Elevated Total Bilirubin Levels Research Articles

Characteristics and prognostic analysis of simultaneous bilateral sudden sensorineural hearing loss.

To evaluate the clinical characteristics of simultaneous bilateral sudden sensorineural hearing loss (Si-BSSNHL) as well as its prognostic factors. Patients with Si-BSSNHL who were admitted to the Department of Otology Medicine between December 2018 and December 2021 were enrolled in the case group. Propensity score matching (PSM) for sex and age was used to select the control group, which included people who had unilateral sudden sensorineural hearing loss (USSNHL) during the same time period. Hearing recovery, audiological examinations, vestibular function assessments, laboratory tests, and demographic and clinical manifestations were analyzed for intergroup comparisons. Binary logistic regressions were used for both univariate and multivariate analyses of Si-BSSNHL prognostic factors. Before PSM, the Si-BSSNHL and USSNHL groups differed significantly (p < 0.05) in terms of time from onset to treatment, initial pure-tone average (PTA), final PTA, hearing gain, audiogram curve type, proportion of tinnitus, high-density lipoprotein level, homocysteine level, and effective rate. After PSM, significant differences were also observed in time from onset to treatment, initial PTA, final PTA, hearing gain, total and indirect bilirubin levels, homocysteine level, and effective rate between the two groups (p < 0.05). There was a significant difference in the classification of therapeutic effects between the two groups (p < 0.001). For prognostic analysis, the audiogram curve type was significantly different between the effective group and the ineffective groups of Si-BSSNHL (p = 0.01), in which the sloping type was an independent risk factor for the prognosis of the right ear in Si-SSNHL (95% confidence interval, 0.006-0.549, p = 0.013). Patients with Si-BSSNHL had mild deafness, elevated total and indirect bilirubin and homocysteine levels, and poorer prognosis than those with USSNHL. Audiogram curve type was linked to the therapeutic effect of Si-BSSNHL, and the sloping type was an independent risk factor for a poor prognosis in the right ear of Si-SSNHL.

Association of Liver Function Serum Markers and Unfavorable Outcomes in Traumatic Liver Injury Patients

OBJECTIVE To evaluate serum markers in liver function tests (LFT) at various intervals after traumatic liver injury to identify serum markers associated with unfavorable outcomes. METHODS A retrospective cohort analysis was conducted of trauma center patients older than 18 years with traumatic liver injury. Liver function test (LFT) results of patients with favorable and unfavorable outcomes were compared at different post-injury time points. Statistical significance was established as p-value less than 0.05. RESULTS Of the 206 patients with severe liver injuries in the unfavorable outcome group, 119 (57.8%) needed intervention. Aspartate amino-transferase (AST) and alanine transaminase (ALT) were seen to increase in correlation with injury severity at initial admission. On days 1-5 and 6-10 after admission, the unfavorable outcome group had a slower decline in AST. In the unfavorable group, total bilirubin (TB) and direct bilirubin (DB) levels rose significantly 5 days after the injury and were higher than normal with a higher odds ratio (OR) of unfavorable outcome 11-15 days after injury in multivariable analysis [OR (95% confidence intervals): 2.7 (1.02-7.37) and 6.9 (1.08-44.14), respectively]. CONCLUSIONS Liver function tests can help identify individuals at risk for traumatic liver injury complications. Elevated levels of TB and DB are statistically significantly associated with adverse outcomes, particularly after day 5 following the injury. Early repeating LFT in first five days after injury may be less beneficial in determining patient risk. Blood test results may be affected by the amount of fluid resuscitation, particularly on the first day of admission in cases of high- grade injuries. KEYWORDS aspartate aminotransferase, liver injury, liver function test, unfavorable outcome, alanine transaminase, bilirubin

Evaluation of lung function in a German single center cohort of young patients with sickle cell disease using EIT and standard techniques.

Sickle cell disease (SCD) is a very common autosomal recessive hemoglobinopathy leading to multiple pulmonary complications that are closely associated with mortality. The pathophysiology of chronic pulmonary involvement is not yet fully understood and no specific therapies are available. The aim of this cross-sectional study was to characterize the lung function of children and young adolescents with SCD in a German single-center cohort and to extend conventional lung function testing by the use of a new imaging method. We performed spirometry and body plethysmography in 35 children and young adults with hemoglobin SS, SC, S/β-thalassemia as well as 50 controls. These data were compared with clinical characteristics and typical laboratory parameters of hemolysis and disease activity in SCD. To identify lung inhomogeneities, for example due to atelectasis, hyperinflation, air trapping or vascular occlusions, we used the promising new method of electrical impedance tomography (EIT) and calculated global inhomogeneity indices. Lung function of patients with SCD was significantly reduced compared to that of healthy controls. When the result was found to be pathological, the most commonly observed type of breathing disorder was classified as restrictive. Laboratory parameters showed typical features of SCD including decreased levels of hemoglobin and hematocrit and elevated levels of leucocytes, platelets, lactate dehydrogenase and total bilirubin. However, there was no correlation between blood values and reduced lung function. Electrical impedance tomography (EIT) revealed no abnormalities in SCD patients compared to healthy controls. In particular, we were unable to demonstrate any regional inhomogeneities in lung ventilation. In our study, SCD patients showed impaired lung function, with a relevant percentage of patients suffering from restrictive breathing disorder. Signs of obstruction could not be detected. Electrical impedance tomography (EIT) measurements revealed no unevenness that would suggest air entrapment, blockage of blood vessels, excessive inflation, obstruction, or other forms of lung disease. Additionally, the reduction in lung function observed in SCD patients was not related to the disease severity or laboratory test results.

Prevention, diagnostic evaluation, management and prognostic implications of liver disease in critically ill patients with COVID-19.

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, broke out in December 2019 in Wuhan city of China and spread rapidly worldwide. Therefore, by March 2020, the World Health Organization declared the disease a global pandemic. Apart from the respiratory system, various other organs of the human body are also seriously affected by the virus. Liver injury in patients with a severe form of COVID-19 is estimated to be 14.8%-53.0%. Elevated levels of total bilirubin, aspartate aminotransferase and alanine aminotransferase and low levels of serum albumin and prealbumin are the main laboratory findings. Patients with pre-existing chronic liver disease and cirrhosis are much more prone to develop severe liver injury. This literature review presented the recent scientific findings regarding the pathophysiological mechanisms responsible for liver injury in critically ill patients with COVID-19, the various interactions between drugs used to treat the disease and the function of the liver and the specific tests providing the possibility of early diagnosis of severe liver injury in these patients. Moreover, it highlighted the burden that COVID-19 put on health systems worldwide and its effect on transplant programs and the care provided to critically ill patients in general and particularly to those with chronic liver disease.

Acute suppurative terminal cholangitis: Clinical characteristics of a new subtype of acute cholangitis

BackgroundAcute suppurative terminal cholangitis (ASTC) is rarer than acute obstructive cholangitis and is not well studied. To explore this subtype of acute cholangitis, we described our clinical experience with ASTC. MethodsWe performed a retrospective review of patients with ASTC admitted to our center from September 2014 to August 2020. We analyzed their clinical characteristics, including etiology, clinical manifestations, imaging features, treatment and prognosis. ResultsA total of 32 ASTC patients were included in the analysis. The majority of the patients had a history of biliary operations, and clinical manifestations were occult and atypical. The positive rate of bacterial culture was 46.9%. All the patients had typical imaging features on computed tomography and magnetic resonance imaging. Treatment with effective antibiotics was provided as soon as diagnosis was established. After treatment, most patients had a good outcome. Elevated levels of total bilirubin, aspartate aminotransferase, procalcitonin and gamma-glutamyltransferase were the characteristics of critically ill patients and were associated with relatively poor prognosis. ConclusionsOur results demonstrated that ASTC should be recognized as a new subtype of acute cholangitis, and that earlier diagnosis and more personalized treatments are needed.

Epidemiologic and Clinical Characteristics of Patients with Severe Fever with Thrombocytopenia Syndrome at Tertiary Hospital in Jeju for 10 years.

Severe fever with thrombocytopenia syndrome (SFTS), which was first discovered in China in 2009, is an infectious disease with a high mortality rate, particularly in East Asia. This study aimed to investigate the epidemiological and clinical characteristics and risk factors for mortality by analyzing SFTS cases accumulated for up to ten years in Jeju, Korea. Medical records of patients diagnosed with SFTS between March 2013 and August 2022 at a tertiary hospital in Jeju were analyzed retrospectively. We investigated data of patients with SFTS on the epidemiologic and clinical characteristics, laboratory findings, and administered treatments and compared the differences between fatal and non-fatal groups. We enrolled 91 SFTS-confirmed patients. The median age of patients was 62 years, and the fatality rate increased with age (P = 0.004). Fever was the most common symptom (84.6%), and diarrhea (37.4%) was also present in some cases. The overall fatality rate was 10.9%. Dyspnea (20.0% vs. 0.0%, P = 0.009) and changes in mental status (70.0% vs. 11.0%, P <0.001) were more frequent in fatal cases. Risk factor assessment revealed that a high aspartate aminotransferase /alanine aminotransferase ratio (odds ratio [OR]: 39.568, 95% confidence interval [CI]: 1.479 - 1,058.639, P = 0.028) and elevated total bilirubin levels (OR: 53.037, 95% CI: 1.064 - 2,643.142, P = 0.046) were also significantly associated with fatal cases. Plasma exchange (40.7%) was the most commonly administered treatment. SFTS has a high mortality rate; therefore, awareness of SFTS must be raised among physicians and citizens living in tick-inhabited areas, such as Jeju.

Hepatoprotective and antifibrotic effects of trans-chalcone against bile duct ligation-induced liver fibrosis in rats.

Several lines of research have shown that hepatic fibrosis is one of the leading causes of death worldwide. Trans-chalcone is a flavonoid precursor with anti-oxidant and anti-inflammatory effects. The present study was conducted to examine the antifibrotic properties of trans-chalcone on bile duct ligation (BDL)-induced liver cholestasis in rats. Following the BDL operation, trans-chalcone at doses of 12, 24, and 50 mg/kg was administered orally once a day for 45 consecutive days. Serum levels of liver indices, including alkaline phosphatase (ALP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), total and direct bilirubin, and lipid profile in addition to blood urea nitrogen (BUN) and creatinine, were measured. Additionally, catalase (CAT) and superoxide dismutase (SOD) activities were assessed in liver homogenates. Histopathological evaluations were performed using Masson trichrome (MT) and hematoxylin and eosin (H&E) staining. The elevated levels of liver enzymes, total and direct bilirubin, BUN, creatinine, cholesterol, triglyceride, and low-density lipoprotein (LDL) induced by BDL were significantly reduced following trans-chalcone administration; while serum level of high-density lipoprotein (HDL) increased. Besides, treatment with trans-chalcone elevated the activities of CAT and SOD in the liver tissues of the animals with BDL surgery. According to MT and H&E staining, BDL-induced histopathological changes, including infiltration of inflammatory cells, hepatocyte necrosis, ductal hyperplasia, and collagen deposition were ameliorated using trans-chalcone administration. It can be concluded from the present study that trans-chalcone, possibly by its anti-oxidant and anti-inflammatory properties, may exert hepatoprotective and antifibrotic effects in BDL-induced liver fibrosis.

The Frequency of Abnormally High Liver Enzymes and their Connection to Type 2 Diabetes Mellitus

Objective: The purpose of this research is to measure liver enzyme activity in Pakistani people with type 2 diabetes. Study Design: Cross sectional Place and Duration: The study was conducted in department of Pathology Women Medical&amp; Dental College Abbottabad from January 2022 to June 2022. Methods: 400 people were enlisted for the study (200 in the healthy control group I, and another 200 with type 2 diabetes). Alkaline phosphatase (ALP), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) were assessed, as was body mass index (BMI). We also checked total protein (TP), albumin, and fasting blood glucose (FBG), and we tested glycosylated haemoglobin (HbA1c). Averages and standard deviations were used to describe quantitative data, whereas frequencies were used to characterize qualitative information. Tests for associations, significance, and correlations between groups were conducted using the Pearson/Spearman correlation test, the unpaired t-test, and the Chi-squared test. Statistical significance was defined as a P-value less than.05. Each piece of information was put via SPSS 24.0 for statistical analysis. Results: Among 200 patients of Type 2 DM females were higher in numbers than males. Type 2 DM patients had a mean age of 48.8 years (SD 11.12), whereas the healthy population had a mean age of 40.6 years (SD 11.3) (P .0001). AST activity in Type 2 DM was found to be similar to that of healthy individuals (P =.060). Type 2 DM is associated with elevated levels of ALT, total bilirubin, and alkaline phosphatase when compared to healthy controls (P .0001). Hepatic enzyme levels were abnormal in 60% of those with type 2 diabetes compared to 30% of those without the disease. Conclusion: Liver function tests (LFTs) were shown to be significantly abnormal in the diabetic community as a whole, demonstrating widespread co-existing derangements. It is possible that early diagnosis and therapy might benefit from a thorough workup in such patients. Furthermore, reducing liver-related morbidity and mortality in Type 2 DM would benefit from early diagnosis and therapy of aberrant liver parameters. Keywords: Liver Hepatic pathology, Diabetes mellitus type 2, Liver function tests

Evaluation of the outcome in ischemic stroke acute period

Introduction. As a major cause of both temporary and permanent disability, ischemic stroke is the most common type of cerebrovascular accident (CVA).&#x0D; Objective. To assess fatal outcome probability in the acute period of ischemic stroke.&#x0D; Materials and methods. We performed post-hoc analysis of the fatal outcome probability in the patients with acute ischemic stroke at the Neurology Department of the Ufa Emergency Hospital, the Republic of Bashkortostan, Russian Federation. The analysis included data from the randomly selected medical records of 31 patients with fatal outcomes and 55 patients discharged with favorable outcomes.&#x0D; Results. The patients with fatal outcomes were significantly (p 0.001) older, with more severe strokes and a higher prevalence of disorders of consciousness, medical co-morbidities, and recurrent strokes as compared to the group of patients with favorable outcomes. Regression coefficients showed that brain herniation, kidney and liver disease, post-infarction cardiosclerosis, diabetes mellitus, and atrial fibrillation were associated with a higher probability of the fatal outcome. Increased severity of disorders of consciousness, NIHSS and mRS scores, specific blood tests values, age, and heart rate were associated with a more probable fatal outcome, while elevated hemoglobin, total protein, red blood cells, and lymphocytes, a higher GCS score, and a history of hypotensive drug therapy were associated with a less probable fatal outcome.&#x0D; Multivariate analysis showed that the stroke fatal outcome was related with the age, a NIHSS score, and elevated creatinine and total bilirubin levels.&#x0D; Conclusion. The detected predictors of the stroke fatal outcome can be used as reference points to choose management strategy for patients in the acute period of ischemic stroke.

Temporary Right Ventricular Assist Device Support for Acute Right Heart Failure: A Single-Center Experience

IntroductionSevere right ventricular (RV) failure is associated with significant morbidity and mortality. Although right ventricular assist devices (RVADs) are increasingly used for refractory RV failure, there is limited data on their short- and long-term outcomes. Therefore, we undertook this study to better understand our experience with temporary RVADs. MethodsWe conducted a retrospective review of all RVADS performed from 2017 to 2021. Patients supported with surgical RVADs, the Protek Duo device, and the Impella RP device were included. Patients were stratified by the type of RVAD and by etiology of RV failure. Survival was assessed by the Kaplan–Meier method and multivariable Cox proportional hazards regression models. ResultsFrom 2017 to 2021, 42 patients underwent RVAD implantation: 32 with a Protek Duo, 6 with an Impella RP, and 4 with a surgical RVAD. Majority of patients were already supported with an alternate form of mechanical support. Most patients had impaired renal function, decreased hepatic function, and lactic acidosis at the time of cannulation. The median duration of RVAD support was 8.5 [5-19] d. Survival to decannulation was 68.4%, to discharge was 47.4%, and to 1-y was 40.2%. Multivariable analysis identified elevated total bilirubin levels to be associated with 30-d mortality while increased hemoglobin levels were protective. After RVAD cannulation, the median number of pressors and inotropes was lower (P < 0.01) and the lactic acidosis was less (P < 0.01). ConclusionsIn conclusion, RVAD support is associated with lower lactate levels, and decreased number of vasoactive medications, but is associated with significant morbidity and mortality.

ANTIULCER, ANALGESIC AND HEPATOPROTECTIVE ACTIVITIES OF HYDROALCOHOLIC ROOT EXTRACT OF JURINEA DOLOMIAEA BOISS

The herb Jurinea Dolomiaea Boiss, which is a member of the Astraceae family, has long been used in Ayurveda to treat liver diseases and as an anticancer, antioxidant, and anti-diabetic. The antiulcer, analgesic, and hepatoprotective effects of Jurinea dolomiaea Boiss aqueous and hydroalcoholic root extracts against carbon tetrachloride-induced hepatotoxicity in albino wistar rats were investigated in this work. The experimental rats were given Jurinea dolomiaea root hydroalcoholic extract (100 mg/kg and 200 mg/kg p.o.) daily for seven days. By measuring SGOT, SGPT, ALP, and total bilirubin, the hydroalcoholic extract of Jurinea dolomiaea roots was examined for its hepatoprotective properties. The toxic effect of carbon tetrachloride was greatly reduced in the rats treated with the hydroalcoholic extract of Jurinea dolomiaea roots by restoring the elevated levels of SGOT, SGPT, ALP, and total bilirubin compared to the toxicant control. Jurinea dolomiaea root hydroalcoholic extract shown notable hepatoprotective effects.

Evaluation of Polyherbal preparation of Livina against Ethanol Induced Liver Dysfunction

The present study was performed to evaluate the hepatoprotective activity of ployherbal preparation of livina against ethanol-induced hepatotoxicity in rats. Four groups of adult albino wistar rats were taken for the study. Rats were divided into four groups each containing 6 animals. Group first is normal group received the normal saline 10ml/kg for 21th days. Group second negative control this group received ethanol 12ml/kg bw per day is standard dose of this group is Silymarin (100mg/kg) daily for 21th days and in 21th day administered ethanol. Group third is standard dose of this group is Silymarin (100mg/kg) daily for 21th days and in 21th day administered ethanol. Silymarin and ethanol is administered orally. Fourth group is treated with ethanol + livina (Herbal capsule). The level of Serum Glutamic Pyruvic Transaminase Test (SGPT), Serum Glutamic-Oxaloacetic Transaminase Test (SGOT), alkaline phosphatase (ALP) and total bilirubin were determined to assay hepatotoxicity. Ethanol administration caused severe hepatic damage in rats as evidenced by elevated serum SGPT, SGOT, ALP and total bilirubin levels. The polyherbal preparation of livina and silymarin administration prevented the toxic effect of ethanol. The present study concludes polyherbal preparation of livina that has significant hepatoprotective activity against ethanol induced hepatotoxicity, which may be associated with its bioactive component.

Clinical relationship between histopathological necrotic/partial necrotic findings and disease condition of gallbladder mucoceles in dogs.

Gallbladder mucocele (GM) is a common extrahepatic biliary disease recognized in dogs and is defined as the expansion and extension of the gallbladder by an accumulation of semi-solid bile or bile acid. Histopathological diagnosis of necrotizing cholecystitis and transmural coagulative necrosis of the gallbladder wall shows poor prognosis. Conversely, histopathological diagnosis with partial necrotic findings is often achieved. We hypothesized that histopathological partial necrosis of the gallbladder wall is the primary lesion of necrotic cholecystitis or transmural ischemic necrosis. Therefore, we investigated the relationship between histopathological necrosis/ partial necrosis findings and their clinical conditions. We retrospectively analyzed 55 dogs diagnosed with GM that had undergone cholecystectomy at the Yamaguchi University Animal Medical Center. The group with histopathological necrosis/partial necrosis of the gallbladder wall showed elevated levels of preoperative white blood cells, alanine transaminase, alkaline phosphatase, γ-glutamyltransferase, total bilirubin, and C-reactive protein compared to the non-necrotic group. Partial necrosis of the gallbladder wall may affect the progression of the disease and hematological abnormalities. Additionally, all death cases until 2 weeks were included in the histopathological necrosis/partial necrosis group. In this study, we found that poor prognosis factors were associated with partial necrosis of the gallbladder wall. Furthermore, these cases of partial necrosis showed elevated levels of blood test parameters. These results suggest that necrosis of the gallbladder wall is associated with poor prognosis and poor pathophysiological conditions.

Definition and classification of acute-on-chronic liver diseases.

Patients with chronic liver diseases (CLDs) develop acute liver injury and/or acute decompensation under the attack of various precipitants and present with significantly elevated alanine aminotransferase and/or total bilirubin levels, liver failure, or acute decompensation of liver cirrhosis, which is called acute-on-CLD (AoCLD). AoCLD accounts for the majority of patients hospitalized in the Department of Hepatology or Infectious Diseases. AoCLD is complicated by various clinical types, the severity of the disease, and may pose a high risk of death. To date, the definition of AoCLD is still vague, and a consensus concept of the clinical classification is lacking. This review aimed to define the concept and clinical types of AoCLD based on related studies and the literature.

Treatment practices and implementation of guidelines for hyperbilirubinemia and rebound hyperbilirubinemia.

Hyperbilirubinemia (HB), defined as elevated total serum bilirubin (TSB) levels, commonly affects neonates and requires prompt treatment to prevent neurological complications. Up to 10%of neonates experience rebound hyperbilirubinemia (RHB), requiring re-initiation of treatment. Unfortunately, treatment guidelines lack practical recommendations surrounding subthreshold phototherapy, treatment termination, and RHB investigations. We examined local management practices for HB and RHB treatment in a well newborn nursery. As a secondary aim, we investigated the association between treatment practices and RHB rates. Retrospective chart review identified neonates treated for hyperbilirubinemia between January 2015 and December 2019 during their birth hospitalization at a tertiary care centre. Standardized data collection sheets were used to record treatment parameters. Over the 5-year period, there were 9683 births and 305 (3.15%) neonates received phototherapy. Of the treated cases, 20-25%were subthreshold to practice guideline values. Upon treatment termination 25-55%of cases had TSB levels within 3 mg/dL, which may increase the risk of RHB. In our cohort, 20.3%of treated cases experienced one episode of RHB and 3.9%experienced two episodes of RHB. Although clinicians evaluated neonates for RHB 0-12 hours following treatment termination prior to discharge, many cases were identified in outpatient settings and required re-admission for phototherapy. When managing HB and RHB, treatment practices such as when to terminate treatment in relation to threshold values, and timing of RHB investigations, are largely inconsistent amongst clinicians. Future studies are required to better understand the landscape of hyperbilirubinemia treatment beyond initiation of phototherapy.

Risk Factors for Prognosis after the Maze IV Procedure in Patients with Atrial Fibrillation Undergoing Valve Surgery

The present study evaluated risk factors related to persistent atrial fibrillation (AF) at discharge (AF-d) and recurrent atrial fibrillation (rAF) and all-cause death after the maze IV procedure. Two hundred nineteen patients (63 female, aged 52.5±8.8 years) with valve disease and persistent AF undergoing valve surgery and the maze IV procedure in our center between 2015 and 2016 were included. Baseline demographic and clinical data were obtained by review of medical records. The median follow-up period was 27 months (interquartile range 21–34 months) in our patient cohort. The primary end point was all-cause death. The secondary end point was AF-d or rAF. rAF is defined as AF recurrence at 3 months or later after the procedure. Twenty-eight patients (12.8%) died during follow-up. Multiple logistic regression analysis showed that thrombocytopenia, elevated serum total bilirubin level, a larger right atrium, AF-d, and rAF were independent determinants for all-cause death after the maze IV procedure after adjustment for age, sex, and clinical covariates, including New York Heart Association class III/IV disease, hypertension, and aortic regurgitation, while valvular disease duration and left atrial diameter greater than 80.5 mm were independent determinants for AF-d, and thrombocytopenia, elevated serum total bilirubin level, higher mean pulmonary artery pressure, and AF-d were independent predictors for rAF. In conclusion, thrombocytopenia, elevated serum total bilirubin level, an enlarged right atrium, AF-d, and rAF are independent predictors of all-cause death in patients undergoing the maze IV procedure.

Serum bilirubin as a predictor of complications of acute appendicitis in adults

Introduction: Acute appendicitis is a very common cause of acute abdomen and the diagnosis is essentially clinical. A decision to operate based on clinical suspicion alone can result in removal of a normal appendix; whereas, if left untreated, appendicitis can result in necrosis and perforation. Therefore, improving the diagnostic accuracy of appendicitis is a need of the hour. This study was conducted to evaluate hyperbilirubinaemia in acute appendicitis to find out its predictive value in complications like perforation. Materials and Methods: This prospective study for diagnostic test evaluation was conducted amongst the inpatients in the Department of General Surgery, KIMSHEALTH Trivandrum, during the period from August 2019 to August 2020. A total number of 100 patients who were admitted with the clinical diagnosis of acute appendicitis were studied, and serum bilirubin and liver function tests were carried out in all of them. Results: Total bilirubin levels when compared with histopathological diagnosis by unpaired samples t-test, the t-value = 0.763, P = 0.447 > 0.05 which shows no statistically significant difference between total bilirubin levels in uncomplicated and complicated acute appendicitis based on histopathological diagnosis. Sensitivity is 81.8%; specificity is 29.2%; positive predictive value (PPV) is 12.5%; negative predictive value (NPV) is 92.9%. Conclusion: Elevated total serum bilirubin levels have a fairly high sensitivity and NPV in predicting complications of acute appendicitis, but the specificity and PPV are quite low, and hence, hyperbilirubinaemia could be used as an aid in diagnosing complicated acute appendicitis along with the clinical findings and ultrasonography findings, but it is not reliable as a standalone diagnostic test. If the total serum bilirubin levels are low, an alternate diagnosis could be suspected, and the chances of complicated appendicitis are quite low, but elevated serum bilirubin values alone cannot confirm the presence of complications. Therefore, our study could not find any correlation between the absolute levels of elevation of total bilirubin values and the presence or absence of complications in acute appendicitis.

A patient with Rotor syndrome and coronary artery disease: is it a coincidentalor related?

Rotor syndrome is a rare, benign and inherited cause of chronic hyperbilirubinemia. Several studies have provided evidence that elevated bilirubin level has cardioprotective benefits with reduction in the severity of coronary artery disease (CAD). However, current evidence is inconclusive regarding the protective effect of bilirubin on CAD. A57-year-old male with a history of chronic jaundice since childhood, presents tothe Gastroenterohepatology clinic ofDr. Soetomo Hospital with CAD Triple Vessel Dissease pro urgent CABG. Physical examination revealed icteric sclerae without hepatosplenomegaly. The patient suffered from hypertension and dyslipidemia for 10 years. He had an elevated total bilirubin level of 5.92 mg/dL with a direct bilirubin of 4.02 mg/dL (68% of total bilirubin), with normal aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase (ALP) levels. An evaluation for chronic liver disease revealed negative hepatitis serologies, anti-smooth muscle antibody, antinuclear antibodyand antimitochondrial antibody as well as normal. BSP clearance test results show a delay. Abdomencomputed tomography (CT) scan showed normal without any biliary dilation. The liver biopsy was normal with no hepatocellular pigment. A patient with chronic jaundice symptoms has been reported who is later diagnosed as Rotor syndrome. The patient also suffered from CAD. The protective effects of bilirubin are not proven in this patients.

Case Report: Management and Outcomes of COVID-19 in a Patient with Cirrhosis of Liver

Introduction: The outbreak of coronavirus disease 2019 (COVID-19) has recently become a major problem affecting thousands of individuals around the world. It is understood that a significant proportion of patients infected with COVID-19 have disturbed liver function tests. This is a case report of a patient with liver cirrhosis and COVID-19.&#x0D; Presenting Complaints and Investigations: A 39 year old female patient was admitted in AVBRH on 06/02/2021 with chief complaint of distension of abdomen, breathlessness, shortness of breath, reduced urine output over last 3 months. She had skin lesions over the hand, foot, abdomen and back with itching since 4 months. Physical examination, blood investigations and abdominal ultrasound showed cirrhosis of liver with gross ascites seen clinically. She had mild splenomegaly and gall bladder was enlarged. Laboratory tests showed elevated total bilirubin level. In peripheral blood examination, RBC count was low (3.66m/cu mm), Haemoglobin level was 8.2 gm/dl, Platelets count was low (1.19 lakh per cu. mm). WBC count was 3600 cu mm. Doctor diagnosed this as the case of cirrhosis of liver with pemphigus vulgaris with COVID-19.&#x0D; Past History: 6 months ago, patient was admitted in Aarogyadham hospital Yawatmal with chief complaint of abdominal pain, loss of appetites, fever. On ultrasonography, she had splenomegaly for which she took the treatment.&#x0D; The Main Diagnosis, Therapeutic Intervention and Outcomes: This case was diagnosed as a case of COVID-19 with Cirrhosis of liver. Interferon alpha 2b solution was given for 10 days to help improve the immunity. Tab. Ursoldiolis (ursodeoxycholic acid) was used to dissolve gallstones.&#x0D; Conclusion: Good clinical assessment, appropriate care, good nursing care by trained nurses and appropriate treatment can save lives even in complicated COVID-19 infected cases.

Alterations in gut microbiota and elevated serum bilirubin in primary biliary cholangitis patients treated with ursodeoxycholic acid.

The prognosis of primary bile cholangitis (PBC) is linked to gut microbiota dysbiosis. This study investigated the association between the gut microbiome and elevated total bilirubin (TB) level in PBC patients treated with ursodeoxycholic acid (UCDA). A total of 47PBC patients with 12months of UCDA treatment were enrolled. Patients were divided into the TB (+) (TB>1× upper limit of the normal range [ULN]; n=20) and TB(-) (TB≤1× ULN; n=27) groups. Stool and serum specimens were collected, and microbiota composition and functional characteristics in the 2groups were evaluated by 16S RNA gene sequencing and bioinformatic analysis. Bacterial diversity was lower in the TB(+) group than in the TB(-) group, although there was no significant difference in bacterial community profile. The phylum Saccharibacteria showed differential abundance in the 2groups. Meanwhile, the TB(-) group had lower abundance of the Gemmiger, Blautia, Anaerostipes and Coprococcus genera than the TB(+) group, whereas Holdemania was absent. The abundance of Gemmiger formicillis and Coprococcus eutactus was positively correlated with that of Faecalibacterium prausnitzii, while Blautia, Anaerostipes and Coprococcus were negatively correlated with total bile acid level. TB level in PBC patients treated for 12months with UCDA is associated with a distinct gut microbiome profile.