Higher Serum Bilirubin Levels Research Articles

Comparison of post-hepatectomy long-term survival outcome between non-colorectal non-neuroendocrine and colorectal liver metastases: A population-based propensity-score matching analysis

BackgroundHepatectomy is an established treatment for colorectal liver metastasis (CLM) or neuroendocrine liver metastasis. However, its role in non-colorectal non-neuroendocrine liver metastasis (NCNNLM) is controversial. This study aims to compare long-term survival outcomes after hepatectomy between NCNNLM and CLM in a population-based cohort. MethodsFrom 2009 to 2018, curative hepatectomy were performed in 964 patients with NCNNLM (n ​= ​133) or CLM (n ​= ​831). Propensity score (PS) matching was performed. Short-term and long-term outcomes were compared between PS-matched groups. Univariate and multivariate analyses were performed to identify prognostic factors affecting survival. ResultsThere were 133 patients in the NCNNLM group and 266 patients in the CLM group. The mortality (1.5 ​% vs 1.5 ​%) and morbidity (19.5 ​% vs 20.3 ​%) rates were comparable between the two groups. There was no statistically significant difference in 5-year overall (48.9 ​% vs 39.8 ​%) and recurrence-free (25.1 ​% vs 23.4 ​%) survival rates between NCNNLM and CLM groups. A high pre-operative serum bilirubin level, severe postoperative complications and multiple tumors were independent prognostic factors for poor survival. ConclusionHepatectomy for selected patients with NCNNLM can achieve similar long-term oncological outcomes as those with CLM. High serum bilirubin, severe postoperative complication and multiple tumors are poor prognostic factors for survival.

Relationship between bilirubin and systemic lupus erythematosus: A systematic review and meta-analysis.

Systemic lupus erythematosus (SLE) is an autoimmune disease with a high prevalence worldwide. This study aimed to examine the correlation between serum bilirubin levels and SLE. The Cochrane library, Embase, PubMed, and China National Knowledge Infrastructure (CNKI) databases were examined and assessed until March 2023. RevMan 5.3 software was utilized for the analysis of clinical trails. Five case-control studies were chosen and incorporated, examining the levels of serum bilirubin in patients with SLE compared to healthy individuals, as well as in active SLE patients versus inactive ones, in different sexes and in SLE patients with or without lupus nephritis (LN). The results of this meta-analysis demonstrated that serum bilirubin in healthy individuals were obviously increased compared to SLE patients (MD = 4.76; 95% CI, 3.15-6.38, p < .00001). Additionally, inactive SLE patients had higher levels of bilirubin than active SLE patients (MD = 3.15; 95% CI, 0.46-5.84, p = .02), and SLE patients without lupus nephritis had higher levels of serum bilirubin than those with lupus nephritis (MD = 4.91;95% CI, 2.87-6.95, p < .00001). Nevertheless, there were no disparities observed among SLE patients of varying sexes (MD = 0.34; 95% CI, -0.01 to 0.69, p = .06). The concentration of serum bilirubin may potentially be used as an indicator for estimating the advancement of SLE and reflecting the presence of kidney complications in individuals with SLE. Furthermore, more high quality studies were needed to identify these findings.

The role of high serum bilirubin as a predictor of complicated appendicitis: a retrospective cohort study

Introduction: An appendectomy is one of the most common emergency surgeries. The delay in diagnosis and treatment of appendicitis can lead to complicated appendicitis. The definitive predictive factor that can diagnose complicated appendicitis is still lacking. The authors aim to assess the role of high serum bilirubin level as a predictor of complicated appendicitis. Methods: A retrospective cohort study was conducted among patients with acute appendicitis (AA) between March 2017 and March 2018. Appendicitis cases diagnosed with the help of the Alvarado score undergoing surgery were taken in study and based on the histopathological report, the cases were classified into two groups: uncomplicated and complicated. Preoperatively, biochemical parameters like increased white blood cell count (&gt;11000/cubic millimeter), and level of serum bilirubin &gt;1.4 mg/dl were studied. Informed written consent for the study was taken from the patients with AA. A χ 2 test was applied for the association between categorical variables. Statistical analysis was done with a statistical package for the social sciences (SPSS) version 20; P-value less than 0.05 was considered statistically significant. Results: A total of 100 patients were enrolled in the study with a mean age of 31.2±18.3 years, and 60% were male. Seventy-four (74%) had uncomplicated appendicitis and 26 (26%) had complicated appendicitis. Mean bilirubin was 1.2±0.8 mg/dl in uncomplicated and 1.8±0.8 mg/dl in complicated groups (P &lt;0.05). The sensitivity and specificity of hyperbilirubinemia as a predictor of complicated appendicitis were 50 and 78.38%, respectively. Conclusion: The study revealed that patients with AA and a higher serum bilirubin level have a higher risk of having complicated appendicitis. Serum bilirubin level helps to predict complicated appendicitis and thus plan for timely and appropriate management. Thus, the study concludes that bilirubin should be used together with clinical examination and other laboratory investigations in the assessment of patients with suspected AA.

Faktor-Faktor Yang Berhubungan Dengan Kejadian Ikterus Pada Bayi Baru Lahir Di Rsia Budhi Asih Purwokerto Tahun 2021

Neonatal jaundice is a complication of infection in newborns which is characterized by high serum bilirubin levels of &gt;5 mg/dL. The incidence of jaundice in newborns can cause several problems in infants so it is necessary to properly and correctly manage jaundice in newborns through a systematic management approach taking into account the risks and influencing factors. The aim of this study was to determine the factors that influence the incidence of jaundice in newborns at RSIA Budhi Asih Purwokerto in 2021. This research is an analytical survey study with a retrospective approach. The sampling technique was total sampling with a total of 227 medical record data for all newborns with hyperbilirubinemia at RSIA Budhi Asih in 2021. The research instrument used a checklist sheet. The results showed that the characteristics of jaundice in newborns based on the degree of kern were mostly in the IV category (63%), the factor of the type of delivery with jaundice had a p-value of 0.707, the factor of birth trauma with jaundice had a p-value of 0.394, the factor of gestational age with the incidence of jaundice has a p-value of 0.000, the factor of birth weight with the incidence of jaundice has a p-value of 0.000 and the factor of history of asphyxia with the incidence of jaundice has a p-value of 0.028

STUDY TO KNOW THE EFFECT OF PHOTOTHERAPY ON SERUM CALCIUM LEVEL IN NEONATAL HYPERBILIRUBINEMIA

Background: Phototherapy is the most common method to treat neonatal jaundice. The effect of phototherapy on serum calcium levels is a questionable issue. Objective: To study to know the effect of phototherapy on serum calcium level in neonatal hyperbilirubinemia. Methods: Cohort study compared total serum calcium level before and after phototherapy in neonates with hyperbilirubinemia. Study was conducted on 54 neonates with high total serum bilirubin levels, according to the Bhutani curve and was treated with phototherapy at neonatal intensive care unit in the Department of Pediatrics at Mayo Institute of Medical Sciences from November 2021 to April 2022. Results: Hypocalcaemia was observed in 33.33% of neonates after phototherapy. The difference between pre- and post-phototherapy serum calcium levels was found to be statistically significant (p&lt;0.005). Conclusion: Hypokalcemia has a significant association with phototherapy.

Serum total bilirubin level is associated with contrast induced nephropathy after primary percutaneous coronary intervention.

Contrast Induced Nephropathy (CIN) is a major complication of angiographic procedures. Primary percutaneous coronary intervention (pPCI) is the preferred treatment for ST-segment elevation myocardial infarction (STEMI) but is associated with a risk of CIN. Oxidative stress and free radical damage play a role in the pathogenesis of CIN. Bilirubin has anti-inflammatory and antioxidant activity and has been shown to have a protective effect on endothelial cells. The present study aimed to assess the association between serum bilirubin level and development of CIN after pPCI. Sequential STEMI patients (n = 595) who underwent pPCI between January 2021 and December 2022 were enrolled. Among the participants, 116 (19.5%) developed CIN. Serum total bilirubin level was significantly lower in the CIN group (P = .001). In multivariate logistic regression analysis, serum bilirubin level was found as an independent predictor of CIN. Age, gender, contrast volume, and white blood cell count were other independent predictors of CIN. A higher serum bilirubin level is associated with a lower risk of CIN in the present study. In STEMI patients undergoing pPCI, serum bilirubin level may be helpful to predict the risk of CIN and may help ensure early initiation of preventive treatment and careful follow-up.

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.

Higher serum bilirubin levels are associated with hemorrhagic transformation after intravenous thrombolysis in acute ischemic Stroke.

Bilirubin has both antioxidative and prooxidative properties. The study aimed to explore the relationship between serum bilirubin and hemorrhagic transformation (HT) after intravenous thrombolysis in patients with acute ischemic stroke. The patients receiving intravenous thrombolysis with alteplase were retrospectively analyzed. HT was defined as new intracerebral hemorrhage in follow-up computed tomography images within 24-36 h after thrombolysis. Symptomatic intracranial hemorrhage (sICH) was defined as HT accompanied by worsening neurological function. Multivariate logistic regression and spline regression models were performed to investigate the relationship between serum bilirubin levels and the risk of HT and sICH. Among 557 included patients, 71 (12.7%) were diagnosed with HT and 28 (5.0%) developed sICH. Patients with HT had significant higher baseline serum total bilirubin, direct bilirubin, and indirect bilirubin levels than those without HT. Multivariable logistic regression analysis indicated that patients with higher serum bilirubin levels, including total bilirubin (OR 1.05, 95% CI 1.01-1.08, p = 0.006), direct bilirubin (OR 1.18, 95% CI 1.05-1.31, p = 0.004), and indirect bilirubin (OR 1.06, 95% CI 1.02-1.10, p = 0.005) had increased risk of HT. Furthermore, multiple-adjusted spline regression models excluded nonlinear association between serum bilirubin levels and HT (p > 0.05 for nonlinearity). Similar results were present between serum bilirubin and sICH. The data showed the positively linearly relationship between serum bilirubin levels and the risk of HT and sICH in patients with acute ischemic stroke undergoing intravenous thrombolysis.

Health implications of pesticides application among cocoa farmers in Idanre local government area, Southwest Nigeria

Pesticides are routinely applied by cocoa farmers to enhance cocoa production, which is threatened by pest infestations and diseases. However, the undesired health implications of pesticide applications on the farmers are yet to be fully elucidated especially among cocoa farmers in Idanre despite being the hub of cocoa production in Southwestern Nigeria. This study assessed the extent of pesticide use by cocoa farmers in the study area and determined the effects of exposure on their health using haematological and biochemical parameters as indices. A cross-sectional survey comprising 150 cocoa farmers and 50 controls (artisans) was carried out using structured questionnaire. Blood samples were obtained from participants for the determination of copper and sulphate levels, haematological (haematocrit, red blood cell counts, white blood cell counts and platelet counts) and biochemical (creatinine, cholesterol, direct bilirubin and total bilirubin) parameters. The blood levels of copper and sulphate were significantly higher in the cocoa farmers than in the controls. However, there was no significant difference between the subjects and controls for most of the haematological and biochemical parameters except for the platelet counts and total bilirubin levels. The data from the study did not suggest any serious health effects due to pesticide exposure on the cocoa farmers despite the high blood levels of copper and sulphate, probably due to exposure to copper-based fungicides. However, the high serum bilirubin level among the subjects was an indication of possible liver damage. As such, cocoa farmers should be guided against indiscriminate use of pesticides on their farms.

Prevalence of theDirect Antiglobulin Test and Its Clinical Impact on Multiply Transfused Thalassemia Patients: AProspective Study Conducted at aTertiary Care Center in Northern India.

This study was conducted to estimate prevalence of direct antiglobulin test (DAT) positivity and its impact on transfusion support in patients with thalassemia. The DAT testing was performed for patients with β-thalassemia who received transfusion from November 2021 to March 2022. Elution was done for DAT-positive samples. Of 180 patients, 21 (11.6%) were DAT positive. Immunoglobulin G (IgG) was present in 4 (19%) and IgG+C3d was present in 8 (38%). Only complement was present in 9 (42.8%) patients. The IgG-reactive DATs were associated with pan-reactive eluate. Patients who were DAT-positive had significantly higher levels of serum bilirubin, ferritin, and IgG than those who were DAT-negative. Autoantibody formation in multiply transfused thalassemia patients is common and merits equal attention as alloimmunization. It is particularly important as DAT-positive red bloodcells may undergo clinically significant hemolysis, which may increase the transfusion requirements with associated sequalae such as increased serum ferritin and splenomegaly.

Hidden appendix: A case report and literature review of perforated acute appendicitis masquerading as acute cholecystitis.

IntroductionAcute appendicitis of the subhepatic appendix is uncommon, and a preoperative diagnosis is difficult without a thorough understanding of the various anatomical locations. Cross-sectional imaging is indispensable for prompt diagnosis and subsequent treatment. Surgery is the standard treatment for perforated appendicitis in the subhepatic region. In this study, we present a case of subhepatic appendicitis with an unusual presentation.Case presentationA 28-year-old man presented to our emergency department with a 3-day history of diffuse right abdominal discomfort, diarrhea, fever, and vomiting. Physical examination revealed rebound soreness and guarding in the right upper and lower quadrants. Laboratory tests revealed high levels of C-reactive protein and serum bilirubin and neutrophilic leukocytosis. Abdominal computed tomography revealed an undescended cecum and a subhepatic appendix with an intraluminal appendicolith, fat stranding, and peri-appendiceal fluid. The patient underwent open exploration and appendicectomy, during which the subhepatic perforated appendix was excised. The patient's recovery was uneventful.DiscussionAtypical presentations may indicate an unusual anatomical placement of the appendix. Preoperative diagnosis using cross-sectional computed tomography imaging and a thorough understanding of these situations frequently result in early diagnosis and expeditious surgical care.ConclusionSurgical crises resulting from aberrant anatomical variations of the appendix constitute a distinct diagnostic challenge. A strong index of suspicion for this uncommon presentation permits early surgical intervention and prevents delay-induced morbidity/mortality.

Is Bilirubin Associated with the Severity of Ischemic Stroke? A Dose Response Meta-Analysis.

There is no consensus on the role of bilirubin in acute ischemic stroke. Higher levels of serum bilirubin may provide a treatment advantage in oxidative-stress-mediated diseases but also may simply reflect the strength of the oxidative stress. As of 28 February 2022, the relevant studies were selected from four databases (PubMed, Web of science, Cochrane, and CNKI) through a retrieval strategy, and strict literature screening and quality evaluation were carried out. The dose–response relationship was fitted with a restricted cubic splines function. We found that the serum total bilirubin level and the direct bilirubin level were positively correlated with the severity of ischemic stroke. The direct bilirubin level was linearly correlated with the severity of stroke (P for non-linearity = 0.55), and the direct bilirubin increase of 1 μmol/L may be related to the 1% increase in the possibility of having moderate or severe ischemic stroke. High bilirubin levels are associated with stroke severity in patients with ischemic stroke and may serve as a marker of the intensity of initial oxidative stress.

Spontaneous Ascitic Fluid Infection: Are we Experiencing an Epidemiological shift in Causative Organisms?

Spontaneous ascitic fluid infection (SAI) is common in cirrhotic patients leading to significant morbidity and mortality. Third-generation cephalosporins are currently recommended as first-line therapy. This is a retrospective observational study that aims to determine bacterial etiology, susceptibility patterns of SAI, and its correlation with model for end-stage liver disease-sodium (MELD-Na) and Child-Turcotte-Pugh (CTP) score. The present study was conducted on 274 consecutive cases admitted in Bombay Hospital and Medical Research Centre, Mumbai, India. Cases of cirrhosis (irrespective of etiology) with ascites between the ages of 18-85 years were included in this study. Ascitic fluid of every patient was aspirated under all aseptic measures and was sent for biochemical, culture, and cytological analysis. Of the 274 patients studied, 34 (12.4%) patients were diagnosed to have SAI. Culture-negative neutrocytic ascites (CNNA) was present in 27 patients, spontaneous bacterial peritonitis (SBP) was present in six patients, and monomicrobial bacteriascites was seen in one patient. Mean age of patients enrolled was 56.05 ± 2.47 years. Eighty-two percent were males and 18% were females. Alcohol (45.45%) was the leading cause of cirrhosis followed by nonalcoholic steatohepatitis (NASH) related cirrhosis (26.47.7%) and hepatitis C virus (HCV) related cirrhosis (11.46%) and cryptogenic cirrhosis (8.82%). Average MELD-Na score was 25 and the CTP class C was most common. Klebsiella pneumoniae was the most commonly isolated organism followed by Escherichia coli. The various factors that predispose to development of SBP include low ascitic fluid protein concentration, a high level of serum bilirubin, deranged serum creatinine, high Child-Pugh score, and high MELD-Na score. Ascitic fluid analysis remains the single most important test for identifying and assessing a course of SBP. Early diagnosis and treatment will reduce the mortality rate in these patients.

Predictors of mortality and morbidity in critically ill COVID-19 patients: An experience from a low mortality country.

Background and AimsClinical characteristics and factors associated with mortality in patients admitted to the intensive care unit (ICU) in countries with low case fatality rates (CFR) are unknown. We sought to determine these in a large cohort of critically ill COVID‐19 patients in Qatar and explore the early mortality predictors.MethodsWe retrospectively studied the clinical characteristics and outcomes in patients admitted to the ICU at the national referral hospital for COVID‐19 patients in Qatar. Logistic regression analysis was used to determine factors associated with mortality.ResultsBetween March 7 and July 16, 2020, a total of 1079 patients with COVID‐19 were admitted to the ICU. The median (IQR) age of patients was 50 (41–59) years. Diabetes (47.3%) and hypertension (42.6%) were the most common comorbidities. In‐hospital mortality was 12.6% overall and 25.9% among those requiring mechanical ventilation. Factors independently associated with mortality included older age ([OR]; 2.3 [95% CI; 1.92–2.75] for each 10‐year increase in age, p < 0.001), chronic kidney disease (OR; 1.9 [95% CI; 1.02–3.54], p = 0.04), active malignancy (OR; 6.15 [95% CI; 1.79–21.12], p = 0.004), lower platelet count at ICU admission (OR; 1.41 [95% CI; 1.13–1.75] for each 100 × 103/µl decrease, p = 0.002), higher neutrophil‐to‐lymphocyte ratio at admission (OR; 1.01 [95% CI; 1–1.02] for each 1‐ point increase, p = 0.016), higher serum ferritin level at admission (OR; 1.05 [(95% CI; 1.02–1.08] for each 500 µg/L increase, p = 0.002), and higher serum bilirubin level at admission (OR; 1.19 [95% CI; 1.04–1.36] for each 10 μmol/L increase, p = 0.01).ConclusionsThe mortality rate among critically ill COVID‐19 patients is low in Qatar compared to other countries. Older age, chronic kidney disease, active malignancy, higher neutrophil‐to‐lymphocyte ratios, lower platelet counts, higher serum ferritin levels, and higher serum bilirubin levels are independent predictors of in‐hospital mortality.

Correlation Between Peak Serum Bilirubin During 1st Week of Life and Future Neurodevelopmental Outcome in Healthy Term Babies

Study was done to look for the future neurodevelopmental outcome of the babies with extremely high serum bilirubin level at 1st week of life. Fifty one term and near term babies were enrolled with features of acute bilirubin encephalopathy (ABE), with bilirubin level more than20mg/dl. They were followed up at 3rd and 6th month to observe their neurodevelopment. Neurological outcome was measured with Denver Development Screening Test (DDST-II) and brainstem evoked response audiometry (BERA). The mean peak total serum bilirubin (TSB) was 25.3±2.35(mg/dl). Abnormal developmental was found in 23.5% babies (12 out of 51) and abnormalities were more in the babies whose TSB was beyond 28mg/dl. Abnormal BERA was found among 13.7% babies. TSB value below 25 mg/dl can be considered as safe cut off value for reversibility of bilirubin induced acute brain damage.

RECONSTRUCTIVE SURGERY IN PATIENTS WITH MALIGNANT DISEASES OF THE BILIARY TRACT COMPLICATED BY MECHANICAL JAUNDICE

The causes of mechanical jaundice (MJ) are benign and malignant diseases of the hepaticopancreaticoduodenal area. Literature sources indicate the development of MJ in 15-40 % of patients with gallstone disease and in the vast majority of patients with malignant neoplasms of the biliary tract. MJ of malignant etiology occurs in 40-67 % of patients.&#x0D; Aim. To study the results of the use of reconstructive surgery in patients with malignant diseases of the biliary tract complicated by mechanical jaundice.&#x0D; Materials and methods. An analysis of surgical treatment of 22 patients with malignant diseases of the biliary tract complicated by MJ in the SI “ V.T. Zatsev IGUS NAMSU ». Patients are divided into subgroups. Subgroup 1 - 11 (50 %) included patients treated with antegrade endobiliary interventions as biliary decompression. Subsequently, the reconstructive and restorative stage of surgical treatment was performed. Subgroup 2 - 11 (50 %) included patients who underwent reconstructive surgery without prior biliary decompression.&#x0D; Results of the research. After successful biliary decompression, 11 (50 %) patients underwent reconstructive surgery, which was included in 1 subgroup. The remaining 11 (50 %) patients in subgroup 2 underwent similar surgery without prior biliary decompression. In patients of subgroup 1 (n = 11 (50 %)) we performed percutaneous transhepatic cholangiodrainage for biliary decompression and MJ resolution. After its successful implementation, the reconstructive and restorative stage of surgical treatment was performed. This reduced the number of postoperative complications from 18.2 % to 9.1 % compared with subgroup 2 of patients who underwent surgery without prior biliary decompression.&#x0D; Conclusions. Performing reconstructive and reconstructive operations in conditions of high levels of serum bilirubin, cholangitis, hepatic failure is dangerous and is accompanied by a large number of complications in the postoperative period. In patients who underwent antegrade endobiliary interventions as a previous biliary decompression, complications were noted in 2 (18.2 %) cases and mortality was 9.1 % (1 patient), which reduced the number of postoperative complications by 9.1 % and mortality by 9.1 %. This is confirmed by studies that prove the benefits of antegrade endobiliary interventions in the preparation of patients for reconstructive surgery in comparison with their performance without the use of the latter.

Impact of Prior Drug Allergies on the Risk, Clinical Features, and Outcomes of Idiosyncratic Drug-Induced Liver Injury in Adults.

Prior drug allergies are common and may increase susceptibility to adverse medication effects. The aim of this study was to compare the frequency, clinical features, and outcomes of DILI among patients with and without a history of prior drug allergy. The EMR at a large liver referral center was searched for all DILI encounters using ICD-10T-codes for drug poisoning/toxicity and K-71 codes for toxic liver injury between 10/1/2015 and 9/30/2019. Clinically significant liver injury was identified using predefined laboratory criteria, and cases were adjudicated using a 5-point expert opinion scale: 1/2/3 = probable DILI and 4/5 = non-DILI. Drug allergy was defined as a history of anaphylaxis, hives, rash, or pruritus after drug exposure. Among 766,930 patient encounters, 127 unique patients met inclusion criteria with 72 (56.7%) cases adjudicated as probable DILI and 55 (43.3%) as non-DILI. In the probable DILI group, the most frequent suspect drug classes were: antimicrobials (41.9%), herbal and dietary supplements (9.5%), and antineoplastics (8.1%). Twenty-three of the 72 DILI patients (31.9%) had a history of drug allergy before the DILI episode compared to 16 (29.1%) of the 55 non-DILI cases (p = 0.89). However, none of the allergy drugs and suspect DILI drugs were the same although many were in the same drug class. DILI patients with a prior drug allergy were more likely to be female (73.9% vs. 44.9%, p = 0.04) and have lower serum bilirubin (4.0 vs. 7.8, p = 0.08) and INR (1.1 vs. 1.6, p = 0.043) levels at presentation. The likelihood of death or liver transplantation among probable DILI cases with prior drug allergy was lower than those without prior drug allergy (0% vs. 8.2%, p = 0.35). The suspect drug was subsequently documented in the "Drug Allergy" section of the EMR in only 23 (31.9%) of the 72 probable DILI patients, and these patients were more likely to present with a rash (7% vs. 2%, p = 0.006) and higher serum bilirubin levels (10.5 vs. 4.7, p = 0.008) compared to those in whom the suspect drug was not listed as "drug allergy." A prior drug allergy history was not associated with a greater likelihood of developing DILI compared to other causes of acute liver injury. However, the probable DILI patients with a history of prior drug allergy tended to have less severe liver injury and clinical outcomes. The low rate of suspect drug documentation in the "Drug Allergy" section of EMR after a DILI episode is of concern and could lead to avoidable harm from inadvertent suspect drug re-challenge.

Body composition correlates with laboratory parameters and disease severity in infants with biliary atresia.

Infants with biliary atresia (BA) generally have chronic malnutrition. However, the best anthropometric measure to assess malnutrition and its correlation with disease severity is unknown. We aimed to assess correlations of various anthropometric measurements, including air displacement plethysmography (ADP), with laboratory parameters and with the pediatric end-stage liver disease (PELD) score in infants with BA. Infants with BA were followed at a pediatric liver transplantation center during 2014-2018. Follow-up comprised laboratory tests and nutritional assessment by a dietitian including dietary intake, weight, height, mid-upper arm circumference (MUAC), and skin-fold thickness. Fat-free mass (FFM) and fat mass (FM) were measured by ADP. Forty-three nutritional evaluations were performed in 28 infants with BA (13 boys, 44.4%). The median age was 20.7weeks (IQR: 13-25.9). Based on the various anthropometry modalities, infants with BA were found to be malnourished on most of the visits; 63% had a MUAC-Z score lower than -2standard deviations. High serum bilirubin level predicted lower weight for age, length for age, and MUAC-Z. Lower MUAC-Z was associated with a higher PELD score. Neither FM mass nor FFM correlated with PELD or with serum bilirubin level. However, FM correlated with skin-fold thickness-Z and was low in most patients. The majority of BA infants suffer from malnutrition as assessed by most anthropometrics modalities; low MUAC correlated best with disease severity and serum bilirubin level. Further studies are warranted to determine the contribution of FM measurement by ADP to the anthropometric assessment of infants with BA.

Higher Serum Bilirubin Levels in Response to Higher Carbohydrate Intake During Early Pregnancy and Lower Gestational Diabetes Mellitus Occurrence in Overweight and Obese Gravidae.

Background and Aim: Serum bilirubin levels are recently shown to be a novel protector of gestational diabetes mellitus (GDM), yet whether they could be affected by carbohydrate quality is unclear. We aimed to examine the associations between dietary carbohydrate parameters and serum bilirubin levels during early pregnancy, with further exploration on a potential mediating role of serum bilirubin levels on carbohydrate parameters-GDM pathways.Methods: 260 healthy but overweight or obese gravidae (BMI ≥24 kg/m2) derived from a historical cohort in two hospitals in China were included. The associations between carbohydrate parameters (total carbohydrate intake, glycemic index GI, fiber intake, glycemic load GL) and serum bilirubin levels (total bilirubin, TB and direct bilirubin, DB) and GDM were evaluated by multivariable regression analysis. Generalized structural equation modeling was then applied to perform adjusted mediation analysis.Results: Increased serum bilirubin levels (mmol/L) and decreased GDM occurrence were observed following dietary carbohydrate intake (%E) and GL (g/1,000 kcal) in highest tertile compared to the lowest tertile [carbohydrate: TB: β = 0.926 (95%CI: 0.069, 1.782), DB: β = 0.554 (95%CI: 0.192, 0.916);GL:TB: β = 1.170 (95%CI: 0.339, 2.001); DB: β = 0.369 (95%CI: 0.016, 0.700); carbohydrate: adjusted OR = 0.43 (95%CI:0.19–0.99); GL: adjusted OR = 0.36 (95%CI:0.16, 0.84)]. The mediating effect of carbohydrate intake and GL on GDM through bilirubin levels was evaluated as modest (carbohydrate: 6.2% for TB, 1.3% for DB; GL: 8.7% for TB, 2.3% for DB). No association was observed regarding GI and fiber.Conclusions: Mildly elevated serum bilirubin levels appeared to be in response to higher energies consumed from carbohydrate during early pregnancy in healthy overweight or obese gravidae. However, the mediating effect of bilirubin levels on carbohydrate-GDM pathways is not evident. Larger investigation is further needed for solid evidence.

Ayurvedic management of Koshtashrita Kamala (Hepatocellular Jaundice) - A Case report

Kamala is a type of Liver disorder mentioned in our classics. It is caused by vitiation of pitta with the signs and symptoms like Haridra netra (yellow eyes), twak nakha (yellowish skin and nails) and Dourbalya (weakness), based on these clinical features, it can be well understood under the purview of Jaundice. The condition where yellowish discoloration of skin and sclera of the eyes due to high level of serum bilirubin is known as Jaundice. The pitta present in the body aggravates due to specific diet and life style, attains sthana samshraya in koshta due to kha vaigunya, further causes dagdhatwa of Rakta and Mamsa this condition is known as Koshtashirita Kamala. A case presented with Peeta Netrata, Peeta Varnyata Mutra, Aruchi, Agnimandhya etc was diagnosed as Koshtashrita Kamala it was intervened successfully with Shodhana and Shamana oushadi with proper pathya for a period of 11 days. The effect of treatment was assessed based on improvement in clinical signs and symptoms along with Liver Function Test. There was significant improvement in the condition by 60% thus Kamala can be well managed by Ayurvedic intervention.