Cases Of Jaundice Research Articles

Clinical evaluation of endoscopic biliary stenting in treatment of malignant obstructive jaundice.

Malignant obstructive jaundice (MOJ) is characterized by the presence of malignant tumors infiltrating or compressing the bile duct, causing poor bile drainage, generalized yellowing, pain, itching, and malaise. MOJ is burdensome for both the society and the families of affected patients and should be taken seriously. To evaluate the clinical effect of stent placement during endoscopic retrograde cholangiopancreatography for relieving MOJ and the efficacy of percutaneous transhepatic biliary drainage in terms of liver function improvement, complication rates, and long-term patient outcomes. The clinical data of 59 patients with MOJ who were admitted to our hospital between March 2018 and August 2019 were retrospectively analyzed. According to the treatment method, the patients were divided into an observation group (29 patients) and a control group (30 patients). General data, liver function indices, complications, adverse effects, and 3-year survival rates after different surgical treatments were recorded for the two groups. There were no significant differences in baseline information (sex, age, tumor type, or tumor diameter) between the two groups (P > 0.05). Alanine aminotransferase, aspartate aminotransferase, and total bilirubin levels were significantly better in both groups after surgery than before surgery (P < 0.05). The overall incidence of biliary bleeding, gastrointestinal bleeding, pancreatitis, and cholangitis was 6.9% in the observation group and 30% in the control group (P < 0.05). No significant differences in the rates of blood transfusion, intensive care unit admission, or death within 3 years were observed between the two groups at the 1-month follow-up (P > 0.05). The 3-year survival rates were 46.06% and 39.71% in the observation and control groups, respectively. Endoscopic biliary stenting effectively relieves MOJ and significantly improves liver function, with minimal complications. This technique is a promising palliative approach for patients ineligible for radical surgery. However, further research is needed to optimize current treatment strategies and to explore their potential in treating nonmalignant cases of obstructive jaundice.

Rethinking alcoholic foamy degeneration of the liver: a study of nine cases highlighting complex pathological findings

AimsTo reveal clinicopathological characteristics of alcoholic foamy degeneration (AFD)―an uncommon form of alcoholic liver injury.MethodsClinicopathological features of AFD (n=9) were examined in comparison to those of severe alcoholic hepatitis (SAH;...

A Rare Case Report on Jaundice, Alcoholic Liver Disease with a History of Herbal Medicine Induced Liver Injury

Background: Alcoholic liver disease (ALD) is a complex condition caused by excessive alcohol consumption, affecting fatty liver, alcoholic hepatitis, and cirrhosis. Risk factors include alcohol intake, genetic predisposition, and co-existing liver conditions. Alcoholic fatty liver disease (AFLD) accumulates excessive fat in the liver, leading to steatosis and fibrosis. ALD complications include portal hypertension, liver failure, and hepatocellular carcinoma. The use of herbal medicines, such as tamarind and neem extracts, is also concerning due to potential liver damage. Increased awareness and caution are needed from patients and healthcare providers. Case report: A 33-year-old male patient presented with symptoms including right hypochondrium pain, yellowish discoloration of the sclera, fever, decreased urine output, light yellow tongue, and generalized weakness. He was a chronic alcoholic, consuming various alcoholic beverages for 15 years. His dietary routine was mixed, but he preferred non-vegetarian foods. His family suggested he consume traditional herbal medicine to treat jaundice. After collecting his history, lab tests were conducted to confirm his diagnosis of alcoholic liver disease (ALD) with herbal medicine-induced liver (DILI). LFT tests were alarming, and he was diagnosed with alcoholic liver disease with jaundice and DILI due to herbal medicine. To improve his symptoms and prevent liver failure complications, he was prescribed a list of medications to improve his symptoms and to prevent complications of liver failure. Discussion: A holistic treatment approach is needed for patients with alcoholic liver disease and herbal medicine-induced liver injury, focusing on symptom relief, liver function enhancement, and complication prevention. This includes lifestyle changes, nutritional support, and managing potential issues. Regular monitoring is crucial for adjustments. Conclusion: This case report highlights the complex relationship between alcoholic liver disease and herbal medicine-induced liver injury, especially in jaundice cases. It emphasizes the need for thorough patient histories, increased awareness of hepatotoxic potential, and educating patients about alcohol and herbal supplement risks. It calls for multidisciplinary collaboration, enhanced regulation, and safety evaluations of herbal medicines to protect public health. It also underscores the importance of continuous monitoring and monitoring patients with liver injury histories. Keywords: ALD, Herbal medicine, DILI, Liver failure, Patient care

POST-OPERATIVE PORT SITE PAIN AFTER GALL BLADDER RETRIEVAL FROM EPIGASTRIC VS UMBILICAL PORTS IN LAPAROSCOPIC CHOLECYSTECTOMY

Laparoscopic cholecystectomy (LC) is a widely performed procedure for gallstone disease. While epigastric and umbilical ports are commonly used for gallbladder retrieval, their comparative impact on postoperative discomfort, complications, analgesic requirements, and hospital stay remains underexplored. Identifying the optimal port site can improve patient outcomes and safety. Objective: The purpose of the present study was to assess postoperative discomfort, analgesic requirements, complication rates, and duration of hospitalization in patients undergoing LC with gallbladder retrieval either through the epigastric or the umbilical port in order to draw a conclusion on which port site offers better results in terms of patient comfort and safety. Methods: After the ethical approval from the institutional review board, this randomized controlled trial study was conducted at FRPMC PAF hospital from August 2023 to July 2024. Through non-probability consecutive sampling, 100 patients aged 18-65 years, of both gender, diagnosed with gallstones confirmed with ultrasound were included in the present study. Patients with suspected or proven G.B malignancy, coagulation disorder, obstructive jaundice, acute pancreatitis or emergency cases were excluded from the present study. After the informed consent, patients were randomly divided in to two groups: Group A- Epigastric port site (n=50) and Group B- Umbilical port site (n=50). Results: By 12 hours, the epigastric port group had a lower mean pain score of 4.14±3.04 compared to 5.4±3.3 in the umbilical port group (P=0.056). Analgesic requirements were also similar between the groups, with the epigastric port group requiring an average of 93.6±56.6 mg and the umbilical port group 99.96±55.3mg, yielding a p-value of 0.507. Complications were significantly more common in the epigastric port group, with 29 patients (58%) experiencing complications compared to 19 patients (38%) in the umbilical port group, and a p-value of 0.032. Conclusion: The selection of the port in laparoscopic cholecystectomy does not seem to be critical regarding the duration of either surgery or hospitalization; however, an increased complication rate and trends of postoperative pain do underline the importance of port selection.

The New Spectrum of Plasmodium Vivax Malaria Severity: A Single-Center Experience

Plasmodium vivax malaria, once considered a benign and self-limiting disease, has emerged as a significant public health concern, with increasing reports of severe and even fatal cases. Objective: To evaluate the clinical severity and complications associated with Plasmodium vivax malaria in patients in Peshawar. Methods: A descriptive cross-sectional study was conducted at Lady Reading Hospital, Peshawar, for about two months. A total of 160 patients diagnosed with Plasmodium vivax malaria were enrolled. Participants were divided into two groups based on platelet count. Laboratory tests, including complete blood count, liver function tests, and Renal Function Tests were performed. Data were analyzed using SPSS version 20.0 , An Independent sample t-test was used to assess the significant difference between the two groups with statistical significance set at p&lt;0.05. Results: A total of 165 patients were included in the study. In the severe thrombocytopenia group (&lt;100,000/µL), there were 23 cases of anemia, jaundice (n=25), acute renal failure (n=7), cerebral malaria (n=2), seizures (n=1) and hypoglycemia (n=1). In the less severe thrombocytopenia group (&gt;100,000/µL), there were 14 cases of anemia, jaundice (n=17), and acute renal failure (n=2). The blood glucose level (p=0.37), systolic blood pressure (p=0.18) and pulse rate (p=0.21) revealed no significant differences between the two groups. Conclusions: It was concluded that severe thrombocytopenia in P. vivax malaria was associated with more severe clinical manifestations, with a few cases requiring transfusions. Patients with less severe thrombocytopenia had fewer complications

Metabolic and genetic basis of liver damage in mechanical jaundice of non-tumor genesis in obstractive cholangitis or biliary pancreatitis

Aim. Establishment of versatile mechanisms behind liver damage in mechanical jaundice of non-tumor genesis combined with acute obstructive cholangitis or acute biliary pancreatitis.Materials and methods. In total, 64 cases of mechanical jaundice developed against the background of cholelithiasis were studied. Group 1 included 30 patients with mechanical jaundice combined with cholangitis; group 2 included 34 patients with acute biliary pancreatitis. Bile duct reconstruction was performed by an open method followed by standardized treatment. The intensity of membrane lipid peroxidation was determined by the level of diene conjugates, malonic dialdehyde, superoxide dismutase activity, and the activity of phospholipase A2. The severity of endotoxemia was estimated; a molecular-genetic test of the polymorphism of antioxidant system genes was performed.Results. The significance of the gene polymorphism of antioxidant enzymes in the formation of systemic alterative phenomena and severity of liver damage in mechanical jaundice complicated by cholangitis or acute pancreatitis was determined by allocation of patient subgroups depending on the presence of mutant allele T in the gene of superoxide dismutase SOD2 (C1147T). The groups of patients with the presence of such polymorphism, regardless of the combined diseases, demonstrated more pronounced and prolonged liver functional disorders and homeostasis disorders after restoration of biliary tract patency.Conclusion. The presence of mutant alleles of the SOD2 gene (C47T) in patients with non-tumor mechanical jaundice combined with acute cholangitis or pancreatitis is associated with an increase in the intensity of damage mechanisms at the systemic level, primarily with membrane lipid peroxidation, which correlates with the severity of liver damage (r = 0.834–0.967; p &lt; 0.05).

Assessing the effect of high-dose rosuvastatin in elderly patients over 75 with acute coronary syndrome

Backgrounds and objectiveStatins, inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A reductase, are pivotal in managing hypercholesterolemia and reducing cardiovascular risk. While rosuvastatin demonstrates superior efficacy and tolerability compared to other statins, its safety profile in elderly patients older than 75 years old with acute coronary syndrome (ACS) remains underexplored. So, the objective of this study is to evaluate the frequency of adverse reactions and investigate the efficacy of high-dose rosuvastatin on lipid profiles in elderly patients aged over 75 with ACS.MethodsIn this observational study, 110 consecutive elderly ACS patients attending Modarres Hospital in Tehran, Iran, in 2019 were enrolled. The effects of high-dose rosuvastatin were assessed in elderly patients older than 75 years old by comparison of the adverse effects, lipid profile, cardiac function, and other biomarkers at the baseline and after 6 weeks of rosuvastatin therapy with a dose of 40 mg.ResultsFollowing 6 weeks of treatment, there was a significant reduction in total cholesterol (136.2 ± 24.3 to 115.5 ± 24.0, p = 0.001) and LDL levels (72.6 ± 17.5 to 50.9 ± 18.9, p = 0.001), accompanied by a notable increase in HDL levels (38.3 ± 7.1 to 47.2 ± 7.4, p = 0.001). Cardiac function, as measured by ejection fraction (EF), significantly improved from 43.4 ± 8.8 to 48.5 ± 8.5 (p = 0.001). Adverse effects such as cramps (N = 12, p = 0.001), weakness (N = 28, p = 0.001), and anorexia (N = 12, p = 0.001) were reported but did not warrant discontinuation of therapy. Notably, no cases of jaundice were observed. Two deaths occurred due to major adverse cardiac events (MACE) during the study period, unrelated to stroke or recurrent myocardial infarction.ConclusionTotally, high-dose rosuvastatin therapy effectively improved lipid profiles, cardiac function, and liver enzyme levels in elderly ACS patients, with manageable adverse effects. These findings underscore the importance of rosuvastatin in optimizing cardiovascular health in this vulnerable population.

Study of cases of obstructive jaundice due to biliary and pancreatic tumors

Obstructive jaundice has recently become more common, particularly among malignant cases. The aim was to study, evaluate and compare various operative managements for obstructive jaundice due to biliary and pancreatic tumors. This prospective study was conducted by random selection of 20 cases presenting with obstructive jaundice due to biliary and pancreatic tumors at a tertiary care hospital affiliated with Smt. N.H.L. Municipal Medical College. Majority of patients were in age group 51-60 years (35%) and 61-70 years (20%). Males (70%) were found to be in higher proportion compared to females (30%). Most comm on presenting symptom was jaundice (90%). Most common cause was periampullary carcinoma (60%). It was found that the most common complication following Whipple’s procedure and Triple Bypass Surgery was pancreatic fistula.

Diving into the Digital Landscape: Assessing the Quality of Online Information on Neonatal Jaundice for Parents.

Hyperbilirubinemia is a common condition in newborns. While mild cases of jaundice are common and typically resolve spontaneously, severe hyperbilirubinemia can lead to serious neurologic complications if left untreated. With the constant adaptation of guidelines, clinical management has significantly improved, and treatment has become routine for pediatricians. However, for parents of affected children, managing the condition is not routine. In today's digital age, parents often seek additional information by accessing a wide range of medical resources on the internet. While this can be empowering, it also presents challenges, as the quality and accuracy of online medical information can vary widely. Therefore, we analyzed the current quality of information on jaundice found on the internet by parents. A simulated internet search (using the Google search engine) was conducted from a layperson's perspective using German ("Neugeborenes Gelbsucht", "Baby Gelbsucht") and English ("jaundice newborn", "jaundice baby") search terms. Subsequently, the quality of the search results was assessed by two independent neonatologists based on the DISCERN Plus Score, HONcode certification, and the JAMA criteria. Websites targeting non-medical laypersons exhibited significant variability in quality. Notably, the content of English websites was superior to that of websites in the German language. The majority of English sites were predominantly institutional, whereas most German sites were commercially oriented. Although information on jaundice is readily accessible online for non-medical individuals, there were notable differences in quality based on language and significant variability in the quality of information warranting attention from healthcare professionals. Furthermore, German websites providing information on jaundice were often hosted by commercial organizations. We propose that pediatric societies engage in developing and maintaining organization-based medical information to improve online resources for parents.

A case of gallbladder hemangioma detected in a patient with jaundice and suspected Klatskin tumor: case report and review of the literature

Background and objectiveThe diagnosis and treatment of benign tumors of the gallbladder and bile ducts are difficult due to their anatomical relationships with neighboring vital organs. Hemangiomas are non-epithelial benign tumors of the gallbladder. The gallbladder is an extremely rare localization for cavernous hemangiomas. To date, 7 cases of cavernous gallbladder hemangioma have been reported in the literature. Although it is seen very rarely, the main problem is that it mimics malignant lesions. Pre-operative diagnosis of gallbladder hemangiomas is difficult. Ultrasound (US), computed tomography (CT) magnetic resonance imaging(MRI), endoscopic ultrasound (EUS), and angiography are helpful in differential diagnosis.Here, we aimed to present our case, which is the first case of cavernous gallbladder hemangioma and obstructive jaundice in the literature.Case presentationA 49-year-old female patient was admitted with the complaint of pain in the right upper quadrant of her abdomen. Bilirubin levels were high due to obstructive jaundice. Abdominal CT and MRI showed an appearance in favor of hemangioma in the gallbladder. There was an increase in bile duct wall thickness on MRCP, and it was evaluated as suspicious for malignant neoplasia. The patient was operated on, and extrahepatic bile duct resection + Roux-en-Y hepaticojejunostomy procedure was performed. As a result of histopathology, hemangioma was detected in the gallbladder. There was no malignancy in the bile ducts.ConclusionIt should be kept in mind that the mass detected in the gallbladder in a patient with jaundice who is suspected of having a bile duct tumor may also be a hemangioma.

An interpretability model for syndrome differentiation of HBV-ACLF in traditional Chinese medicine using small-sample imbalanced data

ObjectiveClinical medical record data associated with hepatitis B-related acute-on-chronic liver failure (HBV-ACLF) generally have small sample sizes and a class imbalance. However, most machine learning models are designed based on balanced data and lack interpretability. This study aimed to propose a traditional Chinese medicine (TCM) diagnostic model for HBV-ACLF based on the TCM syndrome differentiation and treatment theory, which is clinically interpretable and highly accurate. MethodsWe collected medical records from 261 patients diagnosed with HBV-ACLF, including three syndromes: Yang jaundice (214 cases), Yang-Yin jaundice (41 cases), and Yin jaundice (6 cases). To avoid overfitting of the machine learning model, we excluded the cases of Yin jaundice. After data standardization and cleaning, we obtained 255 relevant medical records of Yang jaundice and Yang-Yin jaundice. To address the class imbalance issue, we employed the oversampling method and five machine learning methods, including logistic regression (LR), support vector machine (SVM), decision tree (DT), random forest (RF), and extreme gradient boosting (XGBoost) to construct the syndrome diagnosis models. This study used precision, F1 score, the area under the receiver operating characteristic (ROC) curve (AUC), and accuracy as model evaluation metrics. The model with the best classification performance was selected to extract the diagnostic rule, and its clinical significance was thoroughly analyzed. Furthermore, we proposed a novel multiple-round stable rule extraction (MRSRE) method to obtain a stable rule set of features that can exhibit the model’s clinical interpretability. ResultsThe precision of the five machine learning models built using oversampled balanced data exceeded 0.90. Among these models, the accuracy of RF classification of syndrome types was 0.92, and the mean F1 scores of the two categories of Yang jaundice and Yang-Yin jaundice were 0.93 and 0.94, respectively. Additionally, the AUC was 0.98. The extraction rules of the RF syndrome differentiation model based on the MRSRE method revealed that the common features of Yang jaundice and Yang-Yin jaundice were wiry pulse, yellowing of the urine, skin, and eyes, normal tongue body, healthy sublingual vessel, nausea, oil loathing, and poor appetite. The main features of Yang jaundice were a red tongue body and thickened sublingual vessels, whereas those of Yang-Yin jaundice were a dark tongue body, pale white tongue body, white tongue coating, lack of strength, slippery pulse, light red tongue body, slimy tongue coating, and abdominal distension. This is aligned with the classifications made by TCM experts based on TCM syndrome differentiation and treatment theory. ConclusionOur model can be utilized for differentiating HBV-ACLF syndromes, which has the potential to be applied to generate other clinically interpretable models with high accuracy on clinical data characterized by small sample sizes and a class imbalance.

A pediatric case of Burkitt’s lymphoma with bile duct obstruction requiring surgical biliary reconstruction

BackgroundBiliary obstruction due to compression by a B-cell solid tumor occurs rarely. A few reports have described biliary reconstruction surgery for obstructive jaundice caused by Burkitt’s lymphoma. However, there are no detailed reports on pediatric cases. We report a pediatric case of obstructive jaundice due to malignant lymphoma treated with biliary reconstruction surgery.Case presentationA 5-year-old girl presented to our hospital with a massive abdominal tumor that caused biliary stricture. Chemotherapy was initiated after an open tumor biopsy. However, endoscopic biliary stent placement was performed owing to elevated bilirubin levels. We treated the patient with chemotherapy for 9 months while endoscopically replacing the biliary stent every few months. She achieved complete tumor remission. However, sclerotic lymph nodes were persistent on the dorsal side of the cholecystic duct junction, and biliary stricture at the same site had changed to stent-dependent biliary obstruction. Therefore, we performed choledochojejunostomy and retrocolic Roux-en-Y reconstruction 15 months after initial admission. There were no postoperative complications or tumor recurrences, and the bilirubin level remained low. Histopathologically, the resected bile duct wall was fibrotic and thick, and the bile duct lumen narrowed.ConclusionsBiliary reconstruction is effective to achieve long-term biliary patency in pediatric patients with stent-dependent biliary obstruction due to malignant lymphoma. However, the decision on when to stop biliary stent replacement and proceed to biliary reconstruction surgery is a matter of debate. Further case studies are required to address this issue.

A rare case of surgical obstructive jaundice due to spontaneous gastro-gastric intussusception

A rare case of surgical obstructive jaundice due to spontaneous gastro-gastric intussusception

Efficacy and safety of antibiotics for treatment of leptospirosis: a systematic review and network meta-analysis

BackgroundLeptospirosis, an important zoonotic bacterial disease, commonly affects resource-poor populations and results in significant morbidity and mortality worldwide. The value of antibiotics in leptospirosis remains unclear, as evidenced by the conflicting opinions published.MethodsWe conducted a search in the PubMed, Web of Science, and Cochrane Library databases for studies. These studies included clinical trials and retrospective studies that evaluated the efficacy or safety of antibiotics for leptospirosis treatment. The primary outcomes assessed were defervescence time, mortality rate, and hospital stays. Subgroup analyses were performed based on whether there were cases involving children and whether there were cases of severe jaundice. Safety was defined as the prevalence of adverse events associated with the use of antibiotics. p scores were utilized to rank the efficacy of the antibiotics.ResultsThere are included 9 randomized controlled trials (RCTs), 1 control trial (CT), and 3 retrospective studies (RS) involving 920 patients and 8 antibiotics. Six antibiotics resulted in significantly shorter defervescence times compared to the control, namely cefotaxime (MD, − 1.88; 95% CI = − 2.60 to − 1.15), azithromycin (MD, − 1.74; 95% CI = − 2.52 to − 0.95), doxycycline (MD, − 1.53; 95% CI = − 2.05 to − 1.00), ceftriaxone (MD, − 1.22; 95% CI = − 1.89 to − 0.55), penicillin (MD, − 1.22; 95% CI = − 1.80 to − 0.64), and penicillin or ampicillin (MD, − 0.08; 95% CI = − 1.01 to − 0.59). The antibiotics were not effective in reducing the mortality and hospital stays. Common adverse reactions to antibiotics included Jarisch–Herxheimer reaction, rash, headache, and digestive reactions (nausea, vomiting, diarrhea, abdominal pain, and others).ConclusionsFindings recommend that leptospirosis patients be treated with antibiotics, which significantly reduced the leptospirosis defervescence time. Cephalosporins, doxycycline, and penicillin are suggested, and azithromycin may be a suitable alternative for drug-resistant cases.Systematic review registrationPROSPERO CRD42022354938.

Proteomics Defines Plasma Biomarkers for the Early Diagnosis of Biliary Atresia.

Early diagnosis of biliary atresia (BA) is crucial for improving the chances of survival and preserving the liver function of pediatric patients with BA. Herein, we performed proteomics analysis using data-independent acquisition (DIA) and parallel reaction monitoring (PRM) to explore potential biomarkers for the early diagnosis of BA compared to other non-BA jaundice cases. Consequently, we detected and validated differential protein expression in the plasma of patients with BA compared to the plasma of patients with intrahepatic cholestasis. Bioinformatics analysis revealed the enriched biological processes characteristic of BA by identifying the differential expression of specific proteins. Signaling pathway analysis revealed changes in the expression levels of proteins associated with an alteration in immunoglobulin levels, which is indicative of immune dysfunction in BA. The combination of polymeric immunoglobulin receptor expression and immunoglobulin lambda variable chain (IGL c2225_light_IGLV1-47_IGLJ2), as revealed via machine learning, provided a useful early diagnostic model for BA, with a sensitivity of 0.8, specificity of 1, accuracy of 0.89, and area under the curve value of 0.944. Thus, our study identified a possible effective plasma biomarker for the early diagnosis of BA and could help elucidate the underlying mechanisms of BA.

A comparative study of uncomplicated acute non-A-E hepatitis with acute viral hepatitis and acute onset autoimmune hepatitis.

Non-A-E hepatitis (NAEH) not leading to acute liver failure (ALF) is poorly documented. The objective was to compare clinical and laboratory features of uncomplicated acute NAEH with acute viral (AVH) and autoimmune hepatitis (AIH) and histopathology in NAEH and AIH. Cases of hepatocellular jaundice were included. These were grouped into AVH, AIH and NAEH based on clinical, laboratory and, when indicated, liver biopsy findings. NAEH and AIH were followed up at three months. Of 336 patients with hepatocellular jaundice, 15 (5%) were NAEH, 25 (7%) acute AIH and 45(14%) AVH. Among NAEH patients, seven (46.7%) were males with a mean age of presentation 39 years. Jaundice (100%) was the most common presentation of NAEH. Peak bilirubin was 10.7 mg/dL. Peak aspartate and alanine aminotransferase (AST, ALT) were 512 and 670 U/L. Five (33.3%) patients had positive anti-nuclear antibody and one had anti-smooth muscle antibody. Mean immunoglobulin G (IgG) levels were 1829. On liver biopsy, all had ballooning degeneration, four (26.7%) had mild and three (20%) moderate interface hepatitis, four (26.7%) mild lymphoplasmacytic infiltrate, one (6.7%) rosette formation, bridging necrosis in none and stage 1 fibrosis in one. Comparing NAEH with AIH, AIH showed significantly older age at presentation, female predisposition, past history of jaundice, lower ALT, more autoantibodies, higher IgG, higher grade interface hepatitis, lymphoplasmacytic infiltrate, rosette formation and higher bilirubin, AST at three months. NAEH and viral hepatitis had similar features. Etiology of NAEH is unlikely to be autoimmune and is probably viral, unidentified as yet. Uncomplicated NAEH likely has self-limiting course even without specific treatment.

Risk factors for urinary tract infection in infants with unexplained hyperbilirubinemia: a single center case-control study

BackgroundUrinary tract infection (UTI) is a potential cause of neonatal jaundice. Nevertheless, there remains a lack of consensus regarding appropriate screening practices for UTI in infants with hyperbilirubinemia. This study aimed to analyze a group of jaundiced infants to assess the prevalence of UTI, explore potential risk factors, and examine the impact of UTI on the course and severity of neonatal jaundice.MethodsThis retrospective case-control study was conducted on 150 jaundiced infants (aged &amp;lt; 8 weeks) without a known etiology in the hyperbilirubinemia work-up. All subjects underwent phototherapy treatment and UTI screening by catheterization. They were then classified into UTI and non-UTI groups based on urine culture results, with a positive urine culture indicating the growth of ≥10,000 colony-forming units. The clinical characteristics and jaundice-related parameters of both groups were analyzed.ResultsAmong the 150 jaundiced patients, the prevalence of UTI was 29%. There was a significantly higher male predominance in the UTI group, and patients with UTI also had a significantly longer duration of hospitalization compared to those without UTI. Significant risk factors associated with UTI in jaundiced infants included male gender and a peak total bilirubin level higher than 18 mg/dl during hospitalization. The most common pathogens identified in urine culture were Escherichia coli (41.9%) and Enterococcus faecalis (30.2%).ConclusionIn cases of neonatal jaundice where the underlying cause is not evident, screening for UTI should be performed, particularly when associated risk factors or inadequate response to phototherapy is present.

The non-HDL-C to APOB ratio as a predictor of inaccurate LDL-C measurement in patients with chronic intrahepatic cholestasis and jaundice: a retrospective study.

Cholestasis is characterized by the accumulation of bile in the liver or biliary system due to obstruction or impaired flow, necessitating lipid profiling to assess lipid metabolism abnormalities. Intrahepatic cholestasis, being the most significant type of cholestasis, further complicates the assessment of lipid abnormalities. However, the accuracy of low-density lipoprotein cholesterol (LDL-C) measurement in intrahepatic cholestasis patients remains uncertain. This study aimed to evaluate the consistency of the homogeneous assay and the Friedewald formula in detecting LDL-C levels and identify factors influencing LDL-C test results in intrahepatic patients with cholestasis. Retrospective analysis of laboratory data was conducted on intrahepatic cholestatic patients. Correlations between LDL-C values obtained using the homogeneous method (LDL-C(D)) and the Friedewald formula (LDL-C(F)), as well as associations between high-density lipoprotein cholesterol (HDL-C) and apolipoprotein A1 (ApoA1), LDL-C(D) and LDL-C(F), and apolipoprotein B (ApoB), were analyzed. Logistic regression analyses were employed to identify diagnostic indicators for inaccurate LDL-C measurements in intrahepatic cholestatic patients. Compared to patients with intrahepatic cholestasis without jaundice, the correlation between LDL-C(F) and LDL-C(D) was weaker in those with jaundice. Additionally, HDL-C exhibited a strong correlation with ApoA1 in both jaundice and non-jaundice cholestasis cases. Elevated non-HDL-C to APOB ratio (NH-C/B Ratio) levels (>4.5) were identified as a reliable predictor of inaccurate LDL-C measurements in patients with chronic intrahepatic cholestasis accompanied by jaundice. LDL-C measurement reliability is moderately weaker in patients with intrahepatic cholestasis accompanied by jaundice. Elevated levels of the NH-C/B ratio serve as a significant predictor of inaccurate LDL-C measurements in this chronic patient population, highlighting its clinical relevance for diagnostic assessments.

A RETROSPECTIVE STUDY OF JAUNDICE IN INFANTS IN KYIV FROM 2017 TO 2021

Study objectives. The aim of the study was to evaluate the effectiveness of inpatient medical care in Kyiv (diagnostic capabilities and prescription of phototherapy) for newborns with various clinical forms of jaundice during 2017–2021. Methods. We performed a retrospective analysis of 616 infant jaundice cases of various clinical forms at the Department of Neonatal Pathology at Children's Clinical Hospital No. 6 in Kyiv (2017–2021), diagnosed as ICD P59 neonatal jaundice (NJ) and prolonged jaundice (PJN) and P55 hemolytic disease of the newborn (HDN) based on the relevant criteria. For statistical analysis, MedStat (v2.6.2) and EZR (v1.61) were used. The analysis showed that hospitalization with various forms of jaundice decreased in 2021 by about 2.1 times vs. 2018 and by 1.5 times vs. 2017 (p &lt; 0.001). PJN was more common (55.0%) than NJ (39.8%) and HDN (5.2%), p &lt; 0.001. A logistic regression model (AUC = 0.785) showed that the manifestation of PJN might be influenced by a history of cesarean section. At the time of hospitalization, there was no significant difference between the bilirubin levels measured by two methods: total serum bilirubin (TSBa) and transcutaneous bilirubin (TcBa), p = 0.380. Children with HDN (84.4%) were more likely to require phototherapy for more than 5 days than children with NJ (63.7%) and PJN (62.2%), p &lt; 0.05. Conclusion. The study showed a decrease in the number of hospitalizations for jaundice in infants from 2017 to 2021. The prevalence of PJN was higher than NJ. A history of cesarean section was associated with PJN. Median bilirubin levels showed no significant difference between the two methods. Children with HDN more often required prolonged phototherapy, which was probably due to a less effective daily decline in bilirubin levels.

Monitoring gestational diabetes mellitus patients with myDiabby Healthcare® smartphone application vs classical diary. Results from the non-inferiority TELESUR-GDM study

ObjectiveThe aim of the TELESUR-GDM study was to demonstrate the non-inferiority of the onset of maternal, fœtal, and neonatal complications for patients with gestational diabetes mellitus (GDM) monitored by myDiabby HealthcareⓇ (app group) compared to patients with a classical glycaemic blood monitoring by diary (control group). Materials and methodsTELESUR-GDM was a retrospective, monocentric, and non-inferiority study including 349 patients in the app group and 295 patients in the control group. The primary outcome was a composite score based on maternal, foetal, and neonatal complications. The statistical analysis used chi square or Student t tests for categorical or continuous variables, and Dunnett–Gent test for non-inferiority. ResultsIn the app and control groups, 46.3 % and 53.7 % of the patients respectively, observed complications. Non-inferiority of telemonitoring by application vs diary was confirmed (odds ratio=0.79 [95 % CI 0.58;1.07], P < 0.001). Caesarean section, labour induction, and insulin treatment rates were: 20 vs 23 % (P = 0.4), 36 vs 28 % (P = 0.047), and 22 vs 23 % (P = 0.8) in the app vs control group, respectively. Macrosomia, intrauterine growth restriction, neonatal hypoglycaemia, and neonatal jaundice rates were: 4.3 vs 6.1 % (P = 0.4), 6.9 vs 3.1 % (P = 0.04), 1.7 vs 14 % (P < 0.001), and 8.6 vs 1.0 % (P < 0.001), in the app versus control group, respectively. ConclusionGDM glycaemic telemonitoring compared to patients with classic glycaemic monitoring by diary was not inferior in terms of maternal, fœtal, and neonatal complications. Neonatal hypoglycaemia, a life-threatening event, was significantly reduced despite the observation of more neonatal jaundice cases.