Serum Bilirubin Levels Research Articles

Choledocholithiasis: A Review of Management and Outcomes in a Regional Setting.

Background Choledocholithiasis is a common surgical presentation with an incidence of 8% to 16% in symptomatic cholelithiasis. Treatment often requires a multi-stage approach via endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic cholecystectomy (LC), which can prolong the length of stay (LoS) and expose patients to unnecessary risks. A single-stage procedure, such as LC with common bile duct exploration (CBDE), is a safe and effective option that may decrease LoS. This study compares patient outcomes and management in a regional center and aims to identify factors that predict the presence of confirmed choledocholithiasis. Methods A retrospective cross-sectional analysis was performed on all patients admitted to Toowoomba Hospital for management of diagnosed or suspected choledocholithiasis from January 2021 to March 2023. Patient demographics, ERCP findings, and operative data were collated. Results A total of 195 patients were identified, including 136 patients undergoing multi-stage management, 34 patients who had an ERCP alone, and 25 patients who underwent single-stage management. Single-stage procedures had an 80% success rate with an average LoS of 3.6 days. Multi-stage procedures had an average LoS of 8.1 days and an ERCP success rate of 93%. Complication rates between ERCP (11.7%) and LC with CBDE (9.7%) were comparable. Time to index ERCP and serum bilirubin level were found to be significantly lower in those with positive index ERCP findings compared to those without. Conclusion Single-stage procedures are a safe way to manage choledocholithiasis and are associated with a reduced LoS when compared to multi-stage management, with comparable efficacy and morbidity rates.

No benefit of soluble fiber on liver function.

Background: To conduct a systematic review and dose-response meta-analysis of current findings from randomized controlled trials (RCTs) on the effect of soluble fiber supplementation on liver function in both healthy individuals and people with specific health conditions, PubMed, Scopus, and ISI Web of Science were systematically searched for relevant RCTs published prior to April 2022. Methods: We estimated the change in liver function parameters for each 5 g/d increment in soluble fiber in each trial and then calculated the mean difference (MD) and 95%CI. A total of 25 RCTs with 27 treatment arms (1744 subjects; 884 cases, 860 controls) were included. Results: A total of 25 RCTs with 27 treatment arms were included. The intervention duration of the included studies ranged from 3 to 52 weeks and the dose of soluble fiber supplementation varied from 0.0025 to 40 g/d. Soluble fiber supplementation could not significantly affect serum alanine transaminase (MD: -0.02 U/L, 95% CI: -1.06 to 1.01), aspartate transaminase (MD: -0.34 U/L, 95% CI: -0.84 to 0.15), alkaline phosphatase (MD: 0.29 U/L, -0.14 to 0.71), gamma-glutamyl transferase (MD: 0.12 U/L; 95% CI: -0.81 to 1.05), serum bilirubin (MD: 0.42μmol/L, 95% CI: -0.08 to 0.93) and albumin (MD: 0.64 g/dl, 95% CI: -0.42 to 1.70) levels. Conclusions: Findings from this study did not support the beneficial effects of soluble fiber supplementation on liver function biomarkers. There is a need for long-term high-quality interventions to examine the effects of different types and doses of soluble fibers on liver function as primary outcome.

Functional Assessment of MGO Nanoparticle Supplementation in an Acute Liver Injury Rat Model

Magnesium supplements have been effective for modulating process of bile resistance, decrease oxidative stress and systemic inflammation. Current study was designed to functionally evaluate the MgO nanoparticle supplementation in an acute liver injury rat model. The animals were randomly divided into five groups. All groups were administrated with CCl4 to induce hepatic injury except of negative control group which received only vehicle. CCl4 administration is followed by MgO nanoparticles in the concentration of 150 and 300 mg/kg in low dose and high dose treated group respectively except of standard control group. After 21 days of treatment, the animals were sacrificed to collect blood and liver samples. Serum levels of bilirubin, AST, ALT and ALP were determined. Liver sample was also subjected to RNA isolation by Trizol method followed by the cDNA synthesis and Real Time PCR. In addition, lipid profile was also assessed. The data obtained was analyzed by one way analysis of variance (ANOVA). The results showed that levels of bilirubin, AST, ALT and ALP were significantly elevated in positive control group while MgO treated groups, somehow, had normal ranges of these enzymes. Furthermore, the qPCR results showed that the expression of Farnesoid X receptor (FXR), transcriptional regulator of the bile salt export pump (BSEP) and sodium taurocholate cotransporting polypeptide (NTCP), is reduced in positive control group, while nanoparticles treated groups had normal expression of these genes. In conclusion, our data showed that MgO nanoparticles possess hepatoprotective activity against hepatic injury.

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.

Age-specific reference intervals for liver function tests in healthy neonates, infants, and young children in Iran.

The reference intervals (RIs) for liver function tests (LFTs) were determined in Iranian children for the first time. A total of 344 healthy pediatrics aged 3 days to 30 months old were recruited. Serum levels of ALT, AST, ALP, direct bilirubin, and total bilirubin were measured. RIs were determined using CLSI Ep28-A3 guidelines. All analytes demonstrated age-specific differences except AST. ALT and ALP demonstrated significantly elevated levels in infants 0 to <5 months relative to the remainder of the age range. Direct and total bilirubin demonstrated markedly elevated levels in early life with mean of 0.28 mg/dL and 1.64 mg/dL observed for direct and total bilirubin, respectively, decreasing by ~50% in the adjacent partition. These novel data will help improve the clinical interpretation of biochemical test results in young Iranian neonates and children and can be of value to clinical laboratories with similar populations.

Impact of Light Emitting Diode Phototherapy in Full-Term Neonates with Hyperbilirubinemia

Abstract Background: To study the difference in serum total calcium levels during phototherapy with light-emitting diodes (LEDs) in full-term neonates with hyperbilirubinemia. Materials and Methods: In this prospective observational study, 74 term neonates with hyperbilirubinemia who were admitted for phototherapy using LEDs devices were examined. The research was carried out in a tertiary care facility. Before and after the phototherapy treatment, total serum bilirubin levels as well as total serum calcium levels were measured and compared. The symptoms observed with hypocalcemia, such as drowsiness irritability/excitability, lethargy, and convulsions, were also evaluated in full-term neonates during this study. Results: After treatment, the total serum calcium level decreased significantly (P &lt; 0.001) compared to the pretreatment level. Around 5% of the term neonates who participated in the study had hypocalcemia, where the serum calcium level is defined that is lower than 8 mg/dL in term neonates. Conclusions: In the context of the treatment of neonatal jaundice in full-term neonates, LED phototherapy, which is analogous to traditional blue and white light phototherapy, also has hypocalcemia as one of its potential side effects. During their treatment with light-emitting diode phototherapy, we advise checking up on these full-term neonates for signs of hypocalcemia.

Predictive factors in the differential diagnosis of benign and malignant causes in patients undergoing endoscopic retrograde cholangiopancreatography for extrahepatic cholestasis.

Diagnosing benign vs. malignant extrahepatic cholestasis is challenging despite the currently available advanced imaging and endoscopic techniques. This study aims to determine the predictive accuracy of initial biochemical data and bile duct dilatation findings in transabdominal ultrasound (US) to differentiate between benign and malignant disease in patients with extrahepatic cholestasis. We reviewed the case records of 814 patients who had undergone endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiography (in cases of unsuccessful ERCP) for extrahepatic cholestasis. The etiology of biliary obstruction was determined based on ERCP, endoscopic ultrasonography, radiology, cytology, biopsy, and/or clinical follow-up at one year. The patients were divided into benign and malignant groups according to the underlying etiology of biliary obstruction. A complete biochemical profile, transabdominal ultrasonography at presentation, and other demographic data were recorded. Alkaline phosphatase (p = 0.002), aspartate aminotransferase (p = 0.038), and bilirubin levels were significantly higher in malignant patients. The mean age of patients with malignancy was 69.5 years, vs. 60.6 years in benign patients (p < 0.001). The likelihood of malignancy increased with the increased bilirubin levels (> 200 µmol/l: 30.0% sensitivity, 97.6% specificity). The total bilirubin level predicting malignancy as the best cut-off value was 111 mmol/L with optimum sensitivity and specificity (61.8% and 83.8%, respectively) and area under the curve = 0.756, (p < 0.001). Intrahepatic bile duct (IHBD) dilatation was significantly higher in malignant patients (p < 0.001). A serum bilirubin level of 111 µmol/L or higher and the detection of IHBD dilatation on abdominal ultrasonography are important predictors in the differential diagnosis of benign and malignant causes of extrahepatic cholestasis.

Comparing the safety and effectiveness of various umbilical cord milking techniques and delayed cord clamping in full-term and preterm infants: A systematic review and meta-analysis.

We compare the hematocrit, hemoglobin, need for transfusion, recurrent phototherapy, serum bilirubin level, and serum ferritin at different time frames for the umbilical cord milking (UCM) and delayed cord clamping (DCC) in both full-term and preterm infants. A comprehensive search through various databases aimed to compare UCM and DCC studies until May 2nd, 2023. Cochrane and NIH tools assessed RCTs and cohorts, respectively. Meta-analysis employed Review Manager 5.4 software, calculating MD and RR with 95% CIs for continuous and dichotomous data. We included 20 studies with a total of 5189 infants. Regarding preterm infants, hematocrit level showed no significant difference between intact Umbilical Cord Milking (iUCM) compared to DCC (MD = -0.24, 95% CI [-1.11, 0.64]). Moreover, Neonatal death incidence was significantly higher with the UCM technique in comparison to DCC (RR = 1.28, 95% CI [1.01 to 1.62]). Regarding term and late preterm infants, Hematocrit level showed no significant difference between the iUCM or cUCM techniques compared to DCC (MD = 0.21, 95% CI [-1.28 to 1.69]), (MD = 0.96, 95% CI [-1.02 to 2.95]), respectively. UCM led to a higher risk of neonatal death in preterm infants compared to DCC. However, the incidence of polycythemia was lower in the UCM group. Additionally, UCM was associated with higher rates of severe IVH events. Based on these findings, DCC may be preferred due to its lower incidence of severe IVH and neonatal death.

Health status outcome among cannabis addicts after treatment of addiction.

The abuse of Cannabis is a widespread issue in the Asir region. It has a lot of legal and occupational repercussions. The purpose of this study was to evaluate the health status of cannabis addicts at admission and after treatment using body mass index, glycemic status, liver function, renal function, and oxidative stress. A cross-sectional study was conducted with 120 participants. The study was conducted at Al Amal Hospital for Mental Health in Asir region of Saudi Arabia, with 100 hospitalized patients receiving addiction treatment and 20 healthy volunteers. The participants were divided into two groups: group I, the control group, and group II, the cannabis addicts. The socio-demographic data were gathered. The level of cannabis in the urine and the CWAS [Cannabis Withdrawal Assessment Scale] were determined. In addition, the Body Mass Index [BMI], vital signs [temperature, heart rate, systolic blood pressure, diastolic blood pressure, and respiratory rate], serum levels of albumin, total bilirubin, direct bilirubin, AST, ALT, and ALP, urea, creatinine, Thiobarbituric acid-reactive substances [TBARS], superoxide dismutase [SOD], reduced glutathione [GSH], and catalase [CAT] were analyzed on the first day of admission and after treatment. According to the results, there was no significant change in the body mass index. The vital signs in the cannabis user group were significantly lower than the corresponding admission values. Regarding renal function tests such as urea and creatinine, we found that after treatment, the mean urea and creatinine values in the cannabis user group did not differ significantly from the corresponding admission values. However, after treatment, the mean values of fasting blood glucose levels in the cannabis user group were significantly lower than at admission. Also, the mean values of liver function tests such as albumin, total bilirubin, direct bilirubin, AST, ALT, and ALP in the cannabis user group were significantly lower than the corresponding admission values after treatment. In assessing the antioxidant system, we found that the mean values of TBARS, SOD, GSH, and CAT in the cannabis user group did not differ significantly from the corresponding admission values after treatment. The current findings have revealed that cannabis addiction harms the various body systems and has significant implications for the addict's state of health. The values of oxidative stress biomarkers did not change in this study, but other measured parameters improved after treatment.

Hepatitis-Induced Hemolysis in Pediatrics: A Rare Case Report

This article presents a case study of a 6-year-old boy diagnosed with acute Hepatitis A virus (HAV) infection compounded by glucose-6-phosphate dehydrogenase (G6PD) deficiency. The patient exhibited a constellation of symptoms, including low-grade fever, upper abdominal pain, fatigue, and anorexia, over an 8 to 10-day period. Notably, jaundice, dark-colored urine, and hepatomegaly were prominent clinical features. Laboratory investigations revealed severe intravascular hemolysis, evidenced by a decline in hemoglobin, elevated reticulocytes, and unconjugated hyperbilirubinemia. The diagnosis of HAV hepatitis was confirmed through positive IgM anti-hepatitis A virus. Over the subsequent two weeks, the patient experienced peak levels of serum bilirubin, AST, and ALT. Conservative management focused on avoiding hepatotoxic drugs, ensuring adequate urine output, and monitoring metabolic parameters. Gradual improvement was observed over the subsequent month, with a significant reduction in bilirubin levels, restoration of hemoglobin, and a decline in liver enzymes. The patient was discharged for outpatient follow-up, and four weeks post-onset, G6PD levels approached normal, emphasizing the importance of comprehensive care in such complex cases. This case underscores the intricate interplay between viral hepatitis and G6PD deficiency, contributing valuable insights into the clinical presentation and management of severe hemolysis in this specific population

Relationship between the Incidence of Neonatal Hyperbilirubinemia and Gestatinal Age as a Risk Factor

Neonatal hyperbilirubinemia (NH) or neonatal jaundice is characterized by elevated serum levels of total bilirubin in the blood and yellow color of the baby's skin, sclera, and mucous membranes. Neonatal hyperbilirubinemia can cause mild-moderate-severe neurological disorders, up to death, if left untreated. The incidence of neonatal hyperbilirubinemia (NH) in Indonesia in 2016 reached 51.47% of cases where 33.3% of the total NH cases were related to prematurity. The purpose of this study is to determine the incidence of NH in RSAB Harapan Kita This research is a type of quantitative analytical research with a cross sectional approach. The study population is babies born at RSAB Harapan Kita for the period January 2022 – December 2022. Using a random sampling technique with the slovin formula and a margin of error of 5%, a sample of 315 patients met the inclusion and exclusion criteria. Furthermore, statistical analysis was carried out using the chi-square test. As many as 158 (50.2%) babies born at RSAB Harapan Kita experienced NH with the most results of female babies (54.4%), aged 24-48 hours (48.1%), low birth weight (57%), and premature gestational age (67.7%). Bivariate analysis of the association of gestational age with NH incidence has a significance value of &lt;0.001 which proves a significant association. Conclusions: There is a significant association between preterm gestational age and NH incidence

Liver transplantation using magnetic anastomosis in pigs

Magnetic anastomosis substantially shortens the duration of vascular anastomosis. We aimed to apply magnetic anastomosis technology (MAT) to donor liver implantations in pig orthotopic liver transplantation (OLT). Twenty healthy adult pigs were randomly divided into donors and recipients, and major vascular anastomosis was performed using MAT during OLT. Recipient liver and kidney function was measured pre-surgery and 12, 24 and 72 h post-surgery. Vascular anastomoses examinations were performed using ultrasound or angiography weekly post-surgery, and pathological examinations of vascular anastomoses were performed during autopsy after animal euthanasia. All recipients survived 24 h after surgery, which is considered as successful transplantation. Anhepatic duration was only 13 min, and no anastomotic obstruction or stenosis, magnetic displacement and anastomotic angulation, or distortion was found upon postoperative examinations of major liver vasculature. Aspartate aminotransferase, alanine aminotransferase, and total bilirubin serum levels increased considerably postoperatively. The follow-up period for this study was 1 year, and the median survival time of all recipients was 115 d (interquartile range = 11–180 d). The main causes of death were liver failure, immune rejection, infection, and arterial anastomotic bleeding. Moreover, vascular anastomoses healed well with a survival time of more than two weeks. We developed a novel magnetic device to create a fast and safe technique to perform major vascular anastomoses in pig liver transplantations. Additionally, the liver graft implantation using MAT considerably shortened the recipient warm ischemia time, which will reduce the extent of ischemia–reperfusion injury. We conclude that MAT is an effective method for donor liver fast implantation in OLT in pigs.

A zebrafish model for studying the mechanisms of newborn hyperbilirubinemia and bilirubin-induced neurological damage.

Unresolved neonatal hyperbilirubinemia may lead to the accumulation of excess bilirubin in the body, and bilirubin in neural tissues may induce toxicity. Bilirubin-induced neurological damage (BIND) can result in acute or chronic bilirubin encephalopathy, causing temporary or lasting neurological dysfunction or severe damage resulting in infant death. Although serum bilirubin levels are used as an indication of severity, known and unknown individual differences affect the severity of the symptoms. The mechanisms of BIND are not yet fully understood. Here, a zebrafish newborn hyperbilirubinemia model is developed and characterized. Direct exposure to excess bilirubin induced dose- and time-dependent toxicity linked to the accumulation of bilirubin in the body and brain. Introduced bilirubin was processed by the liver, which increased the tolerance of larvae. BIND in larvae was demonstrated by morphometric measurements, histopathological analyses and functional tests. The larvae that survived hyperbilirubinemia displayed mild or severe morphologies associated with defects in eye movements, body posture and swimming problems. Interestingly, a plethora of mild to severe clinical symptoms were reproduced in the zebrafish model.

Predictive modeling of postoperative gastrointestinal dysfunction: the role of serum bilirubin, sodium levels, and surgical duration in gynecological cancer care.

To elucidate the role of preoperative serum bilirubin and sodium levels, along with the duration of surgery, in predicting postoperative gastrointestinal dysfunction (POGD) following gynecological cancer surgery, informing tailored perioperative strategies. We conducted a retrospective analysis of 281 patients undergoing gynecological cancer surgery between 2018 and 2023. This analysis focused on preoperative serum bilirubin and sodium levels and intraoperative factors (surgical duration) as potential predictors of POGD. Logistic regression models were utilized for analysis, controlling for relevant confounders. Elevated preoperative serum bilirubin was associated with a reduced risk of POGD (mean level in non-POGD cases: 14.172 ± 4.0701, vs. POGD cases: 9.6429 ± 3.5351; p< 0.001), suggesting a protective role. Lower preoperative sodium levels were identified in the POGD group (136.26 mEq/L [IQR: 135.2-137.63]) compared to the non-POGD group (139.32 mEq/L [IQR: 137.7-140.75]; p< 0.001), highlighting its predictive value. Additionally, longer surgical duration was associated with increased POGD incidence, with POGD cases experiencing surgeries lasting 6.1547 ± 1.9426 hours compared to 4.5959 ± 1.5475 hours in non-POGD cases (p< 0.001). Our findings underscore the importance of serum bilirubin, sodium levels, and surgical duration as significant predictors of POGD in patients undergoing gynecological cancer surgery. These indicators should be integrated into a predictive model, aiding clinicians in identifying high-risk patients, allowing for personalized perioperative care adjustments, potentially mitigating POGD risks.

Management of Kamala (Jaundice) with Ayurveda Treatment - A Case Study

Jaundice is a yellowish pigmentation of the skin, sclera, mucous membrane and intestinal fluid due to high bilirubin levels. In Ayurveda, Jaundice and their treatment are very well described under the heading of Kamala Vyadhi. Jaundice can develop in all age of peoples. Clinically sign of jaundice occur when the serum bilirubin level exceeds 2.5 to 3 mg/dl. Level of bilirubin in blood are normally below 1.0 mg/dl. Most of the people have become used to spicy food, fast food, alcohol consumption day by day. This has taken human being far away from nature. Ayurvedic text has mentioned hepatocellular jaundice as Kamala. Kamala due to frequently intake of Pittakara Aahara (Spicy and fast food). Its leads to vitiation of Pitta Dosha. Kamala is such a disease where in the Rakta Dhatu is vitiated primarily by Pitta Dosha. Kam means different type of desire of body and mind desire especially regarding the diet and physical activity of body are minimised in Kamala. In Kamala disease there is loss of desire to do anything. This paper discusses a patient in the OPD of Kayachikitsa department in Dhanwantari Ayurveda Hospital, Ujjain. His chief complaint is yellow discolouration of skin, Icterus, yellow discolouration of urine (Pittamootrata), Anorexia, since 7 days. Here is a case report of 12 years old child was having Kamala who was treated with some Ayurvedic internal medicine and mild purgative, after 15 days we got effective result by Ayurvedic management.

Association between serum bilirubin and estimated glomerular filtration rate in diabetic patients with chronic kidney disease

Background and objectives: Hyperglycemia induces oxidative stress in diabetic patients by increasing reactive oxygen species production, which ultimately damage the cells and cause micro and macrovascular complications including diabetic nephropathy. Increased serum bilirubin level, within physiological range, can inhibit oxidative stress; thereby, preventing development of diabetic nephropathy. The aim of this study was to find out association between serum bilirubin and estimated glomerular filtration rate (eGFR) in diabetic patients with or without chronic kidney disease (CKD). Materials and method: Both male and female participants aged 30 to 60 years were enrolled in the study. Enrolled participants included healthy individuals (Group-1), diabetic patients without CKD (Group-2) and diabetic patients with CKD (Group-3). Clinical and biochemical parameters namely blood pressure, body mass index (BMI), fasting blood glucose (FBG), HbA1c, eGFR, serum bilirubin and spot urine ACR were measured by appropriate methods. Pearson’s correlation coefficient, ANOVA and multiple linear regression models were used to analyze the data. Result: Total 189 respondents were enrolled in 3 study groups. Each group consisted of 63 cases. Of the 63 cases in Group-3, 49 and 14 belonged to CKD stage 3 and stage 4 respectively. The mean (± SD) serum bilirubin levels of healthy individuals, diabetic patients without CKD and diabetic patients with CKD were 0.66 ± 0.31, 0.64 ± 0.21, 0.46±0.18 mg/dL respectively. Mean serum bilirubin was significantly low (p&lt;0.001) in diabetic patients with CKD compared to healthy and diabetics without CKD. A Stepwise multiple regression analysis using eGFR as an objective variable adjusted for risk factors as explanatory variables, showed that serum bilirubin (β=0.323, p&lt;0.001) was significantly associated with eGFR, in addition to age, BMI, HbA1c and urinary ACR. Conclusion: The study has demonstrated that low serum bilirubin level is associated with CKD in diabetic patients and it could be used as a simple marker for CKD in diabetics. IMC J Med Sci. 2024; 18(1):006. DOI: https://doi.org/10.55010/imcjms.18.006 *Correspondence: Tanzia Tahfim, Department of Biochemistry, Shaheed Monsur Ali, Medical College, Uttara, Dhaka-1230, Bangladesh. Email: tanzia.uamc@gmail.com

Safety and efficacy of least incompatible red cell units in autoimmune hemolytic anemia: A prospective analysis of hemoglobin increment and hemolysis after transfusion

Abstract BACKGROUND: Red blood cell (RBC) transfusion is a challenge in autoimmune hemolytic anemia (AIHA) patients due to pan reactivity and crossmatch incompatibility. Apprehensions about the safety and efficacy of least incompatible (best-matched) red cells are common among treatment providers. AIM: A primary objective was to study the effect of RBC transfusion on hemolysis parameters (hemoglobin [Hb], serum bilirubin, serum lactate dehydrogenase [LDH], and reticulocyte count) in AIHA patients. SETTINGS AND DESIGN: This was a hospital-based prospective observational study conducted on 40 AIHA patients attending the department of internal medicine from January 2020 to July 2021 who received RBC Transfusions. METHODOLOGY: Blood samples were collected for evaluating hemolysis parameters: Hb, reticulocyte count, serum bilirubin, and serum LDH before transfusion and compared with the same parameters within 12 h after transfusion. STATISTICAL ANALYSIS: Analysis was done by SPSS software Version 16. Paired t-test was used to find the effect of RBC transfusion on hemolysis parameters and independent t-test was used to compare the effect of compatible and incompatible RBC transfusions. RESULTS: The median age at presentation was 42 years with a female preponderance (67.5%). Majority of the patients belong to warm AIHA (73%) and Secondary AIHA (60%). Compatible RBC units could be provided to 57% of cases and 43% were transfused with the least incompatible units. The mean pretransfusion Hb in AIHA was 4.3 mg/dl and showed a statistically significant increase after transfusion (P &lt; 0.001). A significant difference between reticulocyte levels of compatible and incompatible transfusions was noted with a P = 0.025. No statistically significant difference noticed in Hb, serum LDH, serum bilirubin levels between compatible and incompatible RBC transfusions. CONCLUSION: RBC transfusions in AIHA patients provide Hb increment similar to other anemic patients. RBC transfusions should not be denied in AIHA patients in view of hemolysis and best-matched units also may be transfused in indicated cases.

Dose-dependent Oxidative Damage of Molnupiravir (Antiviral Drug for Treatment of COVID-19) in Lung, Liver, Heart, and Kidney Tissues in Rats

Molnupiravir (MOL) is an orally absorbed prodrug of the ribonucleoside analogue N-hydroxycytidine, which has in vitro activity against several coronaviruses, including SARS-CoV-1 and 2. It remains to be seen whether long term MOL has serious side effects. The side effects of MOL, which was the first to be allowed for oral use during the pandemic process, are not yet fully known. In this study, it was aimed to investigate the the mechanisms of possible dose-dependent damage on liver, lung, heart, and kidney tissues. Fourty male Wistar albino rats were separated into four groups as Control, MOL10, MOL100, MOL1000. For five days, MOL (10-100-1000 mg/kg/day) was administered by oral gavaj. At the end of the five days rats were sacrificed and alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bilirubin (TB) levels in serum were measured. Collected tissues (liver, lung, heart, and kidney) were evaluated to the malondialdehyde (MDA), superoxide dismutase (SOD), total antioxidant state (TAS), and total oxidant state (TOS), and oxidative stress indexes (OSI) were calculated. MOL administration showed significant improvement in liver, heart, and kidney in rats (p&lt;0.05). SOD activities which were decreased in the MOL group, while MDA level increased in the MOL groups compared to the control group in all tissue (p&lt;0.05). ALT was increased in the MOL group compared to the control group (p&lt;0.05). Increase of TOS and OSI is statistically significant, but TAS was decreased in the MOL group compared to the control group (p&lt;0.05). MOL used in virus treatment is dose-dependently effective on the oxidant/antioxidant system in tissues. For this reason, the use of antioxidants may be beneficial to reduce tissue damage that may occur in the use of MOL.

Effect of phototherapy on eosinophils count in neonatal hyperbilirubinemia (cross-sectional study)

BackgroundNeonatal jaundice is a common disorder in neonates. Phototherapy is associated with various side effects despite being safe. This research aimed to determine the impact of phototherapy (PT) on eosinophil levels in neonates treated for unconjugated hyperbilirubinemia.MethodsIn this cross-sectional prospective study, icteric neonates admitted to the Neonatal Intensive Care Unit (NICU) of Abo-Elreesh Child Hospital, Cairo University, from July 2020 to June 2021 were assessed. Laboratory data, including serum bilirubin and blood cell differentiation for eosinophils before and after phototherapy, were collected, and demographic data like age, gender, gestational age, and duration of phototherapy were taken.ResultsTwo hundred neonates were included in this study. Hyperbilirubinemia was most frequently related to ABO group incompatibility (44.5%). After phototherapy, total serum bilirubin and neutrophil levels were significantly decreased, and platelet levels were significantly increased. Eosinophil count and percent were significantly increased (p < 0.001) following phototherapy. A statistically significant positive correlation was found between eosinophil count before and after PT (r = 0.583, p < 0.001) and between eosinophil percent before and after PT (r = 0.617, p < 0.001).ConclusionSerum eosinophils were increased after phototherapy in icteric neonates with hyperbilirubinemia.

The role of high serum bilirubin as a predictor of complicated appendicitis: a retrospective cohort study

Introduction: An appendectomy is one of the most common emergency surgeries. The delay in diagnosis and treatment of appendicitis can lead to complicated appendicitis. The definitive predictive factor that can diagnose complicated appendicitis is still lacking. The authors aim to assess the role of high serum bilirubin level as a predictor of complicated appendicitis. Methods: A retrospective cohort study was conducted among patients with acute appendicitis (AA) between March 2017 and March 2018. Appendicitis cases diagnosed with the help of the Alvarado score undergoing surgery were taken in study and based on the histopathological report, the cases were classified into two groups: uncomplicated and complicated. Preoperatively, biochemical parameters like increased white blood cell count (&gt;11000/cubic millimeter), and level of serum bilirubin &gt;1.4 mg/dl were studied. Informed written consent for the study was taken from the patients with AA. A χ 2 test was applied for the association between categorical variables. Statistical analysis was done with a statistical package for the social sciences (SPSS) version 20; P-value less than 0.05 was considered statistically significant. Results: A total of 100 patients were enrolled in the study with a mean age of 31.2±18.3 years, and 60% were male. Seventy-four (74%) had uncomplicated appendicitis and 26 (26%) had complicated appendicitis. Mean bilirubin was 1.2±0.8 mg/dl in uncomplicated and 1.8±0.8 mg/dl in complicated groups (P &lt;0.05). The sensitivity and specificity of hyperbilirubinemia as a predictor of complicated appendicitis were 50 and 78.38%, respectively. Conclusion: The study revealed that patients with AA and a higher serum bilirubin level have a higher risk of having complicated appendicitis. Serum bilirubin level helps to predict complicated appendicitis and thus plan for timely and appropriate management. Thus, the study concludes that bilirubin should be used together with clinical examination and other laboratory investigations in the assessment of patients with suspected AA.