Bilirubin Levels Research Articles

In vivo toxicity test and safety study of Shenfu injection for sepsis treatment

This study aimed to evaluate the preclinical safety of Shenfu injection for the treatment of sepsis. Tests were designed and conducted to determine the acute and long-term toxicity of Shenfu injection in rats, based on the recommended indications and dosage for human use. Rats were administered 22.5 g of raw drug/kg/day via tail vein injection. Toxicity symptoms were monitored for 14 days following the intravenous injection of Shenfu injection, and target organs affected by toxicity were analyzed. To assess long-term toxicity, rats were given 12, 9, or 6 g of raw drug/kg/day by intraperitoneal injection, equivalent to 12, 9, and 6 times the daily clinical dose for adult sepsis patients (3.3 mL of stock solution per 1 g of raw drug/kg/day), for 30 consecutive days. This was followed by a 28-day recovery period after withdrawal of the drug. During the administration and recovery periods, signs of toxicity were observed and compared with those in the control (stromal fluid) group. The aim was to predict potential clinical adverse reactions, including the nature and severity of these reactions, dose-response and time-response relationships, and the reversibility of the effects. Additionally, the study sought to identify the target organs or tissues potentially affected by repeated administration and suggest clinical indicators that should be monitored during the product's use. Furthermore, the safety of co-administration with commonly used chemical medications for the treatment of sepsis was investigated. In the acute toxicity test, administration of the maximum dose of Shenfu injection (75 mL of stock solution/22.5 g of raw drug/kg/day) via tail vein injection resulted in transient symptoms, including piloerection (vertical hair response), weight loss, and reduced food intake. In the long-term toxicity experiments, rats received intraperitoneal injections of 0.3 g/mL (stock solution), 0.225 g/mL, and 0.15 g/mL Shenfu injection per day, which corresponded to 12, 9, and 6 times the daily clinical dose for adults with sepsis. The injections were administered twice daily for 30 days, followed by a 28-day drug withdrawal period for recovery. After 28 days, no significant toxicological changes were observed, apart from a hemodilution effect caused by the excessive volume of the drug and a slight increase in alkaline phosphatase and total bilirubin levels. The effects were reversible upon drug discontinuation. A single intravenous injection of 22.5 g of raw drug/kg/day and long-term intraperitoneal administration of up to 12 g of raw drug/kg/day are considered safe doses for rats.

Pregnancy cholestasis typically occurs in the third trimester of pregnancy and is a significant clinical condition.

The aim of this study is to determine the albumin/bilirubin ratio index and the aspartate aminotransferase (AST)/alanine aminotransferase ratio (ALT) index in patients diagnosed with cholestasis during pregnancy, and to demonstrate their correlation with liver damage. Additionally, potential strategies to prevent liver damage will be elucidated. Our study is a retrospective study. A total of 4019 pregnant women aged between 18 and 40years, presenting with itching complaints at 32-36weeks of gestation, were screened at the Department of Obstetrics and Gynecology, Istanbul Training and Research Hospital of Health Sciences University between January 1, 2018, and December 31, 2023. Among them, 104 pregnant women without any other accompanying diseases were diagnosed with Gestational Cholestasis. Among the 104 diagnosed women, 78 met the inclusion criteria and were included in the study. Twenty-six women were excluded from the study due to missing albumin and total bilirubin values or due to blood samples being taken at different times. The serum albumin/bilirubin ratio index and the alanine aminotransferase/aspartate aminotransferase ratio index were calculated and statistically compared between pregnant women diagnosed with cholestasis and healthy pregnant women at the same gestational week. We found that AST, ALT, albumin, and total bilirubin levels were significantly higher in pregnant women diagnosed with cholestasis compared to the control group (p < 0.05). The AST/ALT index in the case group was significantly lower compared to the control group. However, there were no significant differences found between the case and control groups regarding the albumin/total bilirubin index and ALBI grade. When comparing ALBI grades in cases, no significant differences were found in terms of patients' age, gestational week, AST, ALT, and AST/ALT index. When compared according to ALBI grades, the albumin level was higher in patients with ALBI grade I compared to grade II, and in patients with grade II compared to grade III. The total bilirubin level was significantly higher in patients with ALBI grade III compared to grades I and II, but there was no significant difference between grades I and II. No significant differences were found among the groups separated according to ALBI grades when FBA values were compared. In this study, the negative correlation between lower AST/ALT ratio and FBA values in patients with severe cholestasis suggests the need for careful consideration regarding future liver damage. The lack of difference in ALBI score between the case and control groups, as well as the absence of correlation with FBA values, indicates the necessity to evaluate ALBI score based on patients' long-term prognosis.

Absence of Survival Impact from Hepatitis During Immunotherapy in 193 Patients with Advanced Hepatocellular Carcinoma - An Observational Study from Taiwan.

Hepatitis often occurs after initiating immune checkpoint inhibitor (ICI) treatment. The time and grade of hepatitis after ICI starts and the prognostic role of immune-related hepatitis in patients with advanced hepatocellular carcinoma (aHCC) remain unclear. In this real-world analysis, we enrolled aHCC patients receiving ICIs, documented the highest level of liver enzymes during/after ICIs, and analyzed the survival impact of different hepatitis patterns. One hundred and ninety-three aHCC patients receiving ICIs were recruited. During ICIs, 88.6% of patients experienced aspartate transaminase (AST) elevations (Grade III/IV: 7.8%). For alanine transaminase (ALT), 81.3% had elevated levels (Grade III/IV: 3.6%), and 41.5% of patients had elevated bilirubin levels (Grade 3/4: 6.7%). The median AST, ALT, and total bilirubin values significantly increased after ICI treatment initiated (all p < 0.001) and, similarly, after excluding progressive disease (p = 0.014, p = 0.002, p < 0.001). The median time of hepatitis occurrence is from the 4.0th to 15.9th weeks. Multivariable analysis showed that patterns of liver enzyme change of AST and total bilirubin in patients receiving ICIs significantly correlate to overall survival (OS, p = 0.009 and 0.001, respectively). After ICI termination, patients with elevated bilirubin (p = 0.003) and AST (p = 0.005) would indicate poor survival, with adjustment of viral hepatitis and ICI responses. Hepatitis emerges between the 4th and 20th weeks post-ICI initiation. Changes in liver enzymes during ICI therapy do not directly affect OS, implying the safety of ICI use when corticosteroids are promptly administered if clinically indicated.

Neonatal Jaundice Risk Factors and Multidirectional Intensive Phototherapy Management at Azadi Teaching Hospital in Kirkuk City

Background: A common illness in infants, neonatal jaundice is caused by high bilirubin levels in the first few days of life, which results in yellowing of the skin and eyes. Aim: This study aims to explore neonatal jaundice risk factors and assess the efficacy of multidirectional intensive phototherapy management at Azadi Teaching Hospital in Kirkuk City. Patients and Methods: In this retrospective cross-sectional study spanning from April 1st, 2021, to October 1st, 2021, a total of 497 newborns were examined. Jaundiced neonates underwent intensive phototherapy utilizing the Bilisphere 360 system, which featured a chamber with 16 cylindrical, blue TL 20W/52 fluorescent tubes. The newborns were positioned on a gauze hammock suspended at the chamber's center, illuminated on all sides. Results: A study found that neonatal jaundice affects 50.70% of studied neonates, primarily in the 16-21-day age group, with males accounting for 57.95% of the sample. 94.84% of neonates experience jaundice due to ABO blood group incompatibility and 88.10% due to Rh incompatibility. Additionally, 77.78% of term deliveries are associated with jaundice. Infants with jaundice have higher Thyroid Stimulating Hormone (TSB) and Thyroid Stimulating Hormone (TSH) levels and a younger mean age compared to non-jaundiced infants. Bilisphere 360 proves significantly more effective in the critical 12 to 48 hours after admission, with a mean total bilirubin of 10.71 ± 1.01 mg/dl compared to 14.65 ± 1.71 mg/dl for Neonatal Exchange Transfusions (P-Value: 0.001). Factors like blood group incompatibility, labor duration, and birth weight influence TSB levels in jaundiced neonates. The Bilisphere 360 method is found to be more effective in managing neonatal jaundice than Neonatal Exchange Transfusions in reducing total bilirubin levels.

Risk factors for acute pancreatitis after endoscopic retrograde cholangiopancreatography: a retrospective single-center study

Background. Endoscopic retrograde cholangiopancreatography (ERCP) is an important procedure in the diagnosis and management of pancreaticobiliary diseases. Post-ERCP pancreatitis (PEP) is the most common and serious adverse event after ERCP. Purpose – to evaluate retrospectively PEP incidence and to identify independent risk factors of PEP. Materials and Methods. The analysis of 578 ERCP cases was done. A number of potential risk factors for PEP were taken into uni- and multivariate analisys: age, gender, common bile duct (CBD) size, bilirubin level, presence of cholangitis, Sphincter of Oddi dysfunction (SOD), malignant biliary obstruction, chronic pancreatitis, biliary obstruction, history of cholecystectomy, history of endoscopic papillosphincterotomy (EPST), initial ERCP success, therapeutic success, selective biliary cannulation, pancreatic cannulation/injection, Precut and EPST. Results. PEP was in 29 (5%) cases. Six factors with р &lt; 0,05 by univariate analysis (CBD ≤ 10 mm, normal bilirubin level, SOD, history of cholecystectomy, pancreatic cannulation/injection, precut) were included into multivariate logistic regression model. The independent risk factor for PEP were CBD ≤ 10 mm (OR 2,416; 95% ДІ, 1,037–5,629; p = 0,041), SOD (OR 4,107; 95% ДІ, 1,726–9,771; p = 0,001) та pancreatic cannulation/injection (OR 3,447; 95% ДІ, 1,455–8,166; p = 0,005); and precut was an independent protective factor for PEP (OR 0,129; 95% ДІ, 0,047–0,354; p = 0,014). Conclusions. The incidence of PEP was 5%. Small CBD and SOD are independent PEP risk factors as well as pancreatic cannulation/injection. Early precut technique is an independent factor preventing PEP.

CLINICAL PATTERNS AND OUTCOMES IN CIRRHOTIC YEMENI PATIENTS WITH ACUTE-ON-CHRONIC LIVER FAILURE

Acute-on-chronic liver failure (ACLF) is a clinical condition of abrupt hepatic decompensation in chronic liver disease patients that is associated with extra-hepatic organ failures and a higher mortality rate. This study aimed to identify the clinical patterns and outcomes in cirrhotic Yemeni patients with ACLF. This prospective cohort study was carried out on 160 cirrhotic patients admitted between May 2023 and May 2024 to the Internal Medicine Department in Al-Sadaqah General Teaching Hospital in Aden governorate, Yemen. Based on the European Association for Study of Liver's Chronic Liver Failure Consortium EASL-CLIF criteria, patients were divided into Group A: 54 patients with ACLF. Group B: 106 patients without ACLF. The prevalence of ACLF is 33.8%. The mean age was 41.54± 8.11 years in ACLF and 39.22± 8.14 years in non-ACLF patients. The proportion of males in ACLF was 51.9% vs. 57.5% in non-ACLF patients. The most common causes of cirrhosis were cryptogenic (58.8%) and autoimmune hepatitis (25.6%). A significant correlation was found between prior hospitalization, decompensation, and the increased risk of developing ACLF. The most common complications were jaundice, hepatic encephalopathy, renal failure, signs of bacterial infection, ascites, and gastrointestinal bleeding, respectively. The main precipitating events for ACLF were bacterial infection, especially SBP (48.1%), GIT bleeding (24.1%), and no identified precipitating events (24.1%). The most common organ failures were renal (70.4%), liver (42.6%), and cerebral (31.5%). ACLF patients showed higher levels of WBCs, bilirubin, and serum creatinine. Mortality rates were significantly higher in ACLF patients compared to non-ACLF at both 28 days (33.3% vs. 5.7%) and 90 days (685% vs. 23.6%). This study demonstrated that ACLF patients have worse prognoses, higher mortality rates, increased ICU admission, lower survival, and higher rates of organ failure than non-ACLF patients.

Investigation into the effect of acute exposure to chlorogenic acid in male wistar mice

Chlorogenic acid (CGA) is a natural polyphenolic compound widely present in various fruits, vegetables, and plant-based foods. It has gained considerable attention due to its potential health benefits including antioxidant, hepatoprotective, antibacterial, anti-inflammatory, anti-obesity, cardioprotective, neuroprotective, central nervous system stimulator, and anti-hypertensive amongst others. There is a dearth of information about acute exposure to chlorogenic acid which is also used as a food supplement. Ninety-six male Wistar mice were weight-matched into 8 groups (n=12). Group 1 was treated with distilled water, Group 2 received 1% ethanol, while Groups 3-8 were treated with 30, 60, 120, 240, 480 and 1,000 mg/kg body weight doses of CGA, respectively. Six animals were bled and sacrificed per group 24 hours post-treatment, and the liver and kidney were excised. Sections of the organs were fixed in 10% formalin for histopathological examination. Various antioxidant parameters were assayed in the liver and kidney samples using standard methods. A liver function test was also carried out on the liver samples. Haematological analysis was carried out as well as histopathology analysis of the liver and kidney samples. The remainder of the treated mice in each group were observed for mortality 24 hours post-treatment and for two weeks. Statistical analysis was performed using one-way analysis of variance (ANOVA) with p-values less than 0.05 considered to be significant. The results of this study show that chlorogenic acid led to dose-dependent increased levels of hydrogen peroxide and albumin, increased activity of alkaline phosphatase with decreased activities and levels of alanine aminotransferase, aspartate aminotransferase and bilirubin in the liver function while there were increased hydrogen peroxide levels in the kidney. The haematological parameters were not affected and the histopathological examination complemented the results with mild to moderate lesions in the liver and none in the kidney. Although, the lethal dose (LD 50-i.e., the dose at 50% mortality) was not established in this study. Therefore, chlorogenic acid should be ingested with caution.

EFFECTS OF HUMAN CYTOMEGALOVIRUS ON SOME HEMATOLOGICAL PARAMETERS AND LIVER FUNCTION IN PREGNANT WOMEN, YEMEN

Human Cytomegalovirus (HCMV) infection is a common congenital infection that affects approximately 0.7%–1% of all live births worldwide. Approximately 11% of newborns who are infected show symptoms at birth, and of these, between 30% and 40% are at a risk of experiencing long-term neurological complications. This study aimed to evaluate the effect of HCMV on hematological parameters and liver function in pregnant women in Hajjah governorate, Yemen. This study is a cross-section study that conducted in the Hajjah governorate of Yemen during a period of March to June 2023. A total of 108 blood specimens were collected from participants; 78 from patients group and 30 health group. Hematological parameters, such as total red blood cell count (RBC), hemoglobin (HB), platelet count (PLT), and white blood cells (WBC), as well as liver function tests, such as total protein, albumin, alkaline phosphatase (ALP), serum glutamic oxaloacetic transaminase (SGOT), serum glutamate pyruvate transaminase (SGPT), total bilirubin, and direct bilirubin, were measured. Majority of participant patients aged between 16–21 years 27 (34.7%), studied at secondary schools (46.2%), in their second trimester 51 (65.4%), those with multigravida 54 (69.2%), and those with no history of congenital diseases 60 (76.9%). Compared with the control group, the mean WBC levels were significantly lower in HCMV patients (P &lt; 0.05), whereas PLT levels were higher among HCMV patients (P &lt; 0.05). Additionally, the mean levels of total bilirubin, direct bilirubin, SGOT, ALP, and albumin were significantly lower in patients with HCMV than in HC (P &lt; 0.05). Furthermore, there were no significant differences between the patient and healthy groups in terms of HB, RBC counts, SGPT, and total protein (P &gt; 0.05). It can be concluded that HCMV infection had a statistically significant effect on WBC, PLT, total bilirubin, direct bilirubin, SGOT, ALP, and albumin levels in pregnant women. Consequently, further studies are needed to define the role of HCMV in liver disorders.

Comparison of De Ritis Rate for Del Nido Versus Blood Cardioplegia in Patients Who Underwent Coronary Artery Bypass Graft Under Cardiopulmonary Bypass

Aim: Within the scope of this research, we aimed to compare the liver function tests, liver enzymes and De Ritis ratio (AST/ALT) of patients given Del Nido cardioplegia and blood cardioplegia in coronary heart surgery. Methods: This retrospective study included a total of 80 patients who underwent CPB-guided coronary heart surgery (CABG) with 40 Del Nido cardioplegia solutions and 40 blood cardioplegia solutions. CPB-guided coronary heart surgery patients given Del Nido cardioplegia solution were determined as the first group (Group 1), and patients given blood cardioplegia were determined as the second group (Group 2). Results: Preoperative and postoperative aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin, direct bilirubin, and gamma-glutamyl transferase (GGT) levels of the groups were similar (p

Геронтологические особенности влияния новой коронавирусной инфекции на показатели интерлейкинового профиля, воспаления и эндогенной интоксикации у пациентов зрелого и пожилого возраста с ишемической болезнью сердца

Background: Coronary heart disease (CHD) is considered as an independent risk factor for COVID19, however, the indicators of inflammation and endogenous intoxication in patients with CHD 3-4 weeks after recovery from COVID-19 have not been the subject of scientific research. The aim of the study: Assessment of the gerontological features of the effect of the transferred new coronavirus infection on the indicators of the interleukin profile, inflammation and endogenous intoxication of mature and elderly patients with coronary heart disease in the early stages of recovery. Materials and methods: The study included 58 mature-age patients with coronary heart disease 3-4 weeks after recovery from COVID-19 of moderate severity, who made up the comparison group. The main group of patients was represented by 62 elderly people with coronary heart disease who had suffered a new coronavirus infection and were examined in the same way as the previous group, 3-4 weeks after recovery. The level of C-reactive protein and highly sensitive C-reactive protein in the blood was studied using the Nicomed-reader express analyzer, and antistreptolysin-O was studied using an immunoturbidimetric method on the Cobas 600 analyzer (Switzerland). The blood levels of bilirubin, urea, creatinine and sialic acids were studied using the ROKI biochemical analyzer. The content of systemic cytokines was determined by the Beckton Dickinson FACS Canto 2 (USA). The level of anxiety and depression was studied on the HADS scale. Results: 3-4 weeks after recovery from COVID-19, antistreptolysin-O levels ranged from 120.9 МЕ/ml to 208.1 МЕ/ml. Significant changes among the considered parameters of inflammation and endogenous intoxication in patients with coronary heart disease in old age during recovery from a new coronavirus infection were accompanied by a change in the content of highly sensitive C-reactive protein in peripheral blood. In the early stages of recovery after COVID-19, in elderly patients with coronary heart disease, the concentration of many studied cytokines in blood plasma remained elevated compared with those aged 45-59 years. The excess of reference values in both groups was found for IL-17, TNF-α and IFN-α, and among elderly patients – for IL-3, IL-4, IL-6, IL-7, IL-17. Conclusion: Antistreptolysin-O, highly sensitive C-reactive protein, C-reactive protein can be considered markers of recovery in patients with combined coronary heart disease in the early stages after a new coronavirus infection.

HYPERBILIRUBINEMIA: A NEW DIAGNOSTIC MARKER FOR ACUTE APPENDICITIS AND ITS PART IN PREDICTING APPENDICULAR PERFORATION

Introduction:Acuteappendicitis is the commonest cause of Acute Surgical abdomen.Appendicectomy is the most frequently performed urgent abdominal operation and is often the first major procedure performed by a surgeon in training. Aims&amp;Objectives:The objectives of the study were-To study the relationship between hyperbilirubinemia and acute appendicitis and to evaluate its credibility as a diagnostic marker for acute appendicitis. Materials&amp;Methods:The study was conducted in the Department of General Surgery, HKEs Basaveshwar Teaching and General Hospital, kalaburagi attached to MahadevappaRampure Medical College, kalaburagi during the period of August 2022 to August 2023. A one year cross sectional study. Results:A total of 100 patients with clinical diagnosis of acute appendicitis or appendicular perforation admitted in the Department of General surgery, HKEs Basaveshwar Teaching &amp; General Hospital, kalaburagi attached to MahadevappaRampure Medical College, kalaburagi were studied. Discussion:Acute appendicitis is the most common cause of acute abdomen in young adults. Appendicectomy is the most frequently performed urgent abdominal operation and is often the first major procedure performed by a surgeon in training.PPAbout 8% of people in Westerncountries have appendicitis at some time in their lifetime. Conclusion: The present study suggests-Serum bilirubin levels appears to be a promising new laboratory marker for diagnosing acute appendicitis, however diagnosis of appendicitis remains essentially still - clinical. Its level come out tobe a credible aid in diagnosis of acute appendicitis and would be helpful investigation in decision making.

Bilothorax as an endoscopic retrograde cholangiopancreatography complication and a review of the literature.

Bilothorax, the accumulation of bile in the pleural space, is an uncommon but serious condition often linked to biliary tract or diaphragmatic injury. This case report describes a 70-year-old female with decompensated liver cirrhosis due to primary sclerosing cholangitis, who developed a moderate sized pleural effusion following ERCP and biliary stenting. The patient's pleural effusion persisted for 2 months without respiratory symptoms, indicating a self-limited low-volume leak. She eventually underwent thoracentesis for a non-resolving unilateral effusion, which drained 435 mL of bilious fluid with an elevated pleural fluid bilirubin level, confirming the diagnosis of bilothorax. This case highlights the importance of considering bilothorax as a cause of pleural effusion in patients with biliary tract disease and who undergo high risk procedures including ERCP.

2D MoS2 plasmonic nanocavity based SERS platform for bilirubin detection

Although various methods can be used to detect bilirubin at the micromolar level, achieving reliable detection in the sub-nanomolar range remains challenging. Sensitivity at these ultralow levels is vital, as new evidence strongly associates bilirubin with chronic heart, lung, and neurological disorders. This accuracy is also essential for creating diagnostic protocols that can efficiently track bilirubin levels, assisting in managing related conditions. Such advancements will lead to enhanced diagnostic tools and methods, enabling more precise bilirubin monitoring in clinical environments. Here, the aforesaid blind-spot is addressed by utilizing surface enhanced Raman spectroscopy (SERS) as fingerprint technique to detect bilirubin concentrations as low as 0.1 nM. A plasmonically active 2D MoS2 based SERS substrate is formulated and optimized for single step SERS sensing of bilirubin. Plasmonic cavity based approach is utilized to circumvent the problem related to fluorescent background overwhelming the SERS signal. The 2D MoS2 based SERS platform shows threefold enhancement of scattering in comparison to the traditional gold nanoparticle on Si/SiO2 approach. The Raman signature of bilirubin is calibrated by taking citrate as a stable reference analyte and is shown to vary linearly with logarithmic concentration across the picomolar to micromolar range.

Non-invasive detection of bilirubin concentrations during the first week of life in a low-resource setting along the Thailand–Myanmar border

BackgroundNeonatal hyperbilirubinaemia (NH) is a common problem worldwide and is a cause of morbidity and mortality especially in low-resource settings.MethodsA study was carried out at Shoklo Malaria Research Unit (SMRU)...

Evaluating the performance of egami, kobayashi and sano scores in predicting IVIG resistance in infant kawasaki disease

BackgroundThis study aimed to evaluate the effectiveness of Egami, Kobayashi and Sano scores in predicting intravenous immunoglobulin (IVIG) resistance in infant Kawasaki disease (KD), considering its unique clinical presentation.MethodsWe retrospectively analysed 143 infants aged < 12 months and diagnosed with KD at a single centre from 2019 to 2023. Patients were divided into IVIG-resistant and IVIG-responsive groups. Demographic, clinical and laboratory data were compared between the groups. The diagnostic performance of Egami, Kobayashi and Sano scores in predicting IVIG resistance was evaluated using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under the receiver operating characteristic curve (AUC). Additionally, we developed a new scoring system based on significant predictors identified in our cohort.ResultsAmong 143 infants, 45 (31.5%) showed IVIG resistance. The IVIG-resistant group had a significantly higher rate of coronary artery lesions (15.6% vs. 5.1%, p = 0.036). Incomplete KD was observed in 61.5% of cases. Egami, Kobayashi and Sano scores exhibited low sensitivity (35.6%, 55.6% and 20%, respectively) and moderate specificity (77.6%, 63.3% and 95.9%, respectively) in predicting IVIG resistance. The AUC ranged from 0.583 to 0.674, indicating poor to fair discriminative ability. Our newly developed scoring system, based on total bilirubin and albumin levels, showed similar performance (AUC 0.633) to existing scores.ConclusionsExisting Japanese risk scoring systems and our newly developed score showed limited effectiveness in predicting IVIG resistance in infant KD. The high proportion of incomplete presentation and IVIG resistance in infants highlights the need for age-specific risk assessment and management. Further research is necessary to develop more sophisticated, dedicated prediction model for IVIG resistance in infants with KD.

Evaluation of some haematological, liver, and renal function biomarkers in different job categories at Kufa cement factory workers: a cross-sectional study.

To evaluate the workplace health-related environment of workers in various job categories at a cement factory. The cross-sectional study was conducted at the Kufa Cement Factory, Najaf, Iraq, from November 12, 2021, to January 12, 2022 and comprised adult male non-smoking factory workers in group A, and healthy, unexposed non-smokers in control group B. Subjects in group A were subdivided into factory, kiln and packing workers. All the participants were subjected to blood tests for liver and kidney functions. Data was analysed using SPSS 27. Of the 90 subjects, 45(50%) were each of the 2 groups. The mean age of group A workers was 46.581±1.559 years and they had a mean duration of exposure 15.953±0.873 years. There were 15(33.3%) factory workers and as many kiln and packing workers. Group A subjects worked for at least 7-8 hours per day. The subjects in control group B had a mean age of 45.01±8.17 years and were matched for gender. There was significant elevation in total leukocyte count, alkaline phosphatase, aspartate aminotransferase and alanine aminotransferase in group A compared to group B (p<0.05). Neutrophils were significantly high in factory workers than controls and packing workers (p<0.05), while total bilirubin level was significantly high in factory and kiln workers than controls (p<0.05). There was no significant difference in the mean serum creatinine level between the groups (p>0.05). Workplace exposure to cement particulate in a factory environment was found to have a harmful impact on health.

Safety Evaluation and antioxidant potential of new probiotic strain Bacillus subtilis (NMCC-path-14) in Balb/c mice by sub-acute repeated dose toxicity

Probiotics have recently gained significant interest for their possible therapeutic effects in treating numerous health conditions. Probiotics containing Bacillus subtilis have been shown to have several health benefits, most notably in preventing diarrhea and gastrointestinal problems. A novel probiotic strain, Bacillus subtilis (NMCC-path-14), isolated from the rumen of a Nilli Ravi Buffalo, was evaluated for 28-day repeated dose toxicity in Balb/c mice. The NMCC-path-14 in low dose (1 × 108 CFU/ml) and high dose (1 × 1010 CFU/ml) was administered to the mice through gavage regularly. After 28 days of treatment, it was discovered that the no-observed-adverse-effect level (NOAEL) for NMCC-path-14 wasgreater than 1 × 1010 CFU/animal/day. This study also revealed no treatment-related changes in clinical parameters, body weight, gross pathology, or histology. Food consumption, hemoglobin, hematocrit, red blood cell counts, and colon length increased, while total/differential leukocyte count and platelets remained unchanged. The administration of NMCC-path-14 also resulted in decreased bilirubin and creatinine levels. Furthermore, NMCC-path-14 also displayed a promising antioxidant potential by increasing the antioxidant enzymes (GST, GSH, and CAT) and decreasing oxidant enzyme (MDA and NO) levels in vital organs like the liver, kidneys, spleen, and colon. TheNMCC-path-14also decreased the pathogenic bacterial population while increasing the beneficial population. Given the lack of adverse effects observed after NMCC-path-14 treatment, this strain is safe and must be considered as a potential probiotic in humans.

The role of microenvironmental factors in the pre-ovulatory oocyte in the pathogenesis of “poor” ovarian response to in vitro fertilization (IVF) programs

Background. The “poor” response to ovarian stimulation during IVF (in vitro fertilization) cycles depends on various factors, including the biochemical composition of the follicle microenvironment. Recent studies have focused on the relationship between vascular tone regulators, angiogenic factors, oxidative stress, and the quality of oocytes. Despite this, there is still no consensus on the exact effect of these factors on folliculogenesis or their role in “poor” responses.Objective. To evaluate the content of biochemical factors and regulators of vascular tone and angiogenesis in follicular fluid in patients with a “poor” ovarian response to stimulation in IVF programs, compared to similar indicators in women with a normal ovarian response.Materials and methods. An open prospective cohort study was conducted, including 56 patients who were part of the IVF program. The criterion for separating the cohort of women was their response to controlled ovarian stimulation during the IVF cycle. Women with a “poor” response (n=32) were placed in the main group, while those with a normal response (n=24) were in the comparison group. Follicular fluid samples from women with a “poor” response were divided into two subgroups based on the presence or absence of an oocyte-cumulus complex in the follicle. The biochemical and soluble regulatory factors in follicular fluid were analyzed in both groups after controlled ovarian stimulation was completed. Statistical analysis of the data was done using methods from variation statistics. A critical level of significance for the differences was set at p ≤0.05.Result. The levels of urea, glucose, high-density lipoprotein, and total antioxidant status (TAOS) in follicular fluid (FF) from patients with a “poor” ovarian response were statistically significantly higher compared to those in the control group. The levels of bilirubin, low-density lipoprotein, and uric acid were also significantly lower in VF from patients in the main group compared to the control group, p&lt;0.05. The indices of vascular endothelial growth factor (VEGF-A) and vascular endothelial growth receptor-2 (VEGFR-2) in FF from women with a “poor” response were significantly lower than those from patients with a normal response, while the levels of endogenous nitric oxide were significantly higher in the former group compared to the latter, p&lt;0.05.Conclusion. The absence of an oocyte-cumulus complex in the pre-ovulatory follicle, which is associated with a “poor” response of the ovary to stimulation, is likely due to a disruption in vascularization processes. This is supported by a decrease in the levels of pro- and anti-angiogenic factors, such as VEGF-A and VEGFR-2.

Contrast-enhanced ultrasound-guided percutaneous transhepatic cholangiodrainage is a safe and effective procedure for patients with malignant biliary obstruction and stage 3 chronic kidney disease

ObjectivesThis study aimed to validate the efficacy and safety of contrast-enhanced ultrasound-guided percutaneous transhepatic cholangiodrainage (CEUS-PTCD) as a biliary drainage procedure in patients with malignant biliary obstruction and stage 3 chronic kidney disease (CKD3). Materials and methodsBetween January 2019 and December 2023, 634 patients who underwent CEUS-PTCD were retrospectively enrolled in this study. During the procedure, imaging parameters such as the maximum diameter of the dilated bile duct, presence of ascites, detailed findings from CEUS, and clinical outcomes were meticulously recorded. Laboratory results, including serum bilirubin levels, liver function tests, and estimated glomerular filtration rate (eGFR), were evaluated in one day before and three days after procedure. The aforementioned parameters were compared using the paired-sample t test and the Wilcoxon test. ResultsA total of 66 (10.41 %) patients with malignant biliary obstruction and CKD3 were included in the final analysis (median age: 66, range: 30–89 years, 46 males and 20 females). Procedure records indicated that 23 patients (34.8 %) had a maximum biliary duct dilation diameter of ≤ 4 mm, while 5 patients (7.6 %) exhibited mild ascites. Additionally, 24 patients (36.4 %) had ultrasound contrast agent entry into both the biliary duct and bloodstream. All patients successfully achieved external bile drainage following CEUS-PTCD, with no significant complications observed during or after the intervention. Post-procedure, there was a statistically significant reduction in all previously elevated serum bilirubin and liver enzyme levels (P-values were less than 0.05). Furthermore, no statistically significant alterations in eGFR were observed prior to or following CEUS-PTCD across all patients (P = 0.295), including comparisons between groups with and without the ultrasound contrast agent into the bloodstream (P = 0.254). ConclusionCEUS-PTCD is a safe and effective biliary drainage procedure for patients with malignant biliary obstruction and CKD3.

The use of a simple and affordable skin patch for measurement of transcutaneous bilirubin levels in neonates during phototherapy.

Transcutaneous bilirubin (TcB) measurements during and after phototherapy for hyperbilirubinemia must be performed on unexposed skin. There are commercially made skin patches for this purpose, but they are relatively unavailable in low-resource settings. We devised a simple cotton patch and tested its use for TcB during phototherapy. Measurements were taken in healthy neonates born at a gestational age of ≥35 weeks who were undergoing phototherapy for hyperbilirubinemia in western India before, 12 h after the start, and 12 h after the end of phototherapy. Total serum bilirubin (TSB) was measured using the diazo method in a clinical laboratory. TcB measurements were performed using a Dräger Jaundice Meter JM-105 placed over the sternum on two skin areas that were protected during and after treatment by a commercial (Philips BilEclipse) or self-made patch comprised of cotton gauze and wool. In total, 47 neonates were included in our study. Before phototherapy, TSB and TcB values had a strong correlation (Pearson, r = 0.88), with a mean difference of -1.35 mg/dl. Correlations with TSB were good and equivalent for TcB values measured on skin covered by the commercial and self-made patches during (0.78 and 0.70, respectively) and after (0.57 and 0.58, respectively) phototherapy. TcB values measured on skin covered by the two patches correlated well both during and after phototherapy, with r = 0.82 and 0.90, respectively, and mean (95% confidence interval) differences of -1.21 and -0.32 mg/dl, respectively. Reliable TcB measurements taken during and after phototherapy can be achieved on skin covered with a simple and affordable cotton skin patch.