Blood Bilirubin Levels Research Articles

Bilirubin and Redox Stress in Age-Related Brain Diseases.

Cellular redox status has a crucial role in brain physiology, as well as in pathologic conditions. Physiologic senescence, by dysregulating cellular redox homeostasis and decreasing antioxidant defenses, enhances the central nervous system's susceptibility to diseases. The reduction of free radical accumulation through lifestyle changes, and the supplementation of antioxidants as a prophylactic and therapeutic approach to increase brain health, are strongly suggested. Bilirubin is a powerful endogenous antioxidant, with more and more recognized roles as a biomarker of disease resistance, a predictor of all-cause mortality, and a molecule that may promote health in adults. The alteration of the expression and activity of the enzymes involved in bilirubin production, as well as an altered blood bilirubin level, are often reported in neurologic conditions and neurodegenerative diseases (together denoted NCDs) in aging. These changes may predict or contribute both positively and negatively to the diseases. Understanding the role of bilirubin in the onset and progression of NCDs will be functional to consider the benefits vs. the drawbacks and to hypothesize the best strategies for its manipulation for therapeutic purposes.

Spectral and temporal detection of blood bilirubin level using a point-of-care device.

Bilirubin is a biomarker for liver inflammation used to assess liver functions. Its concentration in the blood has been measured using a range of techniques both in clinical and point-of-care settings. Existing point-of-care devices utilize a spectral approach, namely dual-wavelength absorption measurement, to assess the blood bilirubin concentration. This work examines a novel temporal approach based on the photodegradation of bilirubin in the blood sample. It demonstrates that combining photodegradation characteristics with dual-wavelength measurement produces a more accurate technique for measuring blood bilirubin concentration. Tracking the evolution of absorbed light as a function of time represents a low-cost and simple way of improving the accuracy of point-of-care devices for bilirubin measurements.Clinical Relevance - This work demonstrates a facile and cheap bilirubin monitoring approach that may allow bilirubin monitoring applications in homes after a patient is discharged from a hospital, which may decrease the burden on patients, families, and clinicians.

The Practice of Pancreatoduodenectomy in India: A Nation-Wide Survey.

Introduction The way pancreatoduodenectomy (PD) is performed can vary a lot around the world, and there is no agreed-upon standard approach. To learn more about how PD is practised in India, a survey was conducted among Indian surgeons to gather information about their current practices. Methods A survey was created and shared with surgeons in India who practicepancreatic surgery. It had 33 questions that aimed to capture information about different aspects of PD practice. These questions covered topics such as the surgeons' education and experience, how they evaluated patients before surgery, what they considered during the operation, and how they managed patients after surgery. Results A total of 129 surgeons were sent the survey, and 110 of them completed it. The results showed that 40.9% of the surgeons had less than five years of experience, and 36.4% of them performed more than 15 PDs in a year. When deciding whether to perform preoperative biliary drainage, 60% of surgeons based their decision on the level of bilirubin in the patient's blood, while the rest considered other specific indications. The majority of surgeons (72.7%) looked at the trend of albumin levels to assess the patient's nutritional status before surgery. Venous infiltration was seen as a reason for neoadjuvant therapy by 76.4% of the participants, whereas 95.5% considered upfront surgery in cases of venous abutment. When it came to the type of PD, 40% preferred classical PD, 40.9% preferred pylorus-resecting PD (PRPD), and the rest chose pylorus-preserving PD (PPPD). Pancreatojejunostomy (PJ) was the preferred method for 77.3% of surgeons, while 6.3% preferred pancreatogastrostomy (PG). About 65.5% of surgeons used octreotide selectively during the operation when the duct diameter was small. Nearly all surgeons (94.5%) preferred to secure feeding access during PD, and all of them placed intraperitoneal drains. As for postoperative care, 37.3% of surgeons attempted early oral feeding within 48 hours, while 28.2% preferred to wait at least 48 hours before initiating oral feeds. Conclusions The survey revealed significant differences in how PD is practised among surgeons in India, highlighting the heterogeneity in their approaches and preferences.

Gut–liver axis and the impact of probiotics on neonatal jaundice symptoms: a review

Neonatal jaundice, which can affect up to 60% of term and 80% of preterm babies, can have a serious detrimental effect on their health. The effects of microbiota on neonatal bilirubin are poorly understood, which creates a critical knowledge gap about how they affect the neonate's blood bilirubin levels and how the gut delicately balances close contact with the host. Prebiotics and probiotics have a significant impact on the management of hyperbilirubinemia, but their effectiveness is still being debated. To offer a compelling novel therapeutic approach for newborn hyperbilirubinemia, a thorough understanding of the process is required.

Significance of portal venous blood flow as a factor to determine liver function in patients with decompensated cirrhosis due to hepatitis C virus infection following achievement of sustained viral response by sofosbuvir plus velpatasvir.

To determine the outcomes concerning portal venous blood flow and portosystemic shunts in patients with decompensated cirrhosis due to hepatitis C virus (HCV) infection who achieved sustained viral response (SVR) following antiviral therapy. Portal hypertension-related events and liver function were evaluated in 24 patients achieving SVR following sofosbuvir plus velpatasvir therapy. Serum albumin level (median; g/dL) increased from 2.9 at baseline to 3.5 at 12weeks after the end of treatment (EOT) (p=0.005), while liver volumes (cm3 ) decreased from 1260 to 1150 (p=0.0002). Portal hypertension-related events developed in 10 patients (41.7%), and the cumulative occurrence rates after the EOT were 29.2%, 33.3%, and 46.1% at 24, 48, and 96weeks, respectively. Multivariate logistic regression analysis revealed that the maximal diameter of the shunts (p=0.0235) was associated with the development of the events, with a cut-off value of 8.3mm (p=0.0105). Meanwhile, multiple linear regression analysis revealed that portal venous blood flow, liver volume, serum albumin, and bilirubin levels at baseline were associated with serum albumin levels at 12weeks after EOT (p=0.0019, p=0.0154, p=0.0010, and p=0.0350, respectively). In patients with decompensated cirrhosis due to HCV infection, the baseline portal venous blood flow and liver volume and function were predictive of liver function following SVR, while the maximal diameter of portosystemic shunts predicted the occurrence of portal hypertension-related events.

Preparation of chitin/MXene/poly(L-arginine) composite aerogel spheres for specific adsorption of bilirubin

Currently, hemoperfusion is clinically the most rapid and effective treatment for removing toxins from the blood. The core of hemoperfusion is the sorbent inside the hemoperfusion device. Due to the complex composition of the blood, adsorbents tend to adsorb substances such as proteins in the blood (non-specific adsorption) while adsorbing toxins. Hyperbilirubinemia is caused by excessive levels of bilirubin in the human blood, causing irreversible damage to the patient's brain and nervous system, and even leading to death. High adsorption and high biocompatibility adsorbents with specific bilirubin adsorption are urgently needed to treat hyperbilirubinemia. Herein, poly(L-arginine) (PLA) which can specifically adsorb bilirubin, was introduced into chitin/MXene (Ch/MX) composite aerogel spheres. Ch/MX/PLA prepared by supercritical CO2 technology had higher mechanical properties than Ch/MX and can withstand 50,000 times its own weight. The in vitro simulated hemoperfusion test showed that the adsorption capacity of Ch/MX/PLA was as high as 596.31 mg/g, which was 15.38 % higher than that of Ch/MX. Binary and ternary competitive adsorption tests showed that Ch/MX/PLA also had good adsorption capacity in the presence of a variety of interfering molecules. In addition, hemolysis rate testing and CCK-8 testing confirmed that Ch/MX/PLA had better biocompatibility and hemocompatibility. Ch/MX/PLA can meet the required properties of clinical hemoperfusion sorbents and has the ability to produce mass production. It has good application potential in the clinical treatment of hyperbilirubinemia.

Effect of Seasonal Variation on the Bilirubin Content and Hematological Indices among Neonates in Southern Gaza, Palestine

BACKGROUND & OBJECTIVES: Premature newborns’ bilirubin conjugation and excretion mechanisms are undeveloped. Seasonal changes and other variables affect the severity of newborns’ physiological jaundice. This study examined blood indices, bilirubin levels, and birth season in neonates in the southern Gaza Strip of Palestine.
 
 METHODS: A cross-sectional study of 366 neonates aged one to 14 days was conducted in Medical Nasser Complex-Southern Gaza, Palestine.The newborns were divided into four groups based on season of birth: spring (n=72), winter (n=96), autumn (n=103) and summer (n=95). Blood samples were collected in plain vacutainers for assaying bilirubin profile and complete blood count. Bilirubin and complete blood count were assayed by commercial kits. SPSS software was used for data analysis. 
 
 RESULTS: Indirect and total bilirubin showed significant seasonal variations, whereas direct did not. Spring and winter have increased indirect and total bilirubin. Seasonal hemoglobin levels varied significantly. Red blood cells, hemoglobin, and hematocrit positively correlated with total and indirect bilirubins. 
 
 CONCLUSION: Spring and winter births exhibited higher indirect and total bilirubin in the first two weeks. The birth season appears to affect newborn jaundice. Short sunshine duration may increase neonatal hyperbilirubinemia risk.

Safety Profile of Eltrombopag in Different Age Groups: An Analysis of Real-World Pharmacovigilance and Randomized Clinical Trials.

Eltrombopag is clinically approved for use in immune thrombocytopenia (ITP), chronic hepatitis C-related thrombocytopenia, and aplastic anemia and suitable for children; however, data on its overall safety profile are scarce. This study aimed to explore the clinical features of adverse drug events (ADEs) associated with eltrombopag in different age groups using individual case safety reports (ICSRs) from the World Health Organization database VigiBase and the US Food and Drug Administration Adverse Event Reporting System database from 2008 to 2022 in combination with a meta-analysis of data from randomized clinical trials in the literature from inception to July 28, 2022. We conducted disproportionality analyses by grouping patients into the following age groups: 0-17 (0-23 months, 2-11 years, and 12-17 years), 18-64, and ≥ 65 years. The ADEs about hepatobiliary disorders, thrombosis, skin and subcutaneous tissue disorders, infections, and so on were observed more differently in each age group. Meta-analysis results showed differences in the four system organ classes between adults and children with ITP: infections and infestations, general disorders and administration site conditions, skin and subcutaneous tissue disorders, and investigations. The adverse drug reactions in the latest version of instructions were searched in the databases to analyze their postmarketing safety signal strength. We observed signals of elevated alanine aminotransferase, aspartate aminotransferase, and blood bilirubin levels in all age groups. For children, urinary tract infection and back pain showed signals. Due to the inherent limitations of pharmacovigilance studies, more experiments are needed to assess the risks of eltrombopag in different ages.

A review on role of Indian medicinal plants in treatment of Icterus

Indian medicinal plants play the very effective and important role in human’s life. Numerous medicinal plant species, particularly those used to treat Icterus, are regarded as a crucial therapeutic resource in the fight against these illnesses. When the blood level of bilirubin rises, a chronic condition called Icterus (Jaundice) develops.This review article highlights various medicinal plants that Indian tribal and rural populations utilize to treat Icterus.The study reveals 13 medicinal plant species, which are used for treating Icterus in India. The main aim of this review is to highlight the indigenous information of medicinal plants,which are specifically used for the prevention of Icterus. The plant species that are most frequently observed and utilized as medicines for treating Icterus are Acacia Nicotica, Abrus precatorius, Aloe barbadensis, Arhenome maxicanal, Boerhaavia diffusa, Carica papaya, Cajanus cajan, Cassia angustifolia, Curcurma angustifolia, Eclipta alba, Emlica officinalis, Ficus hispida. In order to create new medications that may be significantly more effective than the ones now available, plants that are often used to treat Icterus must first undergo scientific validation through pharmacological study.

A prospective study on correlation of cord blood bilirubin with occurrence of neonatal hyperbilirubinemia

Background: Neonatal hyperbilirubinemia is one of the most common problems that can occur in a healthy new-born. This physiological rise in indirect component of bilirubin resolves gradually without any intervention in majority of cases. But few babies require intervention in the form of phototherapy and exchange transfusion when the bilirubin levels exceed the normal physiological range for gestational age. The study was aimed to evaluate the predictive value of cord blood bilirubin level for identifying newborn for development of significant hyperbilirubinemia. Methods: It was a prospective observational study carried out in Adichunchanagiri Institute of Medical Sciences, B.G. Nagara, Karnataka. The cord blood bilirubin at birth and 48 hrs serum bilirubin levels were measured. Also, blood group, Rh status and DCT (direct coomb’s test) were tested to estimate the risk in development of hyperbilirubinemia. Results: A total of 210 were included in the study, out of which 52 babies required phototherapy, with a sensitivity of 94.23% and specificity of 3.97%, with the mean cord blood bilirubin level of 2.6mg/dl, having sensitivity of 63.46% and specificity of 90.50%. The multivariate analysis showed ABO and Rh incompatibility, cord blood bilirubin level and lower gestational age had an increased the risk of hyperbilirubinemia requiring phototherapy. Conclusions: Cord blood bilirubin may be used as a potential tool to determine hyperbilirubinemia in newborns. And initiation of phototherapy early in at-risk neonates may decrease the hyperbilirubinemia related morbidity and mortality. Keywords: hyperbilirubinemia; cord blood bilirubin; phototherapy; newborn

Frequency of Glucose 6 Phosphate Dehydrogenase Deficiency in Neonates Presenting with Jaundice

Objective: Frequency of Glucose – 6- Phosphate Dehydrogenase deficiency in neonates presenting with jaundice Study design: A cross-sectional study Place and Duration: Pediatric department, civil hospital Karachi from January to June 2019 Methodology: The study included all infants who were hospitalized in the neonatology unit with jaundice. At the beginning of the trial, the parents of each neonate gave their assent after being assured that there would be no monitoring burden placed on the parents for the examinations. When entering the hospital, the researcher himself completed a predesigned proforma that asked for specific details about the patient's age, sex, ethnicity, jaundice onset age, consanguinity, and family history of G6PD deficiency. Investigations on newborns included measuring serum bilirubin and looking for signs of G6PD deficiency. (Estimation of G6PD enzymes). Sigma Diagnostic G6PD Reagent was used to estimate the G6PD enzymes for the qualitative, visual, and calorimetric assessment of G6PD deficit in red blood cells. When the sample's deep blue colour changes Results: 174 infants with jaundice in total were included during the study period. Participants in the study had an average age of 16.12 +/- 7.2 days. 95 (54.6%) of the 174 study participants were men, and the male-to-female ratio was 1.2:1. It started at an average age of 8.83.8 days. 79 (45.5%) out of a total of 117 (67.2%) participants are Pathans by consanguineous marriage. 23 (13.2%) of the 174 subjects were G6PD deficient. According to a stratified analysis, out of 23 G6PD-deficient newborns, 11 (47.8%) were between 1 and 11 days old, 19 (82.6%) were between 0 and 6 days old, and 14 (60.8%) had blood bilirubin levels below 15 mg/dl. Conclusion: It was concluded that G6PD is a common cause of neonatal jaundice in our setup. Keywords: Neonates, Jaundice, G6PD deficiency

Cord Blood Albumin and Bilirubin as Predictor of Neonatal Jaundice

Background: Jaundice in newborn is quite common affecting nearly 60% of term and 80% of preterm neonates during the first 7 days of life. It is the most common cause of readmission in the hospital during early neonatal period. Aims: To find out the sensitivity of cord blood bilirubin and albumin level in predicting neonatal hyperbilirubinemia in healthy newborn. Material and Methods: The study was conducted on 200 full term healthy babies delivered by LSCS and were followed up till day 3 of life. 2ml of blood was drawn for estimating albumin and bilirubin in a sterile manner from the umbilical cord & then veni puncture at 72 hrs of life from those neonates for estimation of bilirubin. All these samples were taken to the laboratory immediately. Results: from 200 babies, 53 babies developed significant hyperbilirubinemia (>15mg/dl) with incidence of 26.5%. The mean weight of these babies was 2.47±0.38kg, mean cord blood bilirubin was 2.83±0.44mg/dl, mean cord albumin was 2.64±0.3 gm/dl and mean total serum bilirubin after 72 hrs of life was 17.31±2.09mg/dl. Cord blood bilirubin >2.5mg/dl had a sensitivity of 90.5% and specificity 90.4% in the development of hyperbilirubinemia and had a direct correlation, wherever cord blood albumin <2.8gm/dl has sensitivity 86.0% and specificity of 93% and showing an inverse correlation. Conclusion: Neonates with cord blood bilirubin <2. 5mg.dl and cord blood albumin >2.8 can be safely discharged early whereas neonates with bilirubin >2.5gm/dl and cord blood albumin <2.8g/dl will need close follow up for development of significant hyperbilirubinemia. Keywords: Hyperbilirubinemia, cord blood, bilirubin, albumin

Bi-modal system-on-chip platform for bilirubin monitoring by using photometric and temporal degradation approaches

Hyperbilirubinemia in infants and cirrhosis in adults remain major global causes of sickness and death, predominantly for people living in areas with poor or limited healthcare resources. Clinically, the two conditions require measuring levels of bilirubin in blood for diagnostic and prognostic purposes. While the existing techniques provide the most comprehensive pathology-lab results, they suffer from complexity and size requirements, and measurements are impractical for point-of-Care (PoC) testing. Furthermore, the existing transcutaneous devices (for neonates) are pricey, preventing the possibility of dissemination for home health care applications. This study uses an integrated and all-inclusive miniature (3.5 × 7.0 mm) system-on-chip platform (MAX86916) to measure bilirubin concentration. On MAX86916 embeds two optical sources (blue LED and green LED) which are utilized for dual-wavelength (DWL) measurement. Furthermore, a new photodegradation kinetics approach was incorporated with DWL approach to enhance the overall system reliability and accuracy. Bilirubin concentration was extracted by monitoring the optical transmission and the photodegradation responses. Measurements were carried out on porcine blood, the best existing surrogate for human blood, and the concentration of bilirubin was maintained within the range of pathophysiological levels (1 mg/dL to 50 mg/dL). The measurement could require a volume of less than 10 µL of a blood sample. Our findings show a good system accuracy of ∼ ±10 % and lay the groundwork for PoC bilirubin monitoring, primarily for hyperbilirubinemia and cirrhosis out of clinics and hospitals.

Umbilical Cord Blood Bilirubin and Determination of Neonatal Hyperbilirubinemia

Objective: To determine accuracy of cord blood bilirubin in identifying significant neonatal hyperbilirubinemia. Methodology: A Cross sectional study was conducted in Pediatric department of Fauji Foundation Hospital Rawalpindi from Jan.2019 to June 2019. Cord blood samples were sent for the blood group and bilirubin levels. Neonates with cord bilirubin level > 2mg/dl and < 5 mg/dl were enrolled and admitted for 3 days and serum bilirubin level were done on 3rd day. Those developing significant hyperbilirubinemia were further investigated for hemoglobin, reticulocyte count, Coomb’s test and other causes. Results: Total 74 newborns at >35 weeks of gestation were included in the study of which 35 (47.3%) were male and 39 (52.7%) were female (male: female: 1:1.1). The data was analyzed using SPSS 17. At 3rd day of life mean ± SD cord blood bilirubin was 8.4 ± 2.7 mg/dl, mean direct bilirubin was 1.6 ± 0.9 mg/dl and mean indirect bilirubin was 6.8 ± 2.3mg/dl. Significant hyperbilirubinemia developed in 16 (21.6%) newborns at >35 weeks of gestation, who had a cord blood bilirubin level of > 2 mg/dl, so that the accuracy of cord blood bilirubin level (true positives) in determining significant hyperbilirubinemia was 21.6%. Conclusion: Cord blood bilirubin level >2mg/dl in all healthy term newborns predicts significant hyperbilirubinemia.

A Sex-Specific Comparative Analysis of Oxidative Stress Biomarkers Predicting the Risk of Cardiovascular Events and All-Cause Mortality in the General Population: A Prospective Cohort Study.

Oxidative stress plays a pivotal role in cardiovascular (CV) disease, but current biomarkers used to predict CV events are still insufficient. In this study, we comparatively assessed the utility of redox-related biomarkers in predicting the risk of CV events and all-cause mortality in male and female subjects from the general population. Subjects (n = 5955) of the Prevention of REnal and Vascular ENd-stage Disease (PREVEND) population-based cohort study were included. Blood homocysteine, gamma-GT, HDL cholesterol, bilirubin and protein-adjusted free thiol (R-SH, sulfhydryl groups) levels were quantified at baseline and were prospectively analyzed in association with the risk of CV events and all-cause mortality. After adjustment for potentially confounding factors, protein-adjusted R-SH and homocysteine levels were significantly associated with the risk of CV events in men (HR 0.63 [0.40-0.99], p = 0.045 and HR 1.58 [1.20-2.08], p = 0.001, respectively). Protein-adjusted R-SH and HDL cholesterol levels were significantly associated with the risk of all-cause mortality in men (HR 0.52 [0.32-0.85], p = 0.009 and HR 0.90 [0.85-0.94], p < 0.001, respectively), while the same was observed for bilirubin and homocysteine levels in women (HR 0.68 [0.48-0.98], p = 0.040 and HR 2.30 [1.14-3.76], p < 0.001, respectively). Lower levels of protein-adjusted R-SH were robustly associated with an increased risk of CV events and all-cause mortality in men. Our results highlight the value of R-SH levels in cardiovascular risk assessment and their potential significance as being amenable to therapeutic intervention, while reaffirming the importance of other oxidative stress-related biomarkers, such as homocysteine, HDL cholesterol and bilirubin.

Highly Sensitive Bilirubin Biosensor Based on Photonic Crystal Fiber in Terahertz Region

An unstable bilirubin level in the human blood causes many dangerous health problems, such as jaundice, coronary artery disease, ulcerative colitis, and brain lesions. Therefore, the accurate and early detection of bilirubin concentrations in the blood is mandatory. In this work, a highly sensitive biosensor based on photonic crystal fiber (PCF) for monitoring bilirubin levels is proposed and analyzed. The sensor parameters, including relative sensitivity, effective mode area, confinement loss, and effective material loss, are calculated. The geometrical parameters are studied, and a modal analysis of the suggested sensor is carried out using the full-vectorial finite element method (FEM). The fabrication tolerance of the geometrical parameters is also studied to ensure the fabrication feasibility of the reported design. High sensitivities of 95% and 98% are obtained for the x-polarized and y-polarized modes, respectively. Furthermore, a small material loss of 0.00193 cm−1, a small confinement loss of 2.03 × 10−14 dB/cm, and a large effective mode area of 0.046 mm2 are achieved for the y-polarized mode. It is believed that the presented sensor will be helpful in health care and in the early detection of bilirubin levels in the blood.

Hepatic responses following acute ischemic stroke: A clinical research update.

Acute ischemic stroke (AIS) not only affects the brain but also has significant implications for peripheral organs through neuroendocrine regulation. This reciprocal relationship influences overall brain function and stroke prognosis. Recent research has highlighted the importance of poststroke liver changes in determining patient outcomes. In our previous study, we investigated the relationship between stroke and liver function. Our findings revealed that the prognostic impact of stress-induced hyperglycemia in patients undergoing acute endovascular treatment for acute large vessel occlusion is closely related to their preexisting diabetes status. We found that the liver contributes to stress hyperglycemia after AIS by increasing hepatic gluconeogenesis and decreasing hepatic insulin sensitivity. These changes are detrimental to the brain, particularly in patients without diabetes. Furthermore, we examined the role of bilirubin, a byproduct of hepatic hemoglobin metabolism, in stroke pathophysiology. Our results demonstrated that blood bilirubin levels can serve as predictors of stroke severity and may hold therapeutic potential for reducing oxidative stress-induced stroke injury in patients with mild stroke. These results underscore the potential role of the liver in the oxidative stress response following AIS, paving the way for further investigation into liver-targeted therapeutic strategies to improve stroke prognosis and patient outcomes.

An unexpected association between the blood bilirubin level and eosinophil count

An unexpected association between the blood bilirubin level and eosinophil count

Preoperative predictor laboratory markers for complicated appendicitis: A retrospective analysis of single center experience

In this study, we aimed to investigate the pre-operative predictive role of the serum white blood cell and platelet counts, C-reactive protein (CRP), bilirubin, amylase, lipase, and sodium levels for complicated appendicitis in patients aged≥18 years. We retrospectively evaluated 574 patients (aged≥18 years) who underwent appendectomy due to acute appendicitis (AA) between March 2018 and March 2022 at our clinic. The patient population was divided into two groups as perioperative complicated and uncomplicated appendicitis and the preoperative predictor role of serum white blood cell counts, platelet counts, CRP, bilirubin, amylase, lipase, and sodium levels were compared for complicated versus uncomplicated appendicitis. In multivariate analyses, age&gt;38 years, the timing of Emergency Department (ED) arrival to admission ≥2 days, CRP ≥3.36 mg/dL, and total bilirubin ≥0.76 mg/dL are independent risk factors for detecting complicated AA. Moreover, in the designed scoring system, the AUC: 0.877 (CI: 0.847-0.907) for perforated AA at scores below or above. Estimation of the complications of AA can help clinicians practically with the scoring system designed because of the determined predictive factors.

Treatment principles of Ayurveda to manage Kamala (Jaundice): A case study

Abstract Jaundice is a condition, in which hyperbilirubinemia is found along with yellowish discoloration of the sclera, skin, mucous membrane, and interstitial fluid. The causes of jaundice are hemolytic diseases, hepatocellular dysfunction, and obstructive disorders of the hepatobiliary system. Clinical manifestations of jaundice arise when the blood bilirubin level exceeds 2.5 mg/dL. Jaundice can be put under the heading of Kamala described in Ayurvedic texts. A 12-year-old girl was visited in the outpatient department of the Kayachikitsa department at Ch. Brahm Prakash Ayurved Charak Sansthan with the chief complaints of low appetite, gaseous abdomen, yellowish discoloration of sclera, weakness, and vertigo for 1 week. The patient was investigated in the hospital and was diagnosed Jaundice with investigation. The patient was effectively managed by the combination of Phaltrikadi Kwath 20 mL empty stomach in the morning, combined powder of Katuki Churna 1 g and Bhumi Amalaki Churna 1 g after food with lukewarm water twice a day, and 15 mL of Abhyarishta at night with normal water was given. The outcome was assessed based on symptoms, and lab investigations showed profound results. Therefore, it can be said that these medications are quite successful in treating jaundice.