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Persistent challenges in addressing severe neonatal hyperbilirubinaemia in resource-constrained settings have led to ongoing and often unacceptable rates of morbidity, disability and mortality. These challenges stem from limitations such as inadequate, inefficient or financially inaccessible diagnostic and therapeutic options. However, over the past decade, noteworthy innovations have emerged to address some of these hurdles, and these innovations are increasingly poised for broader implementation. This review provides a concise summary of these novel, economically viable diagnostic solutions, encompassing point-of-care assays and smartphone applications, as well as treatment modalities, notably more effective phototherapy and filtered sunlight. These advancements hold promise and have the potential to meaningfully reduce the burden of neonatal hyperbilirubinaemia, signifying a promising shift in the landscape of neonatal healthcare. [ABSTRACT FROM AUTHOR]

Persistent challenges in addressing severe neonatal hyperbilirubinaemia in resource-constrained settings have led to ongoing and often unacceptable rates of morbidity, disability and mortality. These challenges stem from limitations such as inadequate, inefficient or financially inaccessible diagnostic and therapeutic options. However, over the past decade, noteworthy innovations have emerged to address some of these hurdles, and these innovations are increasingly poised for broader implementation. This review provides a concise summary of these novel, economically viable diagnostic solutions, encompassing point-of-care assays and smartphone applications, as well as treatment modalities, notably more effective phototherapy and filtered sunlight. These advancements hold promise and have the potential to meaningfully reduce the burden of neonatal hyperbilirubinaemia, signifying a promising shift in the landscape of neonatal healthcare.

Neonatal jaundice is a common condition worldwide. Failure of timely diagnosis and treatment can lead to death or brain injury. Current diagnostic approaches include a painful and time-consuming invasive blood test and non-invasive tests using costly transcutaneous bilirubinometers. Since periodic monitoring is crucial, multiple efforts have been made to develop non-invasive diagnostic tools using a smartphone camera. However, existing works rely either on skin or eye images using statistical or traditional machine learning methods. In this paper, we adopt a deep transfer learning approach based on eye, skin, and fused images. We also trained well-known traditional machine learning models, including multi-layer perceptron (MLP), support vector machine (SVM), decision tree (DT), and random forest (RF), and compared their performance with that of the transfer learning model. We collected our dataset using a smartphone camera. Moreover, unlike most of the existing contributions, we report accuracy, precision, recall, f-score, and area under the curve (AUC) for all the experiments and analyzed their significance statistically. Our results indicate that the transfer learning model performed the best with skin images, while traditional models achieved the best performance with eyes and fused features. Further, we found that the transfer learning model with skin features performed comparably to the MLP model with eye features.

The article presents a case study of a 13-year-old male with abdominal pain, jaundice, and liver injury of unknown cause, eventually traced back to the consumption of Herbalife nutritional supplements. It mentions the challenges in diagnosing drug-induced liver injury (DILI), the importance of comprehensive history-taking, and the potential risks associated with dietary supplements, particularly in pediatric patients.

Neonatal jaundice is a common condition worldwide. Failure of timely diagnosis and treatment can lead to death or brain injury. Current diagnostic approaches include a painful and time-consuming invasive blood test and non-invasive tests using costly transcutaneous bilirubinometers. Since periodic monitoring is crucial, multiple efforts have been made to develop non-invasive diagnostic tools using a smartphone camera. However, existing works rely either on skin or eye images using statistical or traditional machine learning methods. In this paper, we adopt a deep transfer learning approach based on eye, skin, and fused images. We also trained well-known traditional machine learning models, including multi-layer perceptron (MLP), support vector machine (SVM), decision tree (DT), and random forest (RF), and compared their performance with that of the transfer learning model. We collected our dataset using a smartphone camera. Moreover, unlike most of the existing contributions, we report accuracy, precision, recall, f-score, and area under the curve (AUC) for all the experiments and analyzed their significance statistically. Our results indicate that the transfer learning model performed the best with skin images, while traditional models achieved the best performance with eyes and fused features. Further, we found that the transfer learning model with skin features performed comparably to the MLP model with eye features.

A 7-day-old male child presented with abdominal distention and jaundice. Radiological investigations revealed an encapsulated sac encasing three fetus-in-fetu (FIF) in the retroperitoneum. Laparotomy revealed a sac occupying almost the whole of the abdomen. The sac was stretching the duodenum and barely visible common bile duct, which were carefully separated. The rest of the bowel was displaced to the left. The sac containing three FIFs was excised intact. One of the fetuses was highly differentiated and had thoracic meningomyelocele, which has never been reported in FIF. [ABSTRACT FROM AUTHOR]

Background: The ability of mothers to correctly detect jaundice in their newborns is largely unknown. The objective was to ascertain the ability of mother to correctly detect the presence of significant jaundice in her newborn. Materials and Methods: This cross-sectional study was conducted in a tertiary care hospital in eastern India from February 2015 to July 2016. All inborn neonates more than 34 weeks' gestation were included. Congenital malformations, perinatal asphyxia, neonatal sepsis, readmission after discharge, and isoimmunization were excluded. A total of 505 inborn newborns were independently assessed by the mother and the treating pediatrician for significant jaundice every day till discharge. Each newborn underwent total serum bilirubin estimation on suspicion of significant jaundice by either of the two or at discharge, whichever was earlier. Results: The sensitivity, specificity, positive predictive value (PPV), and negative predictive value of maternal detection of significant jaundice was 51.47%, 88.33%, 39.29%, and 92.12%, respectively. Conclusion: Mothers have poor sensitivity and PPV to detect significant neonatal jaundice in the Indian population. [ABSTRACT FROM AUTHOR]

Interferences in the clinical laboratory may lead physicians misinterpret results for some biological analytes. The most common analytical interferences in the clinical laboratory include hemolysis, icterus and lipemia. Lipemia is defined as turbidity in a sample caused by the accumulation of lipoproteins, mainly very-low density lipoproteins (VLDL) and chylomicrons. Several methods are available for the detection of lipemic samples, including the lipemic index, or triglyceride quantification in serum or plasma samples, or mean corpuscular hemoglobin (MCHC) concentration in blood samples. According to the European Directive 98/79/CE, it is the responsibility of clinical laboratories to monitor the presence of interfering substances that may affect the measurement of an analyte. There is an urgent need to standardize interference studies and the way interferences are reported by manufacturers. Several methods are currently available to remove interference from lipemia and enable accurate measurement of biological quantities. The clinical laboratory should establish a protocol for the handling of lipemic samples according to the biological quantity to be tested. [ABSTRACT FROM AUTHOR]

Massive hemobilia, an acute life-threatening condition, remains a diagnostic challenge in pediatric patients due to its rarity. In this study, the difficulties encountered in the diagnosis and treatment of acute massive hemobilia and acute obstructive jaundice in a 3-year-old boy are discussed in the light of the literature. [ABSTRACT FROM AUTHOR]

Background/Aims: Biliary atresia (BA) is a cholangio-destructive disease of the infant liver presenting with features of obstructive cholangiopathy. The Kasai portoenterostomy (KPE) is the first line of management. The aim of our study was to identify the characteristic features of liver histology in BA that impact the outcome of KPE. Patients and Methods: Data from 30 consecutive children was retrieved from our prospectively maintained database of children undergoing KPE. This included basic demographics, laboratory values and histopathological data from liver biopsy. The stages of fibrosis, presence of ductal plate malformation (DPM), giant cell transformation, extramedullary hematopoiesis and area percentage of α-SMA (α-smooth muscle actin) expression was correlated with jaundice clearance after KPE using standard statistical tests. Native liver survival was computed. Results: Overall, 13 (43%) children cleared jaundice in this series and 10 (33%) are alive with native liver. Lower area percent expression of α-SMA correlated with increased probability of jaundice clearance after KPE (P < 0.001). There was no correlation between stage of fibrosis and jaundice clearance (P = 0.52). DPM, giant cell transformation and extramedullary hematopoiesis did not correlate with outcome. All children who are alive with native liver had lower expression of α-SMA. Conclusion: α-SMA expression may be a potential predictor of jaundice clearance and native liver survival after KPE. [ABSTRACT FROM AUTHOR]

In children, acute viral hepatitis-A infection is usually a self-limiting illness. In most children, it resolves uneventfully within weeks from the onset of disease. However, rare presentations like acute acalculous cholecystitis and persistent cholestatic jaundice have been reported. We report on a 7-year-old boy with prolonged cholestatic jaundice, which resolved without steroid treatment. [ABSTRACT FROM AUTHOR]

The porphyrias are a group of rare metabolic disorders that result from defects in heme biosynthesis. Erythropoietic protoporphyria (EPP) is the most common inherited porphyria in children and is diagnosed in most individuals after the onset of cutaneous manifestations. Hepatobiliary disease affects the minority of individuals with EPP and usually manifests in patients with an established diagnosis of EPP. We report on a classic but rare case of EPP that masqueraded as cholestasis. An 8-year-old boy was referred to the Hepatology Clinic after an abrupt onset of jaundice with a longstanding history of dermatitis. The diagnosis of EPP was established with liver biopsy, which revealed dense, dark-brown pigment in hepatocytes and Kupffer cells that, on polarization, displayed bright-red birefringence and centrally located Maltese crosses. Plasma total porphyrins and erythrocyte protoporphyrin were elevated and confirmed a diagnosis of EPP. We hope to raise awareness of this diagnosis among pediatricians, hepatologists, and pathologists and increase the consideration of EPP in patients with cholestatic liver disease and chronic dermatitis. [ABSTRACT FROM AUTHOR]

The presence of hemolysis (H), icterus (I) and lipaemia (L) in serum or plasma samples may be regarded as an important preanalytical drawback, since an abnormal concentration of these substances may derange the global quality and reliability of the total testing process. Although the assessment of sample quality before testing by means of the so-called HIL indices has become an essential part of routine practice in most clinical laboratories worldwide, no clear indications have been provided about the quality assurance of these measures. This article is hence aimed to provide an expert opinion about management of internal quality control (IQC) assessment for HIL indices. In summary, we support the use of in-house prepared IQC materials with at least two different levels for each interfering substances. IQC testing should be performed for validating performance of HIL indices in routine and urgent conditions, at least 2 times per day, and systematically recorded. We also suggest that results may be unacceptable when a single value of IQC material exceeds the mean target value by ±3 standard deviations. When results do not meet their set performance goals, the ensuing procedure mirrors that of conventional laboratory IQC management. [ABSTRACT FROM AUTHOR]

Anemia is a common finding in our population. Females are highly predisposed to develop anemia. Evaluation of anemia due to a single cause may be straightforward in most of the situations, however rare causes cannot be ruled out. In this case report, we present to you a case of a 35-year-old female who came with complaints of breathlessness. On further evaluation, she had pallor, icterus, and mild splenomegaly. Her hemoglobin (Hb) was later found to be 8.1 g/dl, pyruvate kinase activity was normal, normal liver enzymes, Heinz body positive, and elevated retics count. Thus, she was found to have a rare form of anemia, i.e., Heinz body hemolytic anemia. She was advised for splenectomy and started on medications. Following the procedure, her Hb started to rise to 9.6 g/dl and reached to 13.8 in the following months. [ABSTRACT FROM AUTHOR]

Obstructive jaundice as the main clinical feature is uncommon in patients with hepatocellular carcinoma (HCC). Only 1-12 % of HCC patients manifest obstructive jaundice as the initial complaint. Such cases are clinically classified as "icteric type hepatoma", or "cholestatic type of HCC". Identification of this group of patients is important, because surgical treatment may be beneficial. HCC may involve the biliary tract in several different ways: tumor thrombosis, hemobilia, tumor compression, and diffuse tumor infiltration. Bile duct thrombosis (BDT) is one of the main causes for obstructive jaundice, and the previously reported incidence is 1.2-9 %. BDT might be benign, malignant, or a combination of both. Benign thrombi could be blood clots, pus, or sludge. Malignant thrombi could be primary intrabiliary malignant tumors, HCC with invasion to bile ducts, or metastatic cancer with bile duct invasion. The common clinical features of this type of HCC include: high level of serum AFP; history of cholangitis with dilation of intrahepatic bile duct; aggravating jaundice and rapidly developing into liver dysfunction. It is usually difficult to make diagnosis before operation, because of the low incidence rate, ignorant of this disease, and the difficulty for the imaging diagnosis to find the BDT preoperatively. Despite recent remarkable improvements in the imaging tools for diagnosis of HCC, such cases are still incorrectly diagnosed as cholangiocarcinoma or choledocholithiases. Ultrasonography (US) and CT are helpful in showing hepatic tumors and dilated intrahepatic and /or extrahepatic ducts containing dense material corresponding to tumor debris. Direct cholangiography including percutaneous transhepatic cholangiography (PTC) and endoscopic retrograde cholangiopancreatography (ERCP) remains the standard procedure to delineate the presence and level of biliary obstruction. Magnetic resonance cholangiopancreatography (MRCP) is superior to ERCP in interpreting the cause and depicting the anatomical extent of the perihilar obstructive jaundice, and is particularly distinctive in cases associated with tight biliary stenosis and along segmental biliary stricture. Choledochoscopy and bile duct brushing cytology could be alternative useful techniques in the differentiating obstructions due to intraluminal mass, infiltrating ductal lesions or extrinsic mass compression applicable before and after duct exploration. Jaundice is not necessarily a contraindication for surgery. Most patients will have satisfactory palliation and occasional cure if appropriate procedures are selected and carried out safely, which can result in long-term resolution of symptoms and occasional long-term survival. However, the prognosis of icteric type HCC is generally dismal, but is better than those HCC patients who have jaundice caused by hepatic insufficiency.