Serum Bilirubin Concentration Research Articles

Temporal alteration of serum bilirubin levels and its renoprotective effects in diabetic kidney disease: exploring the hormonal mechanisms.

This current study represents a novel endeavor to scrutinize the correlation between the temporal alteration in serum total bilirubin (TBIL) concentrations and the rate of estimated glomerular filtration rate (eGFR). Additionally, this study aims to probe the plausible molecular mechanism underpinning the renoprotective effects of bilirubin concerning its hormonal characteristics. In this study, a cohort of 103 patients diagnosed with DKD and receiving medical care at Dongzhimen Hospital were recruited and monitored over a period of 2-7 years. The progression of DKD was ascertained using a threshold of eGFR decline > -5.48%/year. To assess the relationship between the annual change in serum TBIL levels (%/year) and the slope of eGFR, multivariate binary logistic regression analysis was employed. Furthermore, the ROC curve analysis was employed to determine the cut-off value for TBIL levels (%/year). The use of multivariate binary logistic regression models revealed that serum TBIL levels (%/year) exhibited a significant correlation with the slope of eGFR. Moreover, the ROC curve analysis indicated a cut-off value of -6.729%/year for TBIL levels (%/year) with a sensitivity of 0.75 and specificity of 0.603, in diagnosing eGFR decline >-5.48%/year. The findings of this study suggest that the sustained elevation of serum bilirubin concentration within the physiological range can effectively retard the progression of Diabetic Kidney Disease (DKD). Furthermore, the hormonal attributes of bilirubin may underlie its renoprotective effects.

Determination of Serum Biochemical Profile and Oxidant-Antioxidant Activities in Damascus Goats at Different Ages

This study aimed to research changes in biochemical profile and oxidant-antioxidant activities of Damascus goats of different ages. The 45 non-gravid Damascus goats of different ages were included in the research. They were divided into three groups of 15 goats according to age: goat kids ( - ≤ 6-months age), young goats (2-3-year age) and old goats (5-8-year age). Biochemical parameters and oxidant-antioxidant activities were determined in serum samples using commercial kits and colorimetric methods. The lowest serum urea, blood urea nitrogen, aspartate aminotransferase, total protein, albumin, globulin and magnesium levels were observed in goat kids (P < .05). Concentrations of glucose, inorganic phosphorus, non-esterified fatty acids, albumin/globulin and alanine aminotransferase decreased with age in the goats (P < .05). Serum total oxidant capacity, total antioxidants capacity and oxidative stress index levels were increased in goat kids compared to old goats (P < .05). Furthermore the highest serum glutathione and glutathione preoxidase activities were observed in young goats (P < .05). An increase was determined in concentrations of serum β-carotene and bilirubin in old goats compared to goat kids (P < .05). In contrast, serum catalase activity, arylesterase, ceruloplasmin and uric acid values did not differ between the groups. The results obtained on the biochemical profiles and oxidant-antioxidant activities of Damascus goats will contribute to monitoring this breed's age-related health and nutritional status and establishing reference values.

Alteration of Serum Bilirubin and Myeloperoxidase Concentration Associated Moderate Intensity Exercise Among Novice Students Athletes

Alteration of Serum Bilirubin and Myeloperoxidase Concentration Associated Moderate Intensity Exercise Among Novice Students Athletes

Validity of BiliDx as a point-of-care bilirubin measurement device to diagnose and monitor neonatal jaundice at Muhimbili National Hospital, an observational study

BackgroundNeonatal jaundice is a condition caused by elevated levels of bilirubin in the bloodstream. Laboratory determination of serum bilirubin concentration by total serum bilirubin (TSB) test is still considered as gold standard for clinical guidance and practice. In developed countries, diagnosis of neonatal jaundice is shifting towards point-of-care medical devices. BiliDx is a device developed to allow a fast, blood-based determination of bilirubin levels at the point of care. This study aimed to determine the accuracy of the BiliDx device relative to a standard laboratory total serum bilirubin to diagnose and monitor jaundice among neonates admitted at Muhimbili National Hospital (MNH).Material and methodologyThis was a prospective hospital-based observational study conducted at the Neonatal Ward – MNH, Dar-es-Salaam, Tanzania from November 2022 to January 2023. A total of 180 neonates admitted at the neonatal ward with jaundice and whose parents consented were enrolled in the study. Blood samples were collected; 2 ml of venous blood into the vacutainer bottle for standard laboratory measurement of total serum bilirubin (TSB) and 25µL blood collected into a transfer pipette tube and applied to BiliDx. STATA version 15.1 was used for data analysis.ResultsOut of 180 neonates, 39.4% (71/180) had birth weight between 1500 − 2499.9 g, approximately 2/3rd (120/180) were preterm, 92/180 (51.1%) were males and 100/180 (55.6%) were undergoing phototherapy treatment the moment sample taken. The mean bilirubin concentration was 92 mmol/l for BiliDx and 118 mmol/l for standard laboratory TSB. The minimum and maximum values obtained with BiliDx were, 3.4 and 427.5 mmol/l respectively, compared with 10.7 and 382.1 mmol/l using standard laboratory TSB. A linear relationship and correlation coefficient of 0.8408 (p = 0.000) between BiliDx and standard laboratory TSB was found. The regression analysis showed the presence of constant error [coefficient of BiliDx/slope = 0.91, 95% CI (0.82–0.99), p = 0.000] and random error exclusively [coefficient of constant/y-intercept = 48.52, 95%CI (37.70-59.34), p = 0.000]. The Bland–Altman plot showed an acceptable mean difference of 39.1mmol/l, limits of agreement of -48.3mmol/l to 126.4mmol/l, and 179 points (179/180 = 99.4%) lying inside the limits of agreement.ConclusionThe results support the use of BiliDx for rapid and accurate testing of elevated levels of bilirubin in the bloodstream among neonates since 99.4% of the differences between BiliDx and standard laboratory TSB lie between the lines of agreement.

Role of Natural Compounds Modulating Heme Catabolic Pathway in Gut, Liver, Cardiovascular, and Brain Diseases.

The crucial physiological process of heme breakdown yields biliverdin (BV) and bilirubin (BR) as byproducts. BV, BR, and the enzymes involved in their production (the "yellow players-YP") are increasingly documented as endogenous modulators of human health. Mildly elevated serum bilirubin concentration has been correlated with a reduced risk of multiple chronic pro-oxidant and pro-inflammatory diseases, especially in the elderly. BR and BV per se have been demonstrated to protect against neurodegenerative diseases, in which heme oxygenase (HMOX), the main enzyme in the production of pigments, is almost always altered. HMOX upregulation has been interpreted as a tentative defense against the ongoing pathologic mechanisms. With the demonstration that multiple cells possess YP, their propensity to be modulated, and their broad spectrum of activity on multiple signaling pathways, the YP have assumed the role of an adjustable system that can promote health in adults. Based on that, there is an ongoing effort to induce their activity as a therapeutic option, and natural compounds are an attractive alternative to the goal, possibly requiring only minimal changes in the life style. We review the most recent evidence of the potential of natural compounds in targeting the YP in the context of the most common pathologic condition of adult and elderly life.

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

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

Immune thrombocytopenic purpura and thrombotic thrombocytopenic purpura — diagnostic difficulties and errors

Introduction. When establishing a diagnosis of thrombotic thrombocytopenic purpura (TTP) for the first time, other diseases occurring with thrombocytopenia may be misdiagnosed. Aim: to analyze diagnostic difficulties and errors of TTP. Materials and methods. In total, 54 patients (44 women and 10 men) aged 18 to 83 years (median 33 years), who were diagnosed TTP from 2019 to 2023, were included in the study. Anamnesis, baseline hemoglobin, platelets, erythrocytes, lactate dehydrogenase and bilirubin serum concentrations, pre-established diagnoses, treatment, and outcomes were analyzed. Results. Initially TTP was suspected only in 19 (35 %) patients. In 12 out of 54 patients immune thrombocytopenia (ITP) was initially misdiagnosed. Fisher-Evans syndrome was initially suspected in 3 patients. In sporadic cases, myelodysplastic syndrome, systemic lupus erythematosus / antiphospholipid syndrome, autoimmune hemolytic anemia were initially suspected. Among 15 women with associated with pregnancy TTP in 8 (53.3 %), HELLP syndrome was initially misdiagnosed. In total, 12 (22.2 %) of 54 TTP patients died. In 11/12 non-survival patients, TTP treatment was never started, because the doctors were waiting for the ADAMTS13 test results. A case report of Sequential Immune Thrombocytopenia (ITP) and TTP in the same Patient is described. Conclusion. When thrombocytopenia is combined with hemolysis and in the absence of multiple organ pathology, it is difficult to differentiate ITP and TTP without examining the plasma activity of ADAMTS113. With a combination of ITP and TTP in the same patient, the study of ADAMTS13 plasma activity makes it possible to identify the leading mechanism of thrombocytopenia and choose treatment tactics.

Correlation between Bilirubin Elimination with the Cytokine Adsorber CytoSorb® and Mortality in Critically Ill Patients with Hyperbilirubinemia

Introduction: Hyperbilirubinemia is often the first evidence for any kind of liver disorder and over one-third of all patients in intensive care units (ICU) show elevated bilirubin concentrations. In critically ill patients, high concentrations of serum bilirubin are correlated with a poor outcome. Therapies to lower bilirubin concentrations are often just symptomatically and their effect on the patients’ outcome is hardly evaluated. Therefore, this study investigates whether the extracorporeal elimination of bilirubin with the cytokine adsorber CytoSorb^® (CS) reduces mortality in patients with hyperbilirubinemia. Methods: Patients with bilirubin concentrations >10 mg/dL at the ICU were screened for evaluation from 2018 to 2020. Patients with kidney replacement therapy and older than 18 years were included. Patients with continuously decreasing bilirubin concentrations after liver transplantation or other liver support systems (i.e., Molecular Adsorbents Recirculating System [MARS^®], Advanced Organ Support [ADVOS]) were excluded. CS therapy was used in clinical routine and was indicated by the treating physicians. Statistical analysis was performed with IBM SPSS statistics utilizing a multivariate model. Primary outcome measure was the effect of CS on the 30-day mortality. Results: Data from 82 patients (mean Simplified Acute Physiology Score [SAPS] II: 74 points, mean bilirubin: 18 mg/dL, mean lactate: 3.7 mmol/L) were analyzed. There were no significant differences in patients with and without CS treatment. The multivariate model showed no significant effect of CS therapy (p = 0.402) on the 30-day mortality. In addition, a significant effect of bilirubin concentration (p = 0.274) or Model for End-Stage Liver Disease score (p = 0.928) on the 30-day mortality could not be shown. In contrast, lactate concentration (p = 0.001, b = 0.044) and SAPS II (p = 0.025, b = 0.008) had significant impact on 30-day mortality. Conclusion: The use of CS in patients with hyperbilirubinemia did not result in a significant reduction in 30-day mortality. Randomized and controlled studies with mortality as primary outcome measure are needed in the future to justify their use.

Investigation of correlation study among transcutaneous and total serum bilirubin content in preterm neonates

Background. Neonatal jaundice is a commonly occurring problem in both full term and preterm neonates. It is one of the major causes for neonatal mortality and morbidity. Objective. To assess the correlation among transcutaneous bilirubinometer readings and Total serum bilirubin levels at different sites in early and late preterm neonates before and at the end of phototherapy. Method. An observational study was conducted in preterm neonates diagnosed with jaundice. The Transcutaneous Bilirubin (TCB) instrument, Drager JM105 is used to assess TCB and it was recorded on three sites and average of the three readings was noted. Prior to phototherapy, TCB was noted 30 min before TSB was sent. A photo-opaque patch was placed on the sternum and phototherapy was given. At the end of the phototherapy, TCB on the sternum was noted and then TSB was sent with a time gap of not more than 30 min. Results. In this study, out of 50 neonates 14 were early preterm and 36 were late preterm babies. It was found that there was a positive correlation between TCB and TSB in early preterm babies before phototherapy (p value=0.0019), but there was no correlation between TCB and TSB at the end of phototherapy. In late preterm babies there was no correlation between TCB and TSB both before phototherapy and at the end of phototherapy. Conclusion. In this study it was found that TCB has positive correlation with TSB and can be implemented for the screening of hyperbilirubinemia even in preterm neonates.

Noninvasive transcutaneous bilirubin measurement in adults using skin diffuse reflectance.

Accurate measurement of bilirubin concentration in adults is crucial for the diagnosis and management of liver and biliary tract diseases. Traditional methods relying on central laboratory testing pose challenges such as invasiveness, patient discomfort, and time consumption. Non-invasive alternatives have been explored, but their applicability to adult populations remains uncertain. This study aimed to develop and validate a portable non-invasive optical system based on spatially resolved diffuse reflectance spectroscopy (DRS) specifically tailored for adult transcutaneous bilirubin measurement. Forty-two adult patients with various underlying conditions were included in the study. Comparisons between transcutaneous bilirubin values measured by the DRS system and total serum bilirubin concentrations obtained through blood tests revealed strong correlations, particularly at the neck (r = 0.872) and the medial side of the right upper arm (r = 0.940). Bland-Altman analyses demonstrated substantial agreement between the transcutaneous bilirubin values and total serum bilirubin concentrations. The results highlight the potential of the non-invasive DRS system as a convenient and reliable tool for monitoring bilirubin values in adults.

The Impact of Renal Function on Liver Cirrhosis among Patients in Wasit Governorate, Iraq

In Al-Kut city's AL-Zahraa general hospital, this study was carried out.for individuals with liver cirrhosis to evaluate their serum levels of ALT, AST, GGT, ALP, urea, creatinine, T.Protien, Albumin, and Bilirubin. The 50 patients ranged in age from 20 to 60, with 29 male and 21 female individuals.Based on the patient's medical history and physical examination, liver cirrhosis was determined to affect both sexes of the patient. The 30 control groups were drawn from the medical personnel and family of those who did not exhibit any indications or symptoms of renal liver disease or kidney diseases. With ages ranging from 22 to 66, there were 20 men and 10 women. Eight to fourteen hours following the patients' overnight fasts, blood samples were obtained. The research reveals the following. Serum ALT, AST and GGT concentrations in liver cirrhosis patients were found to be significantly increased compared with control group (P&lt;0.01).Serum Bilirubin (Total) and direct Bilirubin concentrations in liver cirrhosis patients were found to be significantly high compared with control group (P&lt;0.5), (P&lt;0.01) respectively. Serum Albumin concentrations in liver cirrhosis patients were found to be no significantly lower compared with control group (P&gt;0.5). Serum Total protein concentrations in liver cirrhosis patients were found to be no significantly lower compared with control group (P≤0.5).Serum Alkaline phosphatase (ALP) concentrations in liver cirrhosis patients were found to be significantly increased compared with control group (P&lt;0.01).Serum urea, creatinine, Uric acid and ammonia level concentrations in liver cirrhosis patients were found to be significantly high compared with control group (P&lt;0.01).

Effect of bilirubin and Gilbert syndrome on health: cohort analysis of observational, genetic, and Mendelian randomisation associations

ObjectivesTo compare associations between the Gilbert syndrome genotype in European populations, measured bilirubin concentrations, genetically predicted bilirubin using this genotype, and a wide range of health outcomes in a large...

Validating a novel three-times-weekly post-hemodialysis ceftriaxone regimen in infected Indigenous Australian patients-a population pharmacokinetic study.

To describe the total and unbound population pharmacokinetics of a 2 g three-times-weekly post-dialysis ceftriaxone regimen in Indigenous Australian patients requiring hemodialysis. A pharmacokinetic study was carried out in the dialysis unit of a remote Australian hospital. Adult Indigenous patients on intermittent hemodialysis (using a high-flux dialyzer) and treated with a 2 g three-times-weekly ceftriaxone regimen were recruited. Plasma samples were serially collected over two dosing intervals and assayed using validated methodology. Population pharmacokinetic analysis and Monte Carlo simulations were performed using Pmetrics in R. The probability of pharmacokinetic/pharmacodynamic target attainment (unbound trough concentrations ≥1 mg/L) and toxicity [trough concentrations (total) ≥100 mg/L] were simulated for various dosing strategies. Total and unbound concentrations were measured in 122 plasma samples collected from 16 patients (13 female) with median age 57 years. A two-compartment model including protein-binding adequately described the data, with serum bilirubin concentrations associated (inversely) with ceftriaxone clearance. The 2 g three-times-weekly regimen achieved 98% probability to maintain unbound ceftriaxone concentrations ≥1 mg/L for a serum bilirubin of 5 µmol/L. Incremental accumulation of ceftriaxone was observed in those with bilirubin concentrations >5 µmol/L. Three-times-weekly regimens were less probable to achieve toxic exposures compared with once-daily regimens. Ceftriaxone clearance was increased by >10-fold during dialysis. A novel 2 g three-times-weekly post-dialysis ceftriaxone regimen can be recommended for a bacterial infection with an MIC ≤1 mg/L. A 1 g three-times-weekly post-dialysis regimen is recommended for those with serum bilirubin ≥10 µmol/L. Administration of ceftriaxone during dialysis is not recommended.

Association of Low Serum Bilirubin Concentrations and Promoter Variations in the UGT1A1 and HMOX1 Genes with Type 2 Diabetes Mellitus in the Czech Population.

Bilirubin has potent biological beneficial effects, protecting against atherosclerosis, obesity, and metabolic syndrome. The aim of this study was to assess serum bilirubin concentrations and (TA)n and (GT)n microsatellite variations in the promoter regions of the UGT1A1 and HMOX1 genes, respectively, in patients with type 2 diabetes mellitus (T2DM). The study was carried out in 220 patients with T2DM and 231 healthy control subjects, in whom standard biochemical tests were performed. The (TA)n and (GT)n dinucleotide variations were determined by means of fragment (size-based) analysis using an automated capillary DNA sequencer. Compared to controls, both male and female patients with T2DM had lower serum bilirubin concentrations (9.9 vs. 12.9 μmol/L, and 9.0 vs. 10.6 μmol/L, in men and women, respectively, p < 0.001). Phenotypic Gilbert syndrome was much less prevalent in T2DM patients, as was the frequency of the (TA)7/7UGT1A1 genotype in male T2DM patients. (GT)nHMOX1 genetic variations did not differ between diabetic patients and controls. Our results demonstrate that the manifestation of T2DM is associated with lower serum bilirubin concentrations. Consumption of bilirubin due to increased oxidative stress associated with T2DM seems to be the main explanation, although (TA)n repeat variations in UGT1A1 partially contribute to this phenomenon.

A sensitive “turn-off-on” fluorescence platform for bilirubin detection based on conjugated polymer nanoparticles and ferric ions

Bilirubin is an important biomarker of jaundice, and the quantitative detection of bilirubin is of great significance in the diagnosis and prevention of early jaundice. In this paper, Fe3+ quenched conjugated polymer nanoparticles were used as a "turn-off-on" fluorescence platform to detect bilirubin for the first time. The CPNsPBMC-COOH were prepared through a nanoprecipitation method based on polystyrene maleic anhydride and PBMC, a conjugated polymer synthesized by our research group. The fluorescence of CPNsPBMC-COOH can be efficiently quenched closely to 95% by Fe3+. The optimized fluorescence platform was obtained (CPNsPBMC-COOH: 10 μg/mL, Fe3+: 4.5 μM). The platform to detect bilirubin has a higher sensitivity with a 5 nM of LOD. The detection range was in the 1.32–26.68 μM, which can cover the concentration of bilirubin in normal adult serum (<25 μM). Moreover, the stoichiometries and binding constants of CPNsPBMC-COOH, bilirubin, and Fe3+ are obtained. The binding ability is better for bilirubin and Fe3+. The static quenching mode is found by the absorption spectra and the fluorescence lifetimes. Lastly, this method has obtained satisfactory results in real biological samples (mouse serum and mouse plasma). This work can be used for daily rapid clinical bilirubin detection.

Serum bilirubin is associated with a reduced risk of subsequent recurrent wheezing following acute respiratory syncytial virus bronchiolitis.

Bilirubin is a potent antioxidant and anti-inflammatory molecule that has been shown to ameliorate airway inflammation. We aimed to study whether serum bilirubin is protective and can predict the development of subsequent recurrent wheezing in infants with severe respiratory syncytial virus (RSV) bronchiolitis. The medical records of 188 infants who were hospitalized during an initial episode of severe RSV bronchiolitis at 6 months of age or less were retrospectively reviewed. Our main outcome of interest was the development of subsequent recurrent wheezing by the age of 3years. Each infant's serum bilirubin concentration was extracted from their blood biochemical results. Seventy-one (37.8%) infants developed recurrent wheezing by the age of 3 and 117 (62.2%) did not. The serum total bilirubin, unconjugated bilirubin, and conjugated bilirubin levels at hospital admission were lower in infants who developed recurrent wheezing as compared to those who did not (p ＜ 0.001). The area under the receiver-operating characteristic curve of serum total bilirubin, unconjugated bilirubin, and conjugated bilirubin for the prediction of subsequent recurrent wheezing were 0.71 (95% confidence interval [CI], 0.64-0.78), 0.70 (95% CI, 0.63-0.78), and 0.67 (95% CI, 0.59-0.75), respectively. Higher admission serum total bilirubin levels were independently associated with a lower risk of development of subsequent recurrent wheezing (adjusted OR 0.17, p ＜ 0.001). During the first episode of severe RSV bronchiolitis in infants <6 months of age, moderately higher levels of serum bilirubin are associated with a reduced risk of developing subsequent recurrent wheezing by 3 years of age.

Magnetic Resonance Imaging for Monitoring of Hepatic Disease Induced by Ebola Virus: a Nonhuman Primate Proof-of-Concept Study.

Severe liver impairment is a well-known hallmark of Ebola virus disease (EVD). However, the role of hepatic involvement in EVD progression is understudied. Medical imaging in established animal models of EVD (e.g., nonhuman primates [NHPs]) can be a strong complement to traditional assays to better investigate this pathophysiological process in vivo and noninvasively. In this proof-of-concept study, we used longitudinal multiparametric magnetic resonance imaging (MRI) to characterize liver morphology and function in nine rhesus monkeys after exposure to Ebola virus (EBOV). Starting 5 days postexposure, MRI assessments of liver appearance, morphology, and size were consistently compatible with the presence of hepatic edema, inflammation, and congestion, leading to significant hepatomegaly at necropsy. MRI performed after injection of a hepatobiliary contrast agent demonstrated decreased liver signal on the day of euthanasia, suggesting progressive hepatocellular dysfunction and hepatic secretory impairment associated with EBOV infection. Importantly, MRI-assessed deterioration of biliary function was acute and progressed faster than changes in serum bilirubin concentrations. These findings suggest that longitudinal quantitative in vivo imaging may be a useful addition to standard biological assays to gain additional knowledge about organ pathophysiology in animal models of EVD. IMPORTANCE Severe liver impairment is a well-known hallmark of Ebola virus disease (EVD), but the contribution of hepatic pathophysiology to EVD progression is not fully understood. Noninvasive medical imaging of liver structure and function in well-established animal models of disease may shed light on this important aspect of EVD. In this proof-of-concept study, we used longitudinal magnetic resonance imaging (MRI) to characterize liver abnormalities and dysfunction in rhesus monkeys exposed to Ebola virus. The results indicate that in vivo MRI may be used as a noninvasive readout of organ pathophysiology in EVD and may be used in future animal studies to further characterize organ-specific damage of this condition, in addition to standard biological assays.

Intrahepatic Cholestasis in Non-Alcoholic Fatty Liver Disease: Pathogenesis and Role of Ademetionine in Treatment

Aim: to evaluate features of intrahepatic cholestasis (IHC) pathogenesis in non-alcoholic fatty liver disease (NAFLD), as well as role of ademetionine in treatment of this condition.Key statements. NAFLD is the most frequent chronic diffuse liver disease. Increase in proportion of people with excess weight, obesity, and metabolic dysregulation leads to higher rates of NAFLD. Concomitant IHC is present in 30 % of NAFLD patients, while it is associated with more active disease course and possible worsening of prognosis. Impairment of adipocyte and hepatocyte metabolism, gut dysbiosis, and inherent factors are recognized as significant factors for NAFLD development. In NAFLD patients most of IHC cases are related to functional cholestasis. IHC in NAFLD is associated with increased risks of fibrosis and all-cause death. Ademetionine may restore transmethylation and improve rheologic properties of hepatocyte membranes in liver disease. In IHC patients treatment with ademetionine led to decreased serum bilirubin concentrations, as well as lowering of the liver transaminases' and alkaline phosphatase activities. At the same time improvement of symptoms severity, including itching, was noted. Taking into account the efficacy of ademetionine in IHC in NAFLD patients, its' use was included in the national clinical guidelines.Conclusion. Use of ademetionine in NAFLD with concomitant IHC is feasible from pathogenesis perspective and may be effective in clinical practice.

Comparison of Two Lipid Emulsions on the Incidence of Parenteral Nutrition Associated Cholestasis in Neonates.

Lipid emulsion contributes to parenteral nutrition associated cholestasis (PNAC). For decades, soybean oil-based intravenous lipid emulsion (SO-ILE) was the predominant product. Recently, a multicomponent lipid emulsion containing soybean oil, medium-chain triglycerides, olive oil and fish oil (SMOF-ILE) has been used off-label in neonatal care. This study evaluates the incidence of PNAC in neonates who received SMOF-ILE or SO-ILE. This was a retrospective review of neonates who received SMOF-ILE or SO-ILE for at least 14 days. Patients receiving SMOF-ILE were matched based on gestational age (GA) and birth weight to a historical cohort receiving SO-ILE. The primary outcomes were the incidences of PNAC among all patients and patients without intestinal failure. The secondary outcomes were clinical outcomes and incidence of PNAC stratified by GA. Clinical outcomes included liver function tests, growth parameters, and development of retinopathy of prematurity and intraventricular hemorrhage. Forty-three neonates who received SMOF-ILE were matched to 43 neonates who received SOILE. There were no significant differences in baseline characteristics. The incidence of PNAC in the total population was 12% in the SMOF-ILE cohort and 23% in the SO-ILE cohort (p = 0.26). The lipid dosage of SMOF-ILE was significantly higher at time of peak direct serum bilirubin concentration compared with SO-ILE cohort (p = 0.05). Clinically significant differences were noted in laboratory endpoints in several subgroups. There was no significant difference in the incidence of PNAC among neonates in a SMOFILE cohort compared with a historical SO-ILE cohort.

Treatment for cholangiohepatitis in cats

Acute bacterial cholangiohepatitis of cats is a common disease associated with the inflammation of bile ducts and liver parenchyma, characterized by development of a pronounced hepatodepressive syndrome (hypoalbuminemia), cytolysis (increase in serum activity of alanine and asparagine transaminase), cholestasis (increase in serum concentration of bilirubin, cholesterol, activity of alkaline phosphatase and gamma-glutamyltranspeptidase), intoxication, dehydration, mesenchymal-inflammatory and pain syndromes. The aim of the research was to study the effectiveness of treatment for acute bacterial cholangiohepatitis in cats with average severity of the pathology course. According to inclusion and exclusion criteria, the study included a cohort of cats (n = 12) with acute bacterial cholangiohepatitis. Clinical, hematological, ultrasonographic, statistical methods of investigation were used in this work. For sick cats with medium severity form of cholangiohepatitis, when administered as a complex therapy the combination of marbofloxacin, metronidazole, ursodeoxycholic acid, cyancobolamine, tocopherol acetate, infusion therapy also had a good therapeutic effect, which was accompanied by improved clinical and laboratory performance. In the blood of cats with cholangiohepatitis, in the background of intensive therapy, there was a significant decrease in white blood cell count, erythrocyte sedimentation rate, and in serum, there was an increase in albumin concentration, reduction of creatinine, aminotransferase activity, alkaline phosphatase, gamma-glutamyltranspeptidase, lipase.