Serum Bilirubin Levels Research Articles

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.

Impact of α-Tocopherol and Ascorbic Acid Pre-Treatment on Paracetamol Induced Liver Injury in Wistar Albino Male Rats

Background: Liver injury may occur by toxic dose of paracetamol administration where liver function markers are elevated and centrilobular hepatic necrosis is visible under a microscopic observation in hepatic lobule configuration. α-tocopherol and ascorbic acid are known antioxidant and they may have hepatoprotective effect against paracetamol induced liver damage. Aim of the study: The aim of this study was to evaluate the effects of α-tocopherol and ascorbic acid on paracetamol induced liver damage in Wistar albino male Rats. Methods: This was an animal model experimental study which was conducted in the Department of Physiology, Sir Salimullah Medical College, Dhaka, Bangladesh from 1st January to 31st December, 2017. Although primarily healthy Wister albino male rats, 90-120 days old, weighing from 160 to 200g were selected for this study, finally data were analyzed on 30 rats. Finalized 30 samples were divided into three groups Group I (baseline control group, n=10), Group II (paracetamol treated control group, n=10) and Group III (combined α-tocopherol with ascorbic acid pretreated & paracetamol treated group n=10). The dose of α-tocopherol 100 mg/kg Body weight and ascorbic acid 200 mg/kg Body weight per day orally were selected as pre-exposure prophylaxis. The statistical analyses were done by one-way ANOVA and Bonferroni test, paired ‘t’ test and Fisher’s Exact test as applicable. Results: The mean serum total bilirubin, ALT and AST were significantly increased in group II and III in comparison to that of group I except the serum levels of total bilirubin and ALT of group III which were increased than that of group I but it was not statistically significant. Again, the mean MDA concentration in liver was significantly increased in group II in comparison to that of group I whereas though this level was increased in group III than that of group I but it was statistically not significant. Furthermore, the mean serum levels of total bilirubin, ALT, AST and ...

Dietary supplementation of low levels of unprocessed Mucuna pruriens utilis seed meal induces mild antinutritional entero-physio-metabolic perturbations without compromising performance and meat quality in finisher broilers

The rapidly growing world human population accentuates the need for improved production especially of protein-rich food. Broiler meat production offers opportunity to ensure security of this food. However, the production of modern broilers is not only limited by high feed costs due to dietary use of expensive energy and protein sources but also their meat possesses undesirable quality attributes. This study thus examined the effect of dietary Mucuna pruriens utilis seed meal (MSM) on growth performance, blood profile, carcass traits, and meat quality in finisher broiler chickens. In a completely randomised design (CRD), 320 21-day-old chicks were randomly allocated to 32 pens in which they were allotted 4 dietary treatments with 0, 2.5, 5, and 10% MSM, each with 8 replicate pens of 10 birds, for 28 days. Growth performance, carcass characteristics, internal organs, haemato-biochemistry, and meat quality were measured. Results showed that dietary MSM did not affect (P > 0.05) broiler performance, weights, and lengths of carcass cuts and internal organs, haematology, and meat quality. The only exception was MSM-induced increase in duodenal weight (linear, P < 0.05) and serum phosphorus (quadratic, P = 0.05) in contrast to a decrease in procalcitonin (quadratic, P < 0.01) and serum levels of total protein (linear, P < 0.05; and quadratic, P < 0.01), albumin (quadratic, P < 0.05), and bilirubin (quadratic, P = 0.001). Therefore, MSM could be supplemented up to 10% without compromising performance, carcass traits, internal organs, haemato-biochemistry, and meat quality in finisher broiler diets.

Total Bilirubin Levels in Nonalcoholic Fatty Liver Disease and All- cause and Cause-specific Mortality in US Adults.

Nonalcoholic Fatty Liver Disease (NAFLD) is a chronic progressive illness with a spectrum of disease severity from steatosis to end-stage liver disease. Emerging evidence suggests total serum bilirubin levels are inversely related to the prevalence of metabolic syndrome including NAFLD. We investigated the effects of bilirubin on all-cause and cause-specific mortality stratified by NAFLD status. We used the third National Health and Nutrition Examination Survey Cohort (1988-1994) and linked mortality dataset through 2019. Cox-regression models were constructed to assess the association between bilirubin levels categorized by quartile with all-cause and cause-specific mortality. During the median follow-up of 324 months (n=11,078), higher bilirubin levels were associated with a reduction in risk of all-cause mortality in the multivariate model (hazard ratio [HR]: 0.83, 95% confidence interval [CI]: 0.71-0.97 for quarter 4 [highest bilirubin levels] vs. quarter 1 [lowest bilirubin levels], p for trend=0.033). Higher bilirubin levels were associated with a lower risk for all-cause mortality in individuals with NAFLD (HR; 0.68, 95% CI: 0.55-0.86 for quarter 4, p for trend=0.010); however, this protective association with higher bilirubin levels was not noted in those without NAFLD. Higher bilirubin levels were associated with a lower risk for cardiovascular and cancer-related mortality in individuals with NAFLD. In this large nationally representative sample of American adults, higher bilirubin levels in NAFLD were associated with a lower risk of all-cause mortality, which may be derived from a lower risk of cardiovascular/cancer-related mortality.

Diagnostic Accuracy Of Hyperbilirubinemia In Acute Appendicitis

Objective: To determine the diagnostic accuracy of serum Bilirubin in cases of acute appendicitis keeping the histopathological findings as Gold standard.&#x0D; Study Design: Cross sectional validation study.&#x0D; Place and Duration of the Study: Surgical Unit, Sheikh Khalifa Bin Zayed Al-Nayhan Hospital (Combined Military Hospital), Rawalakot, Azad Kashmir, from Jan 2022 to June 2022.&#x0D; Methodology: A total of 380 patients aged between 18 to 65 years, who matched the inclusion and exclusion criteria suspected of acute appendicitis were included. Serum Bilirubin level was noted. Appendectomy was done. Specimen of appendix was sent for histopathology for confirmation of the diagnosis.&#x0D; Results: In our study, mean age of the patients was 34.015 with a standard deviation of 13.32. 65% (n=247) of the patients were males and 35% (n=133) were females. Frequency of acute appendicitis on histopathology was 82.89% (n=315) while 17.1% (n=65) had no findings of the disease. Validity of serum Bilirubin in diagnosing appendicitis using histopathology showed 57.36% (n=218) were true positive, 2.1% (n=8) were false positive, 15% (n=57) were true negative and 25.52 %( n=97) were false negative. Specificity, sensitivity, negative predictive value, positive predictive value, accuracy rate, positive likelihood ratio and negative likelihood ratio were 87.69%, 69.20%, 37.01%, 96.46%, 72.36%, 5.62 and 0.35 respectively.&#x0D; Conclusion: Serum Bilirubin is a useful marker for diagnosing the acute appendicitis and can be used as a good alternative diagnostic modality in suspected cases of acute appendicitis.

Nutritional Composition and Anti-Type 2 Diabetes Mellitus Potential of Femur Bone Extracts from Bovine, Chicken, Sheep, and Goat: Phytochemical and In Vivo Studies.

Nutritional deficits in one's diet have been established as the key risk factor for T2DM in recent years. Nutritional therapy has been demonstrated to be useful in treating T2DM. The current study was carried out to assess the nutritional composition of bovine (12 months), chicken (4 months), sheep (13 months), and goat (9 months) femur bone extracts, as well as their potential therapeutic effects on T2DM regression in a Wistar albino rat model (500 mg/kg b.wt.). The proximate composition of the different extracts, their fatty acid composition, their amino acids, and their mineral contents were identified. In vivo data indicated considerably improved T2DM rats, as seen by lower serum levels of TL, TG, TC, ALT, AST, ALP, bilirubin, creatinine, urea, IL-6, TNF-α, sICAM-1, sVCAM-1, and MDA. Low levels of HDL-C, GSH, and total proteins were restored during this study. Histological investigations of liver and pancreatic tissue revealed that the distribution of collagen fibers was nearly normal. The bovine extract, on the other hand, was the most active, followed by the sheep, goat, and finally chicken extract. This research could result in the creation of a simple, noninvasive, low-cost, and reliable method for T2DM control, paving the way for potential early therapeutic applications in T2DM control.

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).

An Overview on Neonatal Jaundice

A significant proportion of term and preterm infants develop neonatal jaundice. Jaundice in a healthy term infant is the most common reason for readmission to hospital. Jaundice is caused by a significant increase in serum bilirubin levels, largely due to the breakdown of red blood cells. Bilirubin is transported in the blood as 'unconjugated' bilirubin, largely bound to albumin. The bilirubin is converted into a conjugated form by the liver, which is excreted in the bile. Very high levels of unconjugated bilirubin led to neurotoxicity. In most infants, severe hyperbilirubinemia is caused due to an increase in bilirubin production (e.g., due to haemolysis) and thus reducing bilirubin production is a rational approach for its management. The situation can become critical in infants with an associated impaired bilirubin elimination mechanism as a result of a genetic deficiency and polymorphism. The simplest way to reduce bilirubin levels is by phototherapy. Current management of jaundice in the UK is guided by the NICE guideline.1

Bilirubin is a superior biomarker for hepatocellular carcinoma diagnosis and for differential diagnosis of benign liver disease

Abstract Objectives To develop a novel diagnostic model combining bilirubin, protein induced by vitamin K absence or antagonist-II (PIVKA-II), and alpha-fetoprotein (AFP) to improve hepatocellular carcinoma (HCC) diagnosis. Methods The serum levels of PIVKA-Ⅱ, AFP, and bilirubin in 718 HCC patients and 2,763 benign liver disease (BLD) patients were measured. A mathematical model was used as the combined diagnostic model (PIVKA-Ⅱ, AFP, and bilirubin: PAB combination) for improving HCC diagnosis. Receiver operating characteristic (ROC) curves were used to analyse the diagnostic value of the individual markers, the PIVKA-II and AFP (PA) combination, and the PAB combination for HCC diagnosis. Results With the increase in bilirubin, the positive predictive value (PPV) of bilirubin in HCC diagnosis decreased (p&lt;0.001) while the negative predictive value (NPV) increased (p&lt;0.001). The areas under the ROC curves (AUCs) of the PAB combination were 0.935 and 0.862 for the diagnosis of HCC and HCC&lt;3.0 cm, respectively, which were significantly higher than those of PIVKA-Ⅱ, AFP, and the PA combination (p&lt;0.001). The AUC values for PIVKA-Ⅱ, AFP, and the PA combination were significantly decreased for the diagnosis of HCC and HCC&lt;3.0 cm when serum levels of PIVKA-Ⅱ≥40 mAU/mL and/or AFP≥20 ng/mL were used for diagnosis, while the AUC value of the PAB combination increased. Conclusions Bilirubin is a superior biomarker for diagnosing HCC and distinguishing HCC from BLD. The combination of bilirubin with PIVKA-Ⅱ and AFP has superior diagnostic value for HCC and early-stage HCC.

Nilotinib alleviates paraquat-induced hepatic and pulmonary injury in rats via the Nrf2/Nf-kB axis

BackgroundParaquat (PQ, 1,1′-dimethyl-4-4′-bipyridinium dichloride) is a highly toxic quaternary ammonium herbicide widely used in agriculture. It exerts its toxic effects mainly as a result of its redox cycle via the production of superoxide anions in organisms, leading to an imbalance in the redox state of the cell causing oxidative damage and finally cell death. The aim of this study was to estimate the beneficial protective role of nilotinib (NIL) on PQ-induced hepatic and pulmonary toxicity in rats. MethodsMale wistar rats were randomly divided into four groups, namely control, PQ (15 mg/kg), PQ plus NIL (5 mg/kg) and PQ plus NIL (10 mg/kg). NIL (5 and 10 mg/kg/day) was taken by oral syringe for five days followed by a single intra-peritoneal administration of PQ (15 mg/kg) on sixth day. ResultsPretreatment with NIL relieved the histological damage in liver and lung tissues and improved hepatic biochemical markers. It significantly (p < 0.05) reduced serum levels of ALT, AST, ALP, Y-GT and total bilirubin while increased that of albumin. Meanwhile, NIL significantly (p < 0.05) reduced oxidative stress markers via reduction of malondialdhyde (MDA) and elevation of glutathione (GSH) contents in liver and lung tissues. In addition, it significantly (p < 0.05) decreased the inflammation by reducing hepatic and pulmonary tumor necrosis factor alpha (TNF-α) and nuclear transcription factor kappa B (NF-KB/p65) contents. Nilotinib also down-regulated apoptosis by reducing cysteinyl aspartate-specific proteinase-3 (caspase-3). Furthermore, it upregulated the expression of nuclear factor erythroid 2-related factor 2 (Nrf2) and microtubule-associated protein 1A/1B-light chain 3 II (LC3II) in liver and lung tissues. SignificanceNIL suppressed PQ-induced inflammation, oxidative stress and apoptosis in liver and lung tissues by modulating Nrf2/Nf-kB axis.

Spectroscopic characterization of eupalitin-3-O-β-D-galactopyranoside from Boerhavia procumbens: In vivo hepato-protective potential in rat model

The liver is one of the most important organs responsible for detoxifying biomolecules and xenobiotics. Herein, we report the isolation, characterization, and hepatoprotective effect of the Boerhavia procumbens-derived eupalitin-3-O-β-D-galactopyranoside (EGP) compound. The structure of the EGP compound was deduced by using NMR spectroscopic techniques and mass spectrometry. The EGP hepatoprotective activities were evaluated with HepG2 cell viability and LDH assays in vitro, and CCl4-induced toxicity was investigated in vivo in the rat model. Compared to the CCl4-treated group, cells exposed to the EGP compound at 200 µg/ml showed increased cell viability (60.52 ± 1.22 %) and decreased LDH levels (23.81 ± 1.89 U/ml). The serum levels of SGPT, SGOT, ALP, and total bilirubin in the CCl4-treated group were substantially higher than those in the control group (64 ± 1.89 U/ml, 86 ± 1.47 U/ml, 252.6 ± 2.96 U/ml, and 5.45 ± 0.32 mg/dl, respectively). When compared to animals treated with CCl4 alone, the EGP compound's in vivo hepatoprotective effect at 60 mg/kg with CCl4 significantly (p < 0.01) decreased the levels of SGPT and SGOT (26 ± 1.34 U/ml and 42.92 ± 1.6 U/ml) respectively. Furthermore, our histological study showed a significant response in restoring and maintaining the normal morphological appearance of the liver. Thus, our results show that the EGP compound is a promising and novel lead molecule for better hepatotoxicity control and therapy.

Utility of Urgent Endoscopic Retrograde Cholangiopancreatography in Patients with Predicted Mild Acute Pancreatitis and Cholestasis.

Endoscopic retrograde cholangiopancreatography (ERCP) within 72h is suggested for patients presenting with acute biliary pancreatitis (ABP) and biliary obstruction without cholangitis. This study aimed to identify if urgent ERCP (within 24h) improved outcomes compared to early ERCP (24-72h) in patients admitted with predicted mild ABP. Patients admitted for predicted mild ABP defined as a bedside index of severity in acute pancreatitis score < 3 and underwent ERCP for biliary obstruction within 72h of presentation during the study period were included. Patients with prior biliary sphincterotomy or surgically altered anatomy preventing conventional ERCP were excluded. The primary outcome was the development of moderately severe or severe pancreatitis based on the revised Atlanta classification. Secondary outcomes were the length of hospital stay, the need for ICU admission, and ERCP-related adverse events (AEs). Of the identified 166 patients, baseline characteristics were similar between both the groups except for the WBC count (9.4 vs. 8.3/µL; p < 0.044) and serum bilirubin level (3.0 vs. 1.6mg/dL; p < 0.0039). Biliary cannulation rate and technical success were both high in the overall cohort (98.8%). Urgent ERCP was not associated with increased development of moderately severe pancreatitis (10.4% vs. 15.7%; p = 0.3115). The urgent ERCP group had a significantly shorter length of hospital stay [median 3 (IQR 2-3) vs. 3days (IQR 3-4), p < 0.01]. Urgent ERCP did not impact the rate of developing more severe pancreatitis in patients with predicted mild ABP but was associated with a shorter length of hospital stay and a lower rate of hospital readmission.

Pattern of liver enzymes and maternal outcome in eclamptic patients admitted to the Intensive Care Unit, University College Hospital, Nigeria

Introduction: Eclampsia, a hypertensive disorder, is one of the leading causes of maternal mortality in developing countries like Nigeria. We evaluated the relationship between the pattern of liver enzymes and maternal mortality in eclamptic women.&#x0D; Method: A retrospective study of 55 eclamptic women admitted to the Intensive Care Unit (ICU), University College Hospital, Nigeria, was conducted. Data were obtained on their demographic, obstetric, and clinical characteristics, liver enzyme patterns, and maternal outcome. Analysis was by descriptive statistics, univariate analysis, and non-parametric tests with level of significance set at p&lt;0.05. &#x0D; Results: Maternal deaths occurred in 27.3% and elevation of liver enzymes was observed more among the dead patients compared with those who survived. Alanine aminotransferase (ALT) was the most commonly elevated liver enzyme, occurring in almost all (90.9%) the patients. Maternal mortality was significantly associated with age (p=0.001), saturated oxygen levels (p=0.007), elevated alkaline phosphatase (p=0.008), alanine aminotransferase (p=0.013), aspartate aminotransferase (p=0.016), and total bilirubin (p&lt;0.001). &#x0D; Conclusion: Maternal mortality due to eclampsia was clinically associated with age, elevated liver enzymes and a lower serum level of total bilirubin. Liver transaminases are therefore important prognostic indicators associated with eclampsia.

Impact of obesity on liver function tests: is nonalcoholic fatty liver disease the only player? A review article.

Obesity and nonalcoholic fatty liver disease (NAFLD) are common worldwide health problems with a strong relationship in between. NAFLD is currently the most common cause of abnormal liver function tests (LFT) because of obesity pandemic. The question is NAFLD the only player of abnormal LFT in obesity? This article reviews the most important topics regarding the derangements of LFT in obesity through a PubMed search strategy for all English-language literature. The reported abnormal LFT in obesity were increased serum levels of transaminases (alanine aminotransaminase, aspartate aminotransaminase), gamma glutamyl transferase, and alkaline phosphatase and decreased serum levels of bilirubin and albumin. Besides novel potential hepatic markers of NAFLD/NASH such as triglycerides/high-density lipoprotein cholesterol ratio, sex hormone-binding globulin, fibroblast growth factor 21, and markers of hepatocyte apoptosis i.e. cytokeratin 18 and microribonucleic acids (miRNAs). Beyond NAFLD, there are other underlying players for the abnormal LFT in obesity such as oxidative stress, inflammation, and insulin resistance. Derangements of LFT in obesity are attributed to NAFLD but also to obesity itself and its related oxidative stress, insulin resistance, and chronic inflammatory state. Abnormal LFT predict more than just liver disease.

Hepatoprotective activity of ethanol root extract and fractions of Hippocratea africana against doxorubicin-induced liver toxicity

Doxorubicin (DOX) is an anthracycline glycoside antibiotic with high efficacy against various forms of cancer, whose clinical usefulness has been limited by associated undesirable organs toxicities such as cardiomyopathy, nephrotoxicity and hepatotoxicity despite its high therapeutic index. Hippocratea africana root used locally in the treatment of poisoning was evaluated for antidotal potentials against DOX-induced liver toxicity in rats. Hippocratea africana ethanol root extract as well as dichloromethane and aqueous fractions were evaluated for hepatoprotective activity against doxorubicin-induced liver injury in rats at various doses of the crude extract (200-600 mg/kg) and 400 mg/kg each of dichloromethane (DCM) and aqueous fractions respectively. Liver function parameters, liver oxidative stress markers and liver histology were used to assess the liver protective potential of the extract and fractions. The root extract and fractions significantly (p&lt;0.05-0.01) reduced the serum levels of AST, ALT, ALP, total and direct bilirubin that were elevated by doxorubincin. Also, the levels of total protein and albumin reduced by doxorubicin were increased by the extract coadministration. The levels of GSH, GST, SOD, GPx, and CAT that were decreased by doxorubicin were significantly (p&lt;0.01) elevated and raised MDA level was reduced by the leaf extract. Histology of the liver sections of extract -treated animals showed reductions in the pathological features compared to the DOX-treated animals. The observed histopathological changes were consistent with chemical pathological observations suggesting marked hepatoprotective potential. The anti-toxic effect of this plant may in part be mediated through the chemical constituents of the plant. The plant, Hippocratea africana possesses anti-toxicant properties which can be exploited in the treatment of doxorubicin related toxicities.

Role of Subcutaneous Bilirubinometre in the Evaluation of Bilirubin Level in Neonatal Jaundice

Objectives: To record the demographic features of neonates presenting with jaundice, identify their cause, and co-relate bilirubin levels obtained by subcutaneous bilirubinometre with a standard biochemical method.&#x0D; Study Design: Cross-sectional study&#x0D; Place and Duration of Study: Nursery of Combined Military Hospital, Malir Cantt Karachi, from Jul to Dec 2020.&#x0D; Methodology: A total of 100 cases of neonatal jaundice were enrolled using a systematic random sampling technique. The demographic data of enrolled neonates and risk factors for jaundice were recorded. Their bilirubin levels were recorded using transcutaneous bilirubinometre (TCB) JH-2. Serum bilirubin levels were analyzed at the same time and recorded.&#x0D; Results: Out of 100 neonates, 61(61 %) were male. Risk factors for jaundice included exaggerated physiological 70(70%), prematurity 11(11%), Rh incompatibility 9(9%), G6PD deficiency 5(5%). For all weight ranges, mean TCB values significantly correlated with mean serum bilirubin level (p-value &lt;0.001) with a co-relation coefficient of 0.683 and device reliability of 74%.&#x0D; Conclusion: Transcutaneous bilirubinometre can be considered a reliable tool to assess bilirubin for screening neonatal jaundice in term and pre-term neonates.

Comparison of Transcutaneous and Total Serum Bilirubin Measurements at Five Different Sites in Newborns before and after Phototherapy.

This study aims to examine the accuracy of transcutaneous bilirubin (TcB) in estimating the total serum bilirubin (TSB) level at five different sites before and immediately after phototherapy. This study prospectively enrolled infants with a gestational age of 34 to 416/7 weeks who were clinically diagnosed with neonatal jaundice and required phototherapy within 28 days after birth. TcB levels were measured on the uncovered four areas (forehead, mid-sternum, abdomen, and interscapular site) and covered hipbone by using the Dräger JM-103 Jaundice Meter before phototherapy and at 0 min after discontinuing phototherapy. Correlation and agreement between TcB and TSB levels were assessed before and after phototherapy. We included 108 infants with a mean gestational age of 37.6±1.5 weeks and birth weight of 3108±548 g. A strong significant correlation was found between TSB and TcB measurements at all five sites before phototherapy with the strongest correlation at the interscapular site (r=0.768, p=0.001). The correlation was weakened between TSB and TcB at all five sites after phototherapy; however, the strongest correlation was at the covered hipbone (r=0.619, p=0.001). TcB measurements at all five sites tended to underestimate TSB levels before and after phototherapy. The difference (TcB - TSB) tended to increase with increasing TSB levels. TcB levels were most accurately measured at the interscapular site and covered hipbone before and immediately after phototherapy, respectively.

Protective Effect of Andropraphis Paniculata Aqueous Extract (EAAp) Against Isoniazid and Rifampicin-Induced Rat Liver Damage

Isoniazid (INH) and rifampicin (RIF) are first-line antituberculosis drugs (OAT) in tuberculosis treatment that are used for at least 6 months. The use of OAT has been associated with toxic reactions in the liver and causes hepatitis. This study aimed to determine the effect of an aqueous extract of Andrographis paniculata (EAAp) on liver damage induced by INH and RIF. Method: Male Sprague-Dawley rats weighing 250–300g were divided into 5 groups, each consisting of 6 mice. Animals were given isoniazid and rifampicin at 100 mg/kg, respectively, to induce liver damage, silymarin (25 mg/kg) for the positive control group, and Ap extract at doses of 200mg and 300 mg/kg for the test group. All treatments were given orally once daily for 28 days. Measurement of serum aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (ALP), bilirubin, and liver histopathology levels was carried out to determine the effect of EAAp on liver damage by INH and RIF. Results: Rats treated with INH+RIF were hepatotoxic, as evidenced by increased serum ALT, AST, and ALP activity, total bilirubin levels, and histopathological changes in the liver. Administration of Ap extract doses of 200 mg/kg and 300 mg/kg significantly decreased liver biochemical and histological changes caused by OAT. Conclusions: EAAp has a protective effect against hepatotoxic-induced INH and RIF in animal models.

Auxiliary partial orthotopic liver transplantation (APOLT) for Crigler-Najjar syndrome: A retrospective analysis

BackgroundCrigler-Najjar syndrome is an ultra-rare hereditary disorder characterized by severe jaundice and risk of neurological complications. Current treatments, such as phototherapy, have limitations, and liver transplantation is often necessary. Auxiliary partial orthotopic liver transplantation (APOLT) is a potential treatment option. Still, its safety and efficacy in Pakistani patients with Crigler-Najjar syndrome Type I (CNS-I) have not been well established. MethodsThis retrospective study reviewed the outcomes of five pediatric patients with CNS-I who underwent APOLT at a tertiary care center in Pakistan. Patient demographics, surgical details, postoperative course, complications, and follow-up data were analyzed. The primary endpoint was the feasibility and safety of APOLT, while secondary endpoints included improvement in serum bilirubin levels, neurological symptoms, and survival rates. ResultsAmong five patients diagnosed with CNS-I, APOLT was performed without intraoperative complications. During the median follow-up period of 6 months, there were no cases of relaparotomy, graft rejection, biliary complications, or portal venous thrombosis. One patient developed a portal venous stricture, but his symptoms were controlled with conservative measures. Postoperative liver function tests showed a significant improvement, with an average reduction of 90% in serum bilirubin levels. There was some improvement in neurological symptoms, and the overall patient and graft survival rate was 100%. ConclusionThis study suggests that APOLT is a feasible and safe treatment option in patients with CNS-I. It improves liver function, bilirubin levels, and neurological symptoms. Further research with larger sample sizes is warranted to confirm these findings and evaluate the long-term outcomes of APOLT in this patient population.

Prediction Model for Early-Stage Pancreatic Cancer Using Routinely Measured Blood Biomarkers

Accurate risk prediction models using routinely measured biomarkers-eg, carbohydrate antigen 19-9 (CA19-9) and bilirubin serum levels-for pancreatic cancer could facilitate early detection of pancreatic cancer and prevent potentially unnecessary diagnostic tests for patients at low risk. An externally validated model using CA19-9 and bilirubin serum levels in a larger cohort of patients with pancreatic cancer or benign periampullary diseases is needed. To assess the discrimination, calibration, and clinical utility of a prediction model using readily available blood biomarkers (carbohydrate antigen 19-9 [CA19-9] and bilirubin) to distinguish early-stage pancreatic cancer from benign periampullary diseases. This diagnostic study used data from 4 academic hospitals in Italy, the Netherlands, and the UK on adult patients with pancreatic cancer or benign periampullary disease treated from 2014 to 2022. Analyses were conducted from September 2022 to February 2023. Serum levels of CA19-9 and bilirubin from samples collected at diagnosis and before start of any medical intervention. Discrimination (measured by the area under the curve [AUC]), calibration, and clinical utility of the prediction model and the biomarkers, separately. The study sample comprised 249 patients in the development cohort (mean [SD] age at diagnosis, 67 [11] years; 112 [45%] female individuals), and 296 patients in the validation cohort (mean [SD] age at diagnosis, 68 [12] years; 157 [53%] female individuals). At external validation, the prediction model showed an AUC of 0.89 (95% CI, 0.84-0.93) for early-stage pancreatic cancer vs benign periampullary diseases, and outperformed CA19-9 (difference in AUC [ΔAUC], 0.10; 95% CI, 0.06-0.14; P < .001) and bilirubin (∆AUC, 0.07; 95% CI, 0.02-0.12; P = .004). In the subset of patients without elevated tumor marker levels (CA19-9 <37 U/mL), the model showed an AUC of 0.84 (95% CI, 0.77-0.92). At a risk threshold of 30%, decision curve analysis indicated that performing biopsies based on the prediction model was equivalent to reducing the biopsy procedure rate by 6% (95% CI, 1%-11%), without missing early-stage pancreatic cancer in patients. In this diagnostic study of patients with pancreatic cancer or benign periampullary diseases, an easily applicable risk score showed high accuracy for distinguishing early-stage pancreatic cancer from benign periampullary diseases. This model could be used to assess the added diagnostic and clinical value of novel biomarkers and prevent potentially unnecessary invasive diagnostic procedures for patients at low risk.