with those of reference methods in saliva and blood. Meeting all WHO's REASSURED criteria by our developed sensor makes it a highly promising sensor for smart noninvasive diagnosis and therapeutic monitoring of jaundice, hepatitis, and other bilirubin-induced neurologic diseases at the POC.

Clinicopathological features and management of obstructive jaundice at Queen Elizabeth Central Hospital, Malawi. A retrospective cohort analysis

IntroductionThe diagnosis of obstructive jaundice (OJ) is a challenge and is often made late especialy in low-resource settings. There is a paucity of data on the aetiology and prognosis of patients with obstructive jaundice in Malawi and Sub-Saharan Africa. The objective of this study was to determine the aetiology, clinical presentations, and short-term treatment outcomes of patients managed for OJ in Malawi. MethodologyA review of case notes of all patients admitted with a clinical diagnosis of OJ from 2012 to 2022 was done. We reviewed the clinical presentation, laboratory findings, management, intra and post–operative complications, and patient outcomes. Data was entered into an Excel spreadsheet and analysed using SPSS version 25. ResultsOf 26,796 patient admissions, 5339 (19.9%) were for non-trauma abdominal symptoms, of which 164 (0.6% of surgical admissions and 3% of abdominal symptoms) were for obstructive jaundice. Ages varied from 16 to 89 years. Females were 45 (58.4 %) of the population. The commonest presenting complaint was jaundice followed by abdominal pain and distention. The mean duration of symptoms at presentation was 8.5 weeks. The most frequent imaging modality was abdominal ultrasound 50(65 %). Twenty-six patients (33.8 %) were discharged with a diagnosis of obstructive jaundice of undetermined pathogenesis. The commonest diagnosis was pancreatic cancer 20(26.0 %) followed by Choledocholithiasis11(14.3 %). Patients younger than 50 years had the same likelihood of presenting with cancer as those older than 50 years. ConclusionIt is important to have a high index of suspicion in all adult patients presenting with obstructive jaundice as patients younger than 50 years have a similar risk of malignancy as older patients.

Development of Non-Invasive Biosensors for Neonatal Jaundice Detection: A Review.

One of the most common problems many babies encounter is neonatal jaundice. The symptoms are yellowing of the skin or eyes because of bilirubin (from above 2.0 to 2.5 mg/dL in the blood). If left untreated, it can lead to serious neurological complications. Traditionally, jaundice detection has relied on invasive blood tests, but developing non-invasive biosensors has provided an alternative approach. This systematic review aims to assess the advancement of these biosensors. This review discusses the many known invasive and non-invasive diagnostic modalities for detecting neonatal jaundice and their limitations. It also notes that the recent research and development on non-invasive biosensors for neonatal jaundice diagnosis is still in its early stages, with the majority of investigations being in vitro or at the pre-clinical level. Non-invasive biosensors could revolutionize neonatal jaundice detection; however, a number of issues still need to be solved before this can happen. These consist of in-depth validation studies, affordable and user-friendly gadgets, and regulatory authority approval. To create biosensors that meet regulatory requirements, additional research is required to make them more precise and affordable.

Validity of BiliDx as a point-of-care bilirubin measurement device to diagnose and monitor neonatal jaundice at Muhimbili National Hospital, an observational study

BackgroundNeonatal jaundice is a condition caused by elevated levels of bilirubin in the bloodstream. Laboratory determination of serum bilirubin concentration by total serum bilirubin (TSB) test is still considered as gold standard for clinical guidance and practice. In developed countries, diagnosis of neonatal jaundice is shifting towards point-of-care medical devices. BiliDx is a device developed to allow a fast, blood-based determination of bilirubin levels at the point of care. This study aimed to determine the accuracy of the BiliDx device relative to a standard laboratory total serum bilirubin to diagnose and monitor jaundice among neonates admitted at Muhimbili National Hospital (MNH).Material and methodologyThis was a prospective hospital-based observational study conducted at the Neonatal Ward – MNH, Dar-es-Salaam, Tanzania from November 2022 to January 2023. A total of 180 neonates admitted at the neonatal ward with jaundice and whose parents consented were enrolled in the study. Blood samples were collected; 2 ml of venous blood into the vacutainer bottle for standard laboratory measurement of total serum bilirubin (TSB) and 25µL blood collected into a transfer pipette tube and applied to BiliDx. STATA version 15.1 was used for data analysis.ResultsOut of 180 neonates, 39.4% (71/180) had birth weight between 1500 − 2499.9 g, approximately 2/3rd (120/180) were preterm, 92/180 (51.1%) were males and 100/180 (55.6%) were undergoing phototherapy treatment the moment sample taken. The mean bilirubin concentration was 92 mmol/l for BiliDx and 118 mmol/l for standard laboratory TSB. The minimum and maximum values obtained with BiliDx were, 3.4 and 427.5 mmol/l respectively, compared with 10.7 and 382.1 mmol/l using standard laboratory TSB. A linear relationship and correlation coefficient of 0.8408 (p = 0.000) between BiliDx and standard laboratory TSB was found. The regression analysis showed the presence of constant error [coefficient of BiliDx/slope = 0.91, 95% CI (0.82–0.99), p = 0.000] and random error exclusively [coefficient of constant/y-intercept = 48.52, 95%CI (37.70-59.34), p = 0.000]. The Bland–Altman plot showed an acceptable mean difference of 39.1mmol/l, limits of agreement of -48.3mmol/l to 126.4mmol/l, and 179 points (179/180 = 99.4%) lying inside the limits of agreement.ConclusionThe results support the use of BiliDx for rapid and accurate testing of elevated levels of bilirubin in the bloodstream among neonates since 99.4% of the differences between BiliDx and standard laboratory TSB lie between the lines of agreement.

Obstructive Jaundice Secondary to Hepatic Hilar Tuberculosis Without Pulmonary Involvement.

Tuberculosis (TB) can affect the biliary system, mimicking cholangiocarcinoma without pulmonary involvement.Early recognition of biliary TB and treatment can prevent permanent complications and invasive intervention requirements.Using standard anti-tuberculous medications has shown high efficiency in treating and eradicating mycobacterial infection in such locations.

Validation of diagnoses of liver disorders in users of systemic azole antifungal medication in Sweden

BackgroundLiver disorders are important adverse effects associated with antifungal drug treatment. However, the accuracy of Clinical International Classification of Diseases (ICD)-10 codes in identifying liver disorders for register based research is not well-established. This study aimed to determine the positive predictive value (PPV) of the ICD-10 codes for identifying patients with toxic liver disease, hepatic failure, and jaundice among patients with systemic antifungal treatment.MethodsData from the Swedish Prescribed Drug Register and the National Patient Register were utilized to identify adult patients who received systemic azole antifungal drugs and had a recorded diagnosis of toxic liver disease (K71.0, K71.1, K71.2, K71.6, K71.8, K71.9), hepatic failure (K72.0, K72.9), or jaundice (R17) between 2005 and 2016. The medical records of all included patients were reviewed. Prespecified criteria were used to re-evaluate and confirm each diagnosis, serving as the gold standard to calculate PPVs with 95% confidence intervals (95% CI) for each diagnostic group.ResultsAmong the 115 included patients, 26 were diagnosed with toxic liver disease, 58 with hepatic failure, and 31 with jaundice. Toxic liver disease was confirmed in 14 out of 26 patients, yielding a PPV of 53.8% (95% CI 33.4–73.4%). Hepatic failure was confirmed in 26 out of 38 patients, resulting in a PPV of 62.1% (95% CI 48.4–74.5%). The highest PPV was found in jaundice, with 30 confirmed diagnoses out of 31, yielding a PPV of 96.8% (95% CI 83.3–99.9%).ConclusionAmong patients who received azole antifungal treatment and were subsequently diagnosed with a liver disorder, the PPV for the diagnosis of jaundice was high, while the PPVs for toxic liver disease and hepatic failure were lower.

Biliary Ascariasis Causing Obstructive Jaundice: A Case Report on ERCP-Assisted Management

BACKGROUND: Biliary tract disorders are predominantly caused by cholelithiasis (gallstones). However, in regions endemic for parasitic infestations, or areas with poor hygiene and sanitation, hepatobiliary disorders may be due to an underlying worm infestation. THE CASE A 55-year-old female from Skardu, Pakistan, an Ascariasis-endemic area, presented to a tertiary care hospital with right hypochondrial pain and jaundice. Her condition did not respond to conservative treatment. Ultrasound (USG) and Magnetic Resonance Cholangiopancreatography (MRCP) identified multiple worms obstructing the common bile duct. Subsequently, an Endoscopic Retrograde Cholangiopancreatography (ERCP) procedure was performed, successfully retrieving the worms and achieving complete ductal clearance. The patient was discharged with oral anthelmintics and made a full recovery. CONCLUSION: This case underscores the importance of considering biliary ascariasis as a differential diagnosis for obstructive jaundice in endemic regions. MRCP emerges as a valuable diagnostic tool, providing a non-invasive and precise way to identify worm infestations of the biliary system. It effectively reduces the dependence on ERCP and its associated risks, reserving ERCP for therapeutic interventions. Equipping local healthcare centers in Ascariasis-endemic regions with the necessary resources to diagnose and treat these conditions is essential for mitigating patient suffering. This may lessen the need for travel to larger hospitals, minimising physical and financial inconveniences to the patient while also decreasing the burden on tertiary care hospitals.

Comparison of diagnostic usefulness of magnetic resonance cholangiopancreatography (MRCP) with endoscopic retrograde cholangiopancreatography (ERCP) in evaluation of patients with obstructive jaundice.

Objective: To determine the diagnostic accuracy of Magnetic Resonance Cholangiopancreatography in diagnosis of obstructive jaundice taking Endoscopic Retrograde Cholangiopancreatography as gold standard. Study Design: Cross-sectional study. Setting: Department of Radiology, Aziz Fatima Medical and Dental Hospital, Faisalabad. Period: 1st October 2022 to 31st March 2023. Material & Methods: A total number of 108 patients reported at the OPD with the obstructive jaundice confirmed with liver function tests and having indication for conducting ERCP was included in this study. MRCP was done by radiologist with a torso phased-array coil. Sequence of MRCP was planned with use of 3 plane gradient-echo localizing images. By using Single–shot fast spine echo axial slices were taken. ERCP was carried out by gastroenterologist under local or general anesthesia. Assessment was done on the basis of pathology and results were compared between the two techniques where results of ERCP were taken as reference. The primary outcomes were sensitivity, specificity and negative & positive predictive values for obstructive jaundice. Results: In this study age range was 18 to 50 years with mean age of 40.805±5.98 years and mean duration of complain was 7.259±1.72months. Female gender was dominant in this study (50.9%) followed by male (49.1%). MRCP diagnosed 58(53.7%) patients while ERCP diagnosed 55(50.9%) patients with obstructive jaundice. MRCP has shown sensitivity of 85.46%, specificity 79.24% and diagnostic accuracy by 82%, PPV 81% and NPV 84% in diagnosis of obstructive jaundice (p < 0.000). Conclusion: The non-invasive technique of MRCP provides a good and reliable diagnostic option in patients with obstructive jaundice which is comparable with invasive technique of ERCP.

The role of magnetic resonance cholangiopancreatography in evaluation of etiological spectrum of obstructive jaundice

Jaundice is a commonly encountered problem in society. Discrimination between obstructive and non-obstructive causes is important to imply surgical intervention in cases of obstructive jaundice whereas medical management in non-obstructive jaundice. Nowadays diagnostic endoscopic retrograde cholangiopancreatography (ERCP) may be replaced by Magnetic resonance cholangiopancreatography (MRCP) as it has high level of resolution and reliability. We studied the role of MRCP in obstructive jaundice to evaluate its etiological spectrums and radiological findings. To evaluate the role of MRCP in the determination of aetiologies in obstructive jaundice, to assess degree and level of biliary obstruction and to correlate MRCP findings with post surgical follow-ups / ERCP/ histopathology. Total sixty-eight patients with a clinical diagnosis of obstructive jaundice referred for MRCP were included in our study. We correlated MRCP findings with the final diagnosis made by post-surgical follow-up / ERCP/ histopathology as a gold standard. For benign lesions, overall sensitivity of MRCP was 97.73%, specificity was 95.83% with an accuracy of 97.06%. MRCP had 94.74% sensitivity, 93.88% specificity, 94.12% accuracy in the diagnosis of choledocholithiasis, and 66.67% sensitivity, 98.39% specificity, and 95.59% accuracy in the diagnosis of benign strictures. For malignant lesions, accuracy, sensitivity, and specificity of MRCP were 97.06%, 95.83%, and 97.73%. MRCP is a highly reliable, accurate, non-invasive imaging technique and has a high sensitivity for the evaluation of aetiologies of obstructive jaundice.

NJN: A Dataset for the Normal and Jaundiced Newborns

Neonatal jaundice is a prevalent condition among newborns, with potentially severe complications that can result in permanent brain damage if left untreated during its early stages. The existing approaches for jaundice detection involve invasive procedures such as blood sample collection, which can inflict pain and distress on the patient, and may give rise to additional complications. Alternatively, a non-invasive method using image-processing techniques and implementing kNN, Random Forest, and XGBoost machine learning algorithms as a classifier can be employed to diagnose jaundice, necessitating a comprehensive database of infant images to achieve a diagnosis with high accuracy. This data article presents the NJN collection, a repository of newborn images encompassing diverse birthweights and skin tones, spanning an age range of 2 to 8 days. The dataset is accompanied by an Excel sheet file in CSV format containing the RGB and YCrCb channel values, as well as the status of each sample. The dataset and associated resources are openly accessible at Zenodo website. Moreover, the Python code for data testing utilizing various AI techniques is provided. Consequently, this article offers an unparalleled resource for AI researchers, enabling them to train their AI systems and develop algorithms that can assist neonatal intensive care unit (NICU) healthcare specialists in monitoring neonates while facilitating the fast, real-time, non-invasive, and accurate diagnosis of jaundice.

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.

Multi-dimensional plasmonic coupling system for efficient enrichment and ultrasensitive label-free SERS detection of bilirubin based on graphene oxide-Au nanostars and Au@Ag nanoparticles

Rapid and sensitive detection of free bilirubin (BR) is essential for early diagnosis of jaundice and other hepatobiliary diseases. Inspired by sandwich immunoassay strategy, a multi-dimensional plasmonic coupling SERS platform composed of graphene oxide-Au nanostars nanocomposites (GANS NCs) and Au@Ag nanoparticles (NPs) was designed for label-free detection of BR. Specifically, GANS NCs were first prepared, and their excellent SERS activity was ascribed to synergistic enhancement effect of electromagnetic enhancement and chemical enhancement. Furthermore, SERS spectroscopy was used to monitor the adsorption process of BR. Subsequently, secondary reinforcing Au@Ag NPs were directly added, ultimately resulting in a multi-dimensional plasmonic coupling effect. The SERS enhancing mechanism of coupled system was discussed through electromagnetic field simulations. Interestingly, the high-density hotspots generated by strong plasmonic coupling in GANS-Au@Ag substrate could lead to more extraordinary SERS enhancing behavior compared to GANS NCs. Sensing efficiency of the SERS platform was examined by BR with a detection limit down to 10−11 M. Besides, GANS-Au@Ag NCs performed high uniformity and reproducibility. This work not only opens up a new avenue for construction of multi-dimensional plasmonic coupling system, but also offers a new biosensing technology for label-free diagnosis of BR-related diseases, thereby expecting to be applied in clinical diagnosis.

A novel ratiometric fluorescent probe for the detection of bilirubin based on the copper nanoclusters-metal organic frameworks hybrids

Bilirubin is a key biomarker in the diagnosis of jaundice. Herein, we proposed a simple and convenient quantitative method for the fluorescent detection of bilirubin. We developed a copper nanoclusters coated by zinc-based metal-organic frameworks (Cu NCs@MOF). The prepared Cu NCs@MOF exhibited bright blue fluorescence excited with ultra-violet light and well stability at various environments. More importantly, Cu NCs@MOF was used for bilirubin detection based on the emerging red fluorescence emission peak induced by bilirubin. Furthermore, Cu NCs@MOF were made into test strip for the visual detection of bilirubin by the fluorescence color variation.

Validity of Kramer Scale in Neonatal Hyperbilirubinemia

Introduction: Jaundice refers to the yellow discoloration of sclera, skin and mucous membranes. It is a common problem that is faced during the first week of life by nearly every neonate. It is important to determine whether the clinical examination can be used reliably as a clinical screening tool for the diagnosis of neonatal jaundice. The diagnostic accuracy of Kramer’s rule was compared to venous method in this study in order to provide less invasive, time consuming and less painful method of measuring neonatal hyperbilirubinemia. Objective: To determine the diagnostic accuracy of Kramer’s rule of assessing neonatal hyperbilirubinemia taking serum bilirubin as “Gold standard”. Setting: New-born nursery at Paediatric Unit, Liaquat University Hospital, Hyderabad, Sindh. Design: Cross sectional validation study. Subject and Methods: A total of 317 neonates coming under inclusion criteria presenting at new-born nursery were examined. First, baby is undressed and clinical assessment of jaundice done. Then the venous blood sample was collected for serum bilirubin level and sent to diagnostic lab. Data was collected on predetermined pro-forma. Results: The average age of the neonate was 3.51±1.55 days. Sensitivity, specificity, positive predicted value, negative predicted value and accuracy of Kramer’s Rule in detection of neonatal hyperbilirubinemia was 90.7%, 80.5%, 88%, 84.6% and 86.75% respectively. Conclusion: Our study demonstrated that the Kramer’s scale could be better choice for detection and screening of neonatal hyperbilirubinemia. It is a non-invasive and quick method that can avoid babies from getting a skin infection or other complications related to blood sampling.

The relationship between gut microbiota and neonatal pathologic jaundice: A pilot case-control study.

Neonatal jaundice is a common clinical disease in neonates. Pathologic jaundice is more harmful to neonates. There are a few studies on the biomarkers of pathologic jaundice and the correlation between gut microbiota and clinical indices. Therefore, we aimed to reveal the characteristics of gut microbiota in pathologic jaundice, provide potential biomarkers for the diagnosis of pathologic jaundice, and find the correlation between gut microbiota and clinical indices. Fourteen neonates with physiologic jaundice were recruited into a control group (Group A). Additionally, 14 neonates with pathologic jaundice were recruited into a case group (Group B). The microbial communities were analyzed using 16S rDNA sequencing. LEfSe and the differences in the relative abundance of gut microbiota were used to identify different bacteria among the two groups. The ROC curve was used to assess effective biomarkers for pathologic jaundice. Spearman's rank-sum correlation coefficient was used to evaluate the correlation between gut microbiota and clinical indices. There were no differences in the total richness or diversity of gut microbiota between the two groups. At the phylum and genus levels, compared with the control group, Bacteroidetes (p = 0.002) and Braydrhizobium (p = 0.01) were significantly higher, while Actinobacteria (p = 0.003) and Bidfldobacterium (p = 0.016) were significantly lower in the case group. Bacteroidetes were valuable in differentiating pathologic jaundice from physiologic jaundice by the ROC curve, and the area under the ROC curve (AUC) value was 0.839 [95%CI (0.648-0.995)]. In the case group, Bacteroidetes were negatively associated with total bilirubin (TBIL) (p < 0.05). In the control group, Bacteroidetes were positively associated with TBIL (p < 0.05). Bacteroidetes could be used as biomarkers to identify pathologic jaundice and Bacteroidetes are positively associated with bilirubin levels.

Limitations and Success Ratio of ERCP in the Treatment of Obstructive Jaundice

Background: Obstructive jaundice can be instigated by benign or malignant lesions. These problems are treated with biliary decompression, which can be done either endoscopically or surgically. Aim: The aim of the study is to assess the advantages and limitations as well as the therapeutic and diagnostic benefits of ERCP in the treatment of obstructive jaundice. Methods: This cross-sectional study was held in the Departments of General Surgery, Liaquat University of Medical and Health Science, Jamshoro for one-year duration from January 2022 to December 2022. A total of 70 consecutive patients were included with purposive sampling and with the diagnosis of obstructive jaundice done with ERCP. Patients with prior diagnostic or therapeutic endoscopic intervention or gastric outlet obstruction or prior gastric surgery were excluded from this study. The results are summarized in a table and conclusions are made. Results: The study included 70 patients (45 males and 25 females) with mean age of 45 years (21-70 years). The most common malignant causes of obstructive jaundice are papillary carcinoma (8.6%), cholangiocarcinoma (17.1%) and pancreatic Carcinoma (27.1%). The most common benign cause was bile duct stone (30%), followed by round warm biliary tree (5.8%) and papillary stenosis (11.4%). 30(93.8%) of patients done with stenting with 92% of success rate. Biopsies were performed to diagnose 8.6% of papillary tumors. 45.7% of patients done with stenting with 93.8% of success rate. In the remaining cases, the success rate was 100%. the most common reason for not performing ERCP; duodenal stenosis in 2.9%, abnormal papillary position in 4.3%, complete papillary obstruction in 4.3% and ampulla was not found endoscopically in 7.1% of subjects. Acute pancreatitis was the most communal complication occurred in 5.7% of cases. Bleeding occurs in 4.3% of cases; 4.3% have acute cholangitis and perforation in 2.9%. Conclusions: In spite of its complications and limitations, ERCP is a reliable stenting procedure as a palliative and tissue diagnostic tool for blockage due to malignant tumor and in the treatment of obstructive jaundice and most benign diseases. In this study, the effectiveness of ERCP in the treatment of obstructive jaundice is satisfactory. Keywords: Cholangiocarcinoma, pancreatic carcinoma, ERCP, Obstructive jaundice, and Stenting.

MATERNAL AND FETAL OUTCOMES OF JAUNDICE DURING A COMPLICATED PREGNANCY IN TERTIARY CARE HOSPITAL IN KAKINADA DISTRICT: A PROSPECTIVE OBSERVATIONAL STUDY

Background: Viral hepatitis is one of the most common and potentially serious infections that can occur in pregnant women. Liver disease in pregnancy, although rare, can seriously affect the mother and fetus. Physiological changes of a normal pregnancy can be confounding with the sign and symptoms of liver diseases. But it is an essential medical disorder because it has adverse effects on the mother and fetus like PPH, preterm labour, IUD, fetal distress, etc. This study aims to analyze the incidence, demographics, obstetric prole, and causes of jaundice in pregnancy and to know the maternal and fetal outcomes. This is an observational Materials And Methods: study conducted by the Department of Obstetrics and Gynaecology, Governments General Hospital (tertiary care hospital) Kakinada, East Godavari District, Andhra Pradesh. 54 antenatal patients with clinical/laboratory evidence of jaundice were selected for the study between January 2020 to December 2020. Results: The mean (Standard deviation) age of patients was 25.5 ± 5.4. 54 patients had jaundice during pregnancy were analysed. 77% of the patients were between 21 and 35 years old. Most cases were Primi gravida. The incidence of jaundice was 3.7%. The most common cause of jaundice was hemolysis, elevated liver enzymes, and low platelets (HELLP). The most common maternal complication was disseminated intravascular coagulation. The maternal mortality rate was eight. The majority of perinatal outcomes were preterm births. Jaundice in pregnancy has Conclusions: adverse feto-maternal consequences. Improving health awareness, education, regular prenatal examinations, and early referrals lead to early diagnosis and treatment of jaundice during pregnancy, thereby reducing maternal and fetal mortality and morbidity.