Search

Objective: To test the accuracy of transcutaneous bilirubinometry (TcB) in neonates 12 h after discontinuing phototherapy. Study design: In a prospective study of 91 neonates at ≥35 weeks of gestation, paired measurements of total serum bilirubin (TSB) and TcB were obtained 12 h after discontinuation of phototherapy. TcB measurements were obtained on the uncovered skin of the sternum and the covered skin of the lower abdomen. Bland–Altman plots were used to evaluate agreement between TSB and TcB. Results: TcB was found to systematically underestimate TSB on both covered and uncovered skin. The smallest but statistically significant difference between TSB and TcB was found on the covered lower abdomen (–1.03, p <.0001) compared with the uncovered skin of the sternum (–1.44, p <.0001). The correlation between TSB and TcB was excellent on both covered (r = 0.86, p <.001) and uncovered skin (r = 0.90, p <.001). Bland and Altman plots showed poor agreement between TcB and TSB. Conclusions: This study demonstrated excellent correlation between TcB and TSB 12 h after phototherapy but poor TcB–TSB agreement. TcB cannot be reliably used in neonates exposed to phototherapy. [ABSTRACT FROM AUTHOR]

Objective Method Results Conclusions Whether metal stents (MS) or plastic stents (PS) yield better outcomes for malignant biliary obstruction in endoscopic ultrasound‐guided hepaticogastrostomy (EUS‐HGS) is controversial. We aimed to compare outcomes of initial EUS‐HGS performed with MS or PS.In this single‐center retrospective study, we included patients (MS/PS groups: n = 151/72) with unresectable malignant biliary obstruction and performed multivariable analysis. The landmark date was defined as day 100 and used to evaluate the time to recurrent biliary obstruction (TRBO).The clinical success rate was similar in both groups. The mean total bilirubin percentage decrease at week 2 was significantly higher in the MS group than in the PS group (−45.1% vs. −23.7%, P = 0.016). Median TRBO was significantly different between the MS and PS groups (183 and 92 days, respectively; P = 0.017). TRBO within 100 days was comparable in both groups but was significantly shorter only after 100 days in the PS group (adjusted hazard ratio 12.8, P < 0.001). Adverse events were significantly more common in the MS group (23.8% vs. 9.7%, P = 0.012), although they occurred relatively frequently even with PS in the cholangitis subgroup (Pinteraction = 0.034). After endoscopic re‐intervention, TRBO tended to be longer with revision PS (hazard ratio 0.40, P = 0.47).Although MS provided early improvement of jaundice and long stent patency, PS provided a better safety profile and comparable stent patency until 100 days. PS might also be an adequate and optimal palliation method in EUS‐HGS. [ABSTRACT FROM AUTHOR]

Background: Secondary or metastatic tumors of the pancreas are exceedingly rare. This study aims to elucidate an uncommon etiology contributing to pancreatic masses: extramedullary plasmacytoma. Case Report: A 77-year-old male patient, undergoing treatment for multiple myeloma, presented with jaundice and abdominal pain. Laboratory findings indicated cholestasis. Imaging techniques revealed a dilated biliary tree and a hypoechoic mass in the head of the pancreas. Endoscopic examination showed significant narrowing of the duodenal lumen with an infiltrative pattern in the duodenal wall. Biopsies were taken from the narrowed area, and percutaneous biliary drainage was performed in the radiology department. Histopathological analysis of the biopsies revealed features consistent with plasmacytoma, characterized by infiltration with atypical plasma cells and positivity for CD138 in immunohistochemistry. Conclusion: In cases where a patient with multiple myeloma presents with a pancreatic mass, it is imperative to consider the possibility of a pancreatic plasmacytoma as a potential diagnosis. [ABSTRACT FROM AUTHOR]

Background: Endoscopic ultrasound (EUS) is important for the evaluation of patients with common bile duct (CBD) dilation. Aims: The purpose of this study was to evaluate the diagnostic performance of EUS for CBD dilation in patients with negative initial studies. Methods: This was a retrospective cohort study that included patients who underwent EUS for CBD dilation (≥ 7 mm if intact anatomy or ≥ 10 mm if prior cholecystectomy) in the absence of pathology on previous ultrasonography (US), computed tomography (CT), and/or magnetic resonance cholangiopancreatography (MRCP). Results: A total of 109 patients were included, among whom 41 had a positive EUS: 33 choledocholithiasis (30.3%), 6 chronic pancreatitis (5.5%), and 2 ampullary cancer (1.8%). If the EUS was negative, no pathology was found during 1-year follow-up. Older age was associated with positive EUS (79 versus 71 years, p = 0.030). Patients with jaundice, cholelithiasis, and altered liver biochemistry were 16.2 (p = 0.002), 3.1 (p = 0.024), and 2.9 (p = 0.009) times more likely to have positive EUS, respectively. A total of 53 patients had a negative MRCP (48.6%); those with biliary abdominal pain and jaundice were 15.5 (p < 0.001) and 20.0 (p = 0.007) times more likely to have positive EUS, respectively. Considering asymptomatic patients with normal liver tests, CBD diameter ≥ 10 mm in US and ≥ 11 mm in CT can predict a positive EUS (AUC 0.754, p = 0.047 and AUC 0.734, p = 0.048). Conclusions: EUS is a useful diagnostic method for patients with unexplained CBD dilation, even if negative MRCP, and especially in patients with older age, abdominal pain, jaundice, cholelithiasis, and/or altered liver biochemistry. CBD diameter in US and CT had a moderate discriminative ability in predicting positive EUS in asymptomatic patients without altered liver biochemistry. [ABSTRACT FROM AUTHOR]

ABSTRACT: Spontaneous biliary perforation is a rare condition, predominantly observed in infants, characterized by the leakage of bile into the peritoneal cavity without any apparent cause. This case report discusses a 3-month-old female infant who presented with symptoms of jaundice and abdominal distension. The successful management of this case with a combination of ultrasound-guided percutaneous drainage and laparoscopic cholecystostomy is detailed, highlighting the importance of minimally invasive techniques in treating this condition. [ABSTRACT FROM AUTHOR]

Background: Jaundice is a significant health issue in Bangladesh. Many patients choose traditional medicine (TM) over conventional medicine (CM) for treating jaundice. This study aimed to identify and analyze the push and pull factors influencing the preferences of jaundiced patients for traditional healing methods in Bangladesh. Methods: This cross-sectional study used a mixed-methods approach. Two focus group discussions (FGDs) were conducted with 16 participants (8 per group) who had experience of using traditional medicine for jaundice. In-depth interviews with five traditional healers were carried out to gather qualitative insights from the healers' perspectives. Quantitative data were collected from 400 jaundiced patients at a tertiary-level hospital using a semi-structured questionnaire. Chi-square tests and binary logistic regression were used to analyze associations between sociodemographic factors, push-pull factors, and treatment preferences. Results: The study found that 62% of participants favored TM for jaundice treatment. The scalp and hand cleansing rituals (46%), herbal remedies (37%), garlanding (23%), and use of talismans or amulets (21%) were the most common practices. Qualitative analysis revealed five push factors, eight pull factors, four intervening obstacles, and five personal factors that influenced jaundiced patients' preference for TM. Patients also emphasized the significance of spiritual and emotional aspects in their decision-making process when choosing TM. Significant associations were observed between treatment preference and age group (p = 0.002), residence (p = 0.018), education level (p<0.001), and religion (p = 0.015). Individuals aged 50 years and above (70.9%), rural residents (68%), and those with no or primary education (72%) were more likely to opt for TM. Key push factors towards TM included high costs of CM (OR: 6.80, 95% CI: 2.10–22.04) and perceived ineffectiveness of CM. Strong pull factors were accessibility of TM (OR: 11.18, 95% CI: 4.03–31.00), perceived effectiveness of TM (OR: 3.45, 95% CI: 1.05–11.37), personal testimonials (OR: 7.55, 95% CI: 2.75–20.69), lower costs of TM (OR: 10.48, 95% CI: 4.30–25.54) and lack of information about conventional treatments for jaundice (OR: 13.82, 95% CI: 4.62–41.33). Conclusion: The study reveals that both push and pull factors influence jaundiced patients in Bangladesh to choose TM over CM, with decisions shaped by personal, socioeconomic, and geographical factors. [ABSTRACT FROM AUTHOR]

Previous investigations on the impact of oral zinc sulfate treatment on newborns' serum bilirubin levels have produced conflicting results. As a result, the goal of this clinical study was to evaluate how oral zinc sulfate affected the levels of serum bilirubin in term infants who were admitted to the neonatal intensive care unit. The study was conducted at the Neonatal Care Unit of Besat Hospital in Sanandaj, Kurdistan Province, as a double-blind randomized controlled trial. The participants included term infants (37–42 weeks of gestation) who required phototherapy and were admitted to the neonatal intensive care unit. A total of 290 infants were enrolled and randomly divided into two groups. The intervention group received oral zinc sulfate supplementation at a dosage of 1 mg/kg per day in addition to phototherapy, while the placebo group received an equivalent amount of placebo daily. Bilirubin measurements were obtained at the initiation of the intervention and subsequently every 24 h until discharge. The collected data were analyzed using STATA software version 17. After the infants were randomly allocated to the zinc-sulfate and placebo groups, the study outcomes, including the average changes in bilirubin levels after intervention, the hours of phototherapy, and the number of days of hospitalization, were analyzed and compared for a total of 160 infants in the zinc sulfate group and 130 infants in the placebo group. The reduction in bilirubin levels in infants receiving zinc sulfate was (− 3.75 ± 0.19 CI 95% − 4.12, − 3.37) and for placebo group was (− 1.81 ± 0.15 CI 95% − 2.12, − 1.50) 24 h after the intervention. Furthermore, 48 and 72 h following the intervention, bilirubin levels in the intervention group demonstrated a more substantial decline. The zinc sulfate group had a shorter hospital stay (2.13 ± 0.04 vs. 2.83 ± 1.42) and required less phototherapy hours than the placebo group (6.21 ± 2.16 vs. 8.78 ± 1.40). Conclusions: Oral zinc sulfate supplementation in term neonates with hyperbilirubinemia decreased the level of bilirubin levels, duration of phototherapy, and hospital stay. Trial registration: IRCT, IRCT20220806055625N1. Study Registered 25 December 2022, http://irct.ir/trial/66,722. What is Known? • Previous studies on oral zinc sulfate as a treatment for neonatal hyperbilirubinemia have yielded mixed results, with some suggesting benefits in reducing serum bilirubin levels, while others found minimal or no impact. • Hyperbilirubinemia is a common condition in neonates, often requiring phototherapy to prevent serious complications. What is New? • This study contributes new evidence demonstrating that oral zinc sulfate supplementation significantly reduces serum bilirubin levels in term neonates more effectively than placebo. Additionally, the study found that zinc sulfate not only accelerates the reduction of bilirubin but also decreases the duration of phototherapy and shortens the length of hospital stay, offering robust data that could influence therapeutic strategies for managing neonatal hyperbilirubinemia. [ABSTRACT FROM AUTHOR]

A 65-year-old male patient presented to his general practitioner with jaundice, which he and his close contacts had seen for the last 2 to 3 months, his medical history include hypothyroidism and glaucoma. His medical history included laparoscopic cholecystectomy, he provides 75 mcg of levothyroxine daily and applies latanoprost eye drops each day; he was first evaluated for jaundice by blood tests and a liver ultrasound, upon further assessment, his health deteriorated, displaying a more noticeable orange tint, and his TSH level was found to be elevated. The next laboratory tests and imaging investigations produced normal findings, the general practitioner suspected carotenemia, and a thorough nutritional examination revealed a diet high in vitamin A, mostly including carrots, his blood tests were re-evaluated, including analyses of vitamin A and betacarotene concentrations, he was provided with dietary guidelines aimed at reducing the intake of vitamin A-rich foods, the dose of his levothyroxine was increased. Upon additional analysis, he was found to have elevated levels of vitamin A and beta carotene, his condition improved with the innovative treatments, this case illustrates a rare diagnosis of carotenemia in an adult male, associated with elevated dietary vitamin A consumption and poorly managed hypothyroidism, carotenemia is characterised by yellow-orange skin discolouration, typically resulting from excessive intake of carotene-rich foods, it transpires without the presence of yellow scleral discolouration, carotenemia is a nonthreatening illness; thus, more diagnostic testing is unwarranted. [ABSTRACT FROM AUTHOR]

Gallstone disease (GD) is one of the most common gastroenterological diseases and is usually detected already at the stage of stone formation. This study aimed to develop personalized surgical tactics, taking into account the stage of the disease, for patients with cholelithiasis manifested by mechanical jaundice, thereby improving treatment results. Laparoscopic cholecystostomy was more often used in patients with mechanical jaundice when choosing biliary drainage. It was found that laparoscopic cholecystectomy remains the most common operation performed for calculous cholecystitis and mechanical jaundice, which is accompanied by external drainage of the choledochus according to 20.8% of cases (according to Piskovsky technique) and in 11.4% of cases (according to Keru technique). The use of a scheme for choosing a method of treatment for MJ at different stages allows for reducing the number of complications by 9.7% to 4.6%; in the group of operations after ERCP, EPST - from 5.4% to 4.3%, with external drainage of choledochus - from 17.9% to 10%. [ABSTRACT FROM AUTHOR]

Objective: To explore the effects of Bifidobacterium triple viable bacteria on intestinal floras and bilirubin in neonatal jaundice. Methods: A total of 300 children with jaundice admitted to Nanjing Jiangning Hospital were enrolled between May 2021 and May 2023. According to random number table method, they were divided into probiotic group (Bifidobacterium triple viable bacteria tables on basis of control group) and control group (routine treatment), 150 cases in each group. All were continuously treated for 1 week. The curative effect, changes of intestinal floras, bilirubin and inflammatory indexes before and after treatment, and the occurrence of adverse reactions during treatment were compared between the two groups. Results: The difference in response rate of treatment between probiotic group and control group was statistically significant (90.67% vs 82.00%, P<0.05). After treatment, counts of Bifidobacteria and Lactobacillus acidophilus in probiotic group were higher than those in control group, while count of Escherichia coli was lower than that in control group (P<0.05). The levels of total bilirubin (TBIL), direct bilirubin (DBIL) and indirect bilirubin (IBIL) in probiotic group were lower than those in control group (P<0.05), inflammation level was lower than that in control group (P<0.05), and levels of y-glutamyltransferase (GGT) and alkaline phosphatase (ALP) were lower than those in control group (P<0.05). There was no significant difference in incidence of adverse reactions between probiotic group and control group (10.00% vs 12.00%, P>0.05). Conclusion: Bifidobacterium triple viable bacteria can improve intestinal floras and inflammation level, reduce liver burden and bilirubin level in neonatal jaundice. [ABSTRACT FROM AUTHOR]

Background: Neonatal jaundice is a common condition affecting newborns worldwide, with potential longterm health implications. Previous studies have suggested a correlation between low birth weight (LBW) and increased risk of neonatal jaundice, yet comprehensive analyses incorporating gestational age, maternal health, and prenatal care remain limited. Methods: This observational study analyzed data from 100 newborns, categorized by birth weight into LBW (<2500 grams) and normal birth weight (NBW, ≥2500 grams) groups. We assessed the incidence of neonatal jaundice, conducted a chi-square test to explore the association between birth weight and jaundice, and utilized a T-test to examine differences in gestational age. Additional analyses included the impact of gender distribution, maternal hypertension, and prenatal care on the incidence of jaundice. Results: Our findings indicate that 80% of LBW newborns developed neonatal jaundice, compared to 30% of NBW newborns. Statistical analysis revealed a significant association between LBW and increased incidence of jaundice (χ²=22.36, p<0.001). LBW newborns were also significantly more likely to be born preterm compared to their NBW counterparts (t=7.88, p<0.001). Maternal hypertension and lower rates of prenatal care utilization were significantly associated with LBW. Conclusion: The study confirms a significant correlation between LBW and the increased incidence of neonatal jaundice. It highlights the importance of addressing factors such as maternal health and prenatal care to mitigate the risks associated with LBW and neonatal jaundice. Further research is recommended to explore targeted interventions for pregnant women and LBW newborns. [ABSTRACT FROM AUTHOR]

Jaundice is one of the common clinical symptoms, which is characterized by eyes stained yellow especially. The classification and prescription of jaundice are improved continuously. This consensus describes the history of jaundice, etiology and pathogenesis, common symptoms, clinical treatment, evaluation of therapeutic effect, preventive regimen and regression follow-up, highlighting its clinical practicality and reflecting the latest research progress. [ABSTRACT FROM AUTHOR]

Objectives The aims of this study were to (1) establish the maximum allowable interference limits for hemolysis, lipemia, and icterus for chemistry analytes tested in body fluid samples and (2) assess the effectiveness of serial dilution to mitigate spectral interferences. Methods Residual body fluids from clinically ordered testing were mixed (<10% by volume) with stock solutions of interferent (spiked) and compared with a control spiked with an equal volume of 0.9% saline. The analytes were measured on the Roche cobas c501 instrument. Difference and percentage difference were calculated and compared with allowable total error limits. A subset of samples were serially diluted with 0.9% saline. Mean (SD) difference and percentage difference were calculated. Results The interference thresholds were lower than the package insert for lactate dehydrogenase, cholesterol, triglycerides, and total protein for hemolysis; amylase, cholesterol, and total protein for icterus; and albumin for lipemia. Only cholesterol and triglyceride results returned to baseline upon dilution of icteric samples. Conclusions Interference thresholds in body fluids were lower than blood for 6 analytes. Diluting interferences that surpass these limits does not produce reliable results that are comparable to the baseline results before spiking in the interferent. [ABSTRACT FROM AUTHOR]

Acute liver failure is rare in the neonatal and infant population; however, when encountered, it requires timely diagnosis, management, and identification of the underlying etiology to provide the best clinical outcomes. Here, we present a case of new-onset liver failure in a 4-month-old infant. She had previously been diagnosed with neonatal mucocutaneous herpes simplex virus disease, but had been healthy in the interval, and was referred to our hospital for evaluation of possible need for liver transplantation because of a rapidly progressing pace of disease. In this diagnostic dilemma article, we review the case history and presentation and consider the differential diagnosis from the points of view of the primary and consultative teams. We then follow the clinical evolution of disease, identify a final diagnosis, and explore the short- and long-term management and health implications of the diagnosis. This case should be of interest to primary care providers, intensivists who care for neonates or infants, and specialists who encounter liver failure in their clinical practice. [ABSTRACT FROM AUTHOR]

Background: Cholestasis is characterized by the accumulation of bile in the liver or biliary system due to obstruction or impaired flow, necessitating lipid profiling to assess lipid metabolism abnormalities. Intrahepatic cholestasis, being the most significant type of cholestasis, further complicates the assessment of lipid abnormalities. However, the accuracy of low-density lipoprotein cholesterol (LDL-C) measurement in intrahepatic cholestasis patients remains uncertain. Objective: This study aimed to evaluate the consistency of the homogeneous assay and the Friedewald formula in detecting LDL-C levels and identify factors influencing LDL-C test results in intrahepatic patients with cholestasis. Methods: Retrospective analysis of laboratory data was conducted on intrahepatic cholestatic patients. Correlations between LDL-C values obtained using the homogeneous method (LDL-C(D)) and the Friedewald formula (LDL-C(F)), as well as associations between high-density lipoprotein cholesterol (HDL-C) and apolipoprotein A1 (ApoA1), LDL-C(D) and LDL-C(F), and apolipoprotein B (ApoB), were analyzed. Logistic regression analyses were employed to identify diagnostic indicators for inaccurate LDL-C measurements in intrahepatic cholestatic patients. Results: Compared to patients with intrahepatic cholestasis without jaundice, the correlation between LDL-C(F) and LDL-C(D) was weaker in those with jaundice. Additionally, HDL-C exhibited a strong correlation with ApoA1 in both jaundice and non-jaundice cholestasis cases. Elevated non-HDL-C to APOB ratio (NH-C/B Ratio) levels (>4.5) were identified as a reliable predictor of inaccurate LDL-C measurements in patients with chronic intrahepatic cholestasis accompanied by jaundice. Conclusions: LDL-C measurement reliability is moderately weaker in patients with intrahepatic cholestasis accompanied by jaundice. Elevated levels of the NH-C/B ratio serve as a significant predictor of inaccurate LDL-C measurements in this chronic patient population, highlighting its clinical relevance for diagnostic assessments. [ABSTRACT FROM AUTHOR]