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Amin SB, Saluja S, Kler N. Unbound Bilirubin and Acute Bilirubin Encephalopathy in Infants Born Late Preterm and Term with Significant Hyperbilirubinemia. J Pediatr 2024; 266:113880. [PMID: 38135027 DOI: 10.1016/j.jpeds.2023.113880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/30/2023] [Accepted: 12/17/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVE To compare the association of unbound bilirubin (UB), total serum bilirubin (TSB), and bilirubin:albumin molar ratio (BAMR) with acute bilirubin encephalopathy (ABE), as assessed by bilirubin-induced neurologic dysfunction (BIND) score, in infants with significant hyperbilirubinemia (TSB ≥20 mg/dL or underwent exchange transfusion). STUDY DESIGN In this prospective cohort study, infants ≥34 weeks of gestational age with significant hyperbilirubinemia during the first 2 postnatal weeks were eligible, unless they had craniofacial malformations, chromosomal disorders, TORCH (toxoplasmosis, other infections, rubella, cytomegalovirus and herpes simplex) infections, surgery, or a family history of congenital deafness. TSB, serum albumin, and UB were measured at hospital admission using the colorimetric, bromocresol green, and modified peroxidase method, respectively. Infants were evaluated on admission for ABE using a standardized neurologic examination and assigned a BIND score by trained physicians. Infants with a total BIND score of 0 were deemed to not have ABE, whereas those with a score ≥1 were deemed to have ABE. RESULTS A total of 151 infants were studied, among whom 37 (24.5%) had ABE. Of these, 19 had mild ABE (BIND score 1-3) and 18 had moderate-to-severe ABE (BIND score 4-9). On logistic regression, UB, but not TSB or BAMR, was associated with ABE (aOR 1.64; 95% CI 1.17-2.3). On ordered logistic regression, UB, but not TSB or BAMR, was associated with severity of ABE (aOR 1.76; 95% CI 1.28-2.4). CONCLUSIONS Our findings of the association between UB and ABE indicate that BIND scoring may be useful for evaluation of ABE in infants ≥34 weeks of gestational age.
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Affiliation(s)
- Sanjiv B Amin
- Department of Pediatrics, Central Michigan University, Mount Pleasant, MI; Department of Pediatrics, Sir Ganga Ram Hospital, Delhi, India.
| | - Satish Saluja
- Department of Pediatrics, Sir Ganga Ram Hospital, Delhi, India
| | - Neelam Kler
- Department of Pediatrics, Sir Ganga Ram Hospital, Delhi, India
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Al-Abdi SY. Glutathione S-Transferase and Moderate Neonatal Hyperbilirubinemia Associated with Glucose-6-Phosphate Dehydrogenase Deficiency. J Pediatr 2024; 265:113811. [PMID: 37923197 DOI: 10.1016/j.jpeds.2023.113811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 10/29/2023] [Indexed: 11/07/2023]
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Vadlapudi SS, Srivastava A, Rai P, Singh RK, Sarma MS, Poddar U, Yadav RR. Jaundice in a Child with Sickle Cell Anemia: A Case Based Approach. Indian J Pediatr 2024; 91:73-80. [PMID: 37556033 DOI: 10.1007/s12098-023-04747-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/21/2023] [Indexed: 08/10/2023]
Abstract
Sickle cell anemia (SCA) is an autosomal recessive disorder caused by a mutation in beta globin gene. Hepatobiliary system is affected in 10-40% of patients with SCA and has a multifactorial etiology. The authors present a child with SCA and conjugated hyperbilirubinemia due to biliary obstruction. He underwent endoscopic retrograde cholangiopancreatography (ERCP) and biliary stenting, had complications of post sphincterotomy bleed, retroperitoneal hematoma and post laparoscopic cholecystectomy sepsis with acute sickle hepatic crisis. He was managed successfully and is doing well on follow-up. Here authors discuss a stepwise approach in management of jaundice in a patient with SCA. Patients with SCA are prone to develop vaso-occlusive crisis (VOC) during periods of stress. VOC affects the liver as acute sickle hepatic crisis, acute hepatic sequestration or sickle cell intrahepatic cholestasis and is collectively termed as sickle cell hepatopathy. Hemolysis due to sickling results in cholelithiasis with its associated complications. These patients are vulnerable to viral hepatitis and hemochromatosis due to multiple blood transfusions. There may be a concomitant acute viral hepatitis, drug induced liver injury, Budd-Chiari syndrome or other chronic liver diseases. These conditions have considerable clinical overlap and may coexist, making the evaluation more challenging. Detailed history, examination and investigations are required for differentiation of etiology. Periods of stress must be tackled with proper hydration, oxygen supplementation, maintaining hemoglobin >10 g/dL, and a low hemoglobin S fraction. Patients with SCA and conjugated hyperbilirubinemia are "high-risk" and best managed by a multidisciplinary team. Preventive strategies like timely vaccinations, chelation, etc. must be practised.
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Affiliation(s)
- Srinivas Srinidhi Vadlapudi
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Anshu Srivastava
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
| | - Praveer Rai
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Rajneesh K Singh
- Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Moinak Sen Sarma
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Ujjal Poddar
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Rajanikant R Yadav
- Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India
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Raffa LH, Fatani M, Alghamdi R. Insights into Risk: Exploring Retinopathy of Prematurity and Short-term Comorbidities in Moderate-to-Late Preterm Infants. Niger J Clin Pract 2024; 27:124-130. [PMID: 38317045 DOI: 10.4103/njcp.njcp_576_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/08/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Retinopathy of prematurity (ROP) and short-term comorbidity data moderate-to-late preterm (MLP) infants in Saudi Arabia are limited. AIM The present study mainly aimed to identify ROP incidence and severity in MLP infants. The secondary objective was to explore whether moderate preterm infants are more prone to systemic short-term comorbidities compared to late preterm infants. MATERIALS AND METHODS This retrospective study was conducted at King Abdulaziz University Hospital, a tertiary center in Jeddah, Saudi Arabia. Two-hundred and sixty-eight MLP infants born with gestational ages (GAs) of 32 to 36 + 6 weeks were included. Births were classified as moderate preterm (GA 32 to 33 + 6 weeks) and late preterm (GA 34 to 36 + 6 weeks) and the two groups were compared with an independent t-test. RESULTS ROP incidence was 1.5%; all cases were stage 1 and involved zone II or III. No patient had type 1 ROP requiring treatment. The short-term comorbidity incidence was high (76.1%) and included hyperbilirubinemia (n = 206, 76.7%), respiratory distress syndrome (n = 178, 66.4%), hypoglycemia (n = 32, 11.9%,), and transient tachypnea of newborn (n = 25, 9.3%). Moderate preterm infants were more likely to have lower birth weight (P < 0.001), any-stage ROP (P = 0.032), respiratory distress syndrome (P = 0.031), intraventricular hemorrhage (P = 0.038), and hyperbilirubinemia (P < 0.001) compared to the late preterm infants. CONCLUSIONS Any-stage ROP incidence among MLP infants was low, with no type 1 ROP cases requiring treatment. Short-term comorbidity incidence was relatively high among the moderate preterm infants. Despite the low non-type 1 ROP incidence at our center, MLP infants require proper surveillance of systemic short-term comorbidities.
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Affiliation(s)
- L H Raffa
- Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Ophthalmology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - M Fatani
- Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - R Alghamdi
- Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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Gao K, Zhao W, Chen L, Zeng K, Wang J, Yu X, Li Z. Prevalence and association of early onset severe hyperbilirubinemia in newborn in the East China region: Retrospective medical record analyses. Medicine (Baltimore) 2023; 102:e36346. [PMID: 38065921 PMCID: PMC10713135 DOI: 10.1097/md.0000000000036346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/06/2023] [Indexed: 12/18/2023] Open
Abstract
Research on the prevalence and association of hyperbilirubinemia is controversial because of different cultures, demographics, and clinical conditions. The etiology of hyperbilirubinemia is affected by the environment and other factors in the newborn. The World Health Organization recommended a 1-day hospital stay after uncomplicated delivery, jaundice assessment before discharge, and screening on 3rd and 7th days after birth for hyperbilirubinemia. However, the implementation of these recommendations is difficult in China. The objective of this study was to evaluate the prevalence and association of early onset severe hyperbilirubinemia in newborns in East China. Retrospective medical record analyses for 250 cesarean sections or vaginal deliveries, ≥2 kg body weight, and negative for Hepatitis B surface antigen by birth newborns were performed. A biochemical analyzer, quantitative assay, and quantitative polymerase chain reaction were used to evaluate total serum bilirubin, glucose-6-phosphate dehydrogenase (G6PD) deficiency, and gene variant phenotyping, respectively. A total in 33 (13%) newborns were reported with early onset severe hyperbilirubinemia (according to the American Academy of Pediatrics, total serum bilirubin ≥ 342 μmol/L within 6 hours of birth). All newborns with severe hyperbilirubinemia were hospitalized and underwent phototherapy. The mothers of all newborns had a gestational age ≥ 35 weeks. Hospitalization included artificial feeding, and breastfeeding was rare (P < .0001). ABO incompatibility ("O" blood type for mother and either "A" or "AB" or "B" blood type for newborn, P = .0411), G6PD deficiency (G6PD/6-phosphogluconate dehydrogenase ≤ 1.0 in quantitative assay, P = .0422), Rh incompatibility (the mother's blood type was Rh negative and newborn blood type was Rh positive, P = .0416), fewer genotype rs4149056 frequencies (P = .0452), higher genotype rs2306283 frequencies (P = .0461), and higher genotype rs1805173 frequencies (P = .0471) were independent parameter for early onset severe hyperbilirubinemia of newborns. The prevalence of early onset severe hyperbilirubinemia in Chinese newborns is 13% in the East China region. Blood incompatibility, G6PD deficiency, fewer genotype rs4149056 frequencies, higher genotype rs2306283 frequencies, and higher genotype rs1805173 frequencies were independent predictors of early onset severe hyperbilirubinemia among newborns in the East China region (Level of Evidence: IV; Technical Efficacy: Stage 5).
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Affiliation(s)
- Ke Gao
- Department of Pediatrics, the First Affiliated Hospital of Ningbo University, Zhejiang, China
| | - Wu Zhao
- Department of Pediatrics, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China
| | - Lijun Chen
- Department of Pediatrics, the First Affiliated Hospital of Ningbo University, Zhejiang, China
| | - Ke Zeng
- Department of Pediatrics, the First Affiliated Hospital of Ningbo University, Zhejiang, China
| | - Jichao Wang
- Department of Pediatrics, the First Affiliated Hospital of Ningbo University, Zhejiang, China
| | - Xiping Yu
- Department of Pediatrics, the First Affiliated Hospital of Ningbo University, Zhejiang, China
| | - Zhifei Li
- Department of Pediatrics, the First Affiliated Hospital of Ningbo University, Zhejiang, China
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Rasiah S, Jegathesan T, Campbell DM, Shah PS, Sgro MD. Intravenous immunoglobulin G therapy for neonatal hyperbilirubinemia. Pediatr Res 2023; 94:2092-2097. [PMID: 37491586 PMCID: PMC10665189 DOI: 10.1038/s41390-023-02712-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 06/06/2023] [Accepted: 06/19/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND Neonatal hyperbilirubinemia (NHb) results from increased total serum bilirubin and is a common reason for admission and readmission amongst newborn infants born in North America. The use of intravenous immunoglobulin (IVIG) therapy for treating NHb has been widely debated, and the current incidence of NHb and its therapies remain unknown. METHODS Using national and provincial databases, a population-based retrospective cohort study of infants born in Ontario from April 2014 to March 2018 was conducted. RESULTS Of the 533,084 infants born in Ontario at ≥35 weeks gestation, 29,756 (5.6%) presented with NHb. Among these infants, 80.1-88.2% received phototherapy, 1.1-2.0% received IVIG therapy and 0.1-0.2% received exchange transfusion (ET) over the study period. Although phototherapy was administered (83.0%) for NHb, its use decreased from 2014 to 2018 (88.2-80.1%) (P < 0.01). Similarly, the incidence of IVIG therapy increased from 71 to 156 infants (1.1-2.0%) (P < 0.01) and a small change in the incidence of ET (0.2-0.1%) was noted. CONCLUSION IVIG therapy is increasingly being used in Ontario despite limited studies evaluating its use. The results of this study could inform treatment and management protocols for NHb. IMPACTS Clinically significant neonatal hyperbilirubinemia still occurs in Ontario, with an increasing number of infants receiving Intravenous Immunoglobulin G (IVIG) therapy. IVIG continues to be used at increasing rates despite inconclusive evidence to recommend its use. This study highlights the necessity of a future prospective study to better determine the effectiveness of IVIG use in treating neonatal hyperbilirubinemia, especially given the recent shortage in IVIG supply in Ontario. The results of this study could inform treatment and management protocols for neonatal hyperbilirubinemia.
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Affiliation(s)
- Saisujani Rasiah
- Department of Pediatrics, St. Michael's Hospital, Toronto, ON, Canada
| | - Thivia Jegathesan
- Department of Pediatrics, St. Michael's Hospital, Toronto, ON, Canada
| | - Douglas M Campbell
- Department of Pediatrics, St. Michael's Hospital, Toronto, ON, Canada
- Keenan Research Centre of the Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Prakeshkumar S Shah
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, ON, Canada
- Department of Pediatrics, Mount Sinai Hospital, Toronto, ON, Canada
| | - Michael D Sgro
- Department of Pediatrics, St. Michael's Hospital, Toronto, ON, Canada.
- Keenan Research Centre of the Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada.
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada.
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
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Pandya F, Mukherji A, Goswami I. An Exploratory Analysis of Gastrointestinal Morbidities and Feeding Outcomes Associated with Neonatal Hypoxic-Ischemic Encephalopathy With or Without Hypothermia Therapy. Ther Hypothermia Temp Manag 2023; 13:216-224. [PMID: 37140459 DOI: 10.1089/ther.2023.0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
This study investigates the clinical profile and predictors of gastrointestinal/hepatic morbidities and feeding outcomes among neonates with hypoxic-ischemic encephalopathy (HIE). A single-center retrospective chart review of consecutive neonates >35 weeks of gestation admitted with a diagnosis of HIE between January 1, 2015, and December 31, 2020, and treated with therapeutic hypothermia, if met the institutional eligibility criteria. Outcomes assessed included necrotizing enterocolitis (NEC), conjugated hyperbilirubinemia, hepatic dysfunction, assisted feeding at discharge, and time to reach full enteral and oral feeds. Among 240 eligible neonates (gestational age 38.7 [1.7] weeks, birth weight 3279 [551] g), 148 (62%) received hypothermia therapy, and 7 (3%) and 5 (2%) were diagnosed with stage 1 NEC and stage 2-3 NEC, respectively. Twenty-nine (12%) were discharged home with a gastrostomy/gavage tube, conjugated hyperbilirubinemia (first week 22 [9%], at discharge 19 [8%]), and hepatic dysfunction (74 [31%]). Time to reach full oral feeds was significantly longer in hypothermic neonates compared with neonates who did not receive hypothermia (9 [7-12] days vs. 4.5 [3-9] days, p < 0.0001). Factors significantly associated with NEC were renal failure (odds ratio [OR] 9.24, 95% confidence interval [CI] 2.7-33), hepatic dysfunction (OR 5.69, 95% CI 1.6-26), and thrombocytopenia (OR 3.6, 95% CI 1.1-12), but no significant association with hypothermia, severity of brain injury, or stage of encephalopathy. Transient conjugated hyperbilirubinemia, hepatic dysfunction within first week of life, and need for assistive feeding are more common than NEC in HIE. Risk of NEC was associated with the severity of end-organ dysfunction in the first week of life, rather than severity of brain injury and hypothermia therapy per se.
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Affiliation(s)
- Febby Pandya
- Department of Biology, McMaster University, Hamilton, Ontario, Canada
| | - Amit Mukherji
- Division of Neonatology, Department of Pediatrics, McMaster Children's Hospital, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Ipsita Goswami
- Division of Neonatology, Department of Pediatrics, McMaster Children's Hospital, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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Di Gioia G, Crispino SP, Monosilio S, Maestrini V, Nenna A, Segreti A, Squeo MR, Lemme E, Ussia GP, Grigioni F, Pelliccia A. Cardiovascular and metabolic effects of hyperbilirubinemia in a cohort of Italian Olympic athletes. Scand J Med Sci Sports 2023; 33:2534-2547. [PMID: 37650311 DOI: 10.1111/sms.14481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 08/09/2023] [Accepted: 08/18/2023] [Indexed: 09/01/2023]
Abstract
INTRODUCTION Bilirubin was supposed to have cardio-metabolic protective role by signaling functions. Indeed, mild hyperbilirubinemia has immunosuppressive and endocrine activities and may offer protection against oxidative stress-mediated diseases. Gilbert syndrome (GS) has been hypothesized to provide cardio-metabolic benefits. OBJECTIVE To investigate the prevalence of hyperbilirubinemia and its cardio-metabolic effects in a cohort of elite Italian athletes engaged in different sports disciplines. METHODS We enrolled 1492 elite athletes (age 25.8 ± 5.1) practising different disciplines (power, skills, endurance, and mixed) underwent blood, echocardiographic, and exercise tests. GS was diagnosed per exclusionem in athletes with isolated asymptomatic unconjugated hyperbilirubinemia. RESULTS GS was highlighted in 91 athletes (6%; globally 9% male and 2.4% female); 82% were males (p < 0.0001) showing higher indirect bilirubin (0.53 ± 0.4 vs. 0.36 ± 0.24 mg/dL in females, p < 0.0001). GS athletes had fewer platelets (201 ± 35 vs. 214 ± 41, p = 0.01), higher iron (male: 124 ± 44 vs. 100.9 ± 34 mcg/dL, p < 0.0001; female: 143.3 ± 35 vs. 99.9 ± 42 mcg/dL, p < 0.0001), and lower erythrocyte sedimentation rate, (1.93 ± 0.9 vs. 2.80 ± 2.7 mm/H, p = 0.03). At multivariate analysis, male (OR 3.89, p = 0.001) and iron (OR 3.47, p = 0.001) were independently associated with GS. No significant differences were found in cardiac remodeling, heart rate, blood pressure, arrhythmias, or power capacity at stress test. Endurance athletes (313) presented higher total (p = 0.003) and indirect bilirubin (p = 0.001). CONCLUSION Bilirubin has several metabolic effects (including immunosuppressive and endocrine) and plays a role in regulating antioxidant pathways exercise-related with hematological consequences but seems not to affect significantly cardiovascular remodeling. Endurance athletes present higher bilirubin concentrations, likely as an adaptive mechanism to counteract increased oxidative stress.
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Affiliation(s)
- Giuseppe Di Gioia
- Institute of Sport Medicine and Science, National Italian Olympic Committee, Rome, Italy
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Simone Pasquale Crispino
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Sara Monosilio
- Institute of Sport Medicine and Science, National Italian Olympic Committee, Rome, Italy
| | - Viviana Maestrini
- Institute of Sport Medicine and Science, National Italian Olympic Committee, Rome, Italy
- Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Antonio Nenna
- Department of Heart Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Andrea Segreti
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Maria Rosaria Squeo
- Institute of Sport Medicine and Science, National Italian Olympic Committee, Rome, Italy
| | - Erika Lemme
- Institute of Sport Medicine and Science, National Italian Olympic Committee, Rome, Italy
| | - Gian Paolo Ussia
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Francesco Grigioni
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Antonio Pelliccia
- Institute of Sport Medicine and Science, National Italian Olympic Committee, Rome, Italy
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Kwon JY, Nietert PJ, Rockey DC. Hyperbilirubinemia in hospitalized patients: Etiology and outcomes. J Investig Med 2023; 71:773-781. [PMID: 37386866 PMCID: PMC10824167 DOI: 10.1177/10815589231180498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
There is little information on the differential diagnosis and prognosis of hospitalized patients with hyperbilirubinemia. Here, we hypothesized that hyperbilirubinemia in hospitalized patients is associated with specific diseases and outcomes. This retrospective cohort analysis included patients admitted to the Medical University of South Carolina with a total bilirubin >3 mg/dL from January 9, 2015 to August 25, 2017. Collected clinical data included demographics, primary diagnosis, Charlson Comorbidity Index (CCI), laboratory data, and clinical outcomes. We separated and analyzed the cohort into seven primary diagnostic groups. We identified 1693 patients with a bilirubin level >3 mg/dL. The cohort was 42% female, had an average age of 54, average CCI of 4.8, and average length of stay of 13 days. The causes of hyperbilirubinemia included the following: primary liver disease (868/1693; 51%) with cirrhosis being most common (385/1693; 23%), benign biliary obstruction (252/1693; 15%), hemolytic anemia (149/1693; 9%), malignant biliary obstruction (121/1693; 7%), unknown etiology (108/1693; 6%), primary liver cancer (74/1693; 4%), and metastatic cancer to the liver (57/1693; 3%). Overall, the mortality/discharge to hospice rate in patients with a bilirubin >3 mg/dL was 30%, and was proportional to the severity of hyperbilirubinemia, including when controlling for the underlying severity of illness. Mortality was highest in patients with primary liver disease and malignancy and was lowest in patients with non-cancerous obstruction or hemolytic jaundice. Hyperbilirubinemia in hospitalized patients is most often due to primary liver disease, and identifies patients with a poor prognosis, particularly when caused by primary liver disease or cancer.
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Affiliation(s)
- Joshua Y Kwon
- Division of Gastroenterology and Hepatology, University of California, Irvine, Orange, USA
| | - Paul J Nietert
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, USA
| | - Don C Rockey
- Digestive Disease Research Center, Medical University of South Carolina, Charleston, USA
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Ozdemir A, Kurtoglu S, Halis H, Bastug O. An evaluation of ursodeoxycholic acid treatment in prolonged unconjugated hyperbilirubinemia due to breast milk. Niger J Clin Pract 2023; 26:1226-1233. [PMID: 37794533 DOI: 10.4103/njcp.njcp_216_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
Background/Aim Prolonged jaundice is one of the most common problems during neonatal period. The aim of this study was to evaluate the efficiency of ursodeoxycholic acid (UDCA) treatment in newborn infants with prolonged unconjugated hyperbilirubinemia. Materials and Methods The present study included 27 patients who were fed by breast milk and followed up in the outpatient clinic due to prolonged jaundice without any underlying etiological factor; 10 mg/kg/day UDCA was administrated in two doses for 7 days. Furthermore, 20 newborns diagnosed with prolonged jaundice with same characteristics were enrolled as the control group. The control group was also given a placebo; demographic characteristics, liver functions tests before and after the treatment, bilirubin decrease rates, and hemogram parameters of groups were compared. Results Total bilirubin levels in the study and control groups before the treatment were 16.02 ± 1.41 mg/dL and 15.93 ± 1.66 mg/dL, respectively (P = 0.84). Total bilirubin levels in the study and control groups at day 7 after UDCA treatment were detected 8.18 ± 2.31 mg/dL and 13.92 ± 2.66 mg/dL, respectively (P < 0.001), and at day 14 after the treatment were 5.45 ± 2.59 mg/dL and 11.91 ± 2.83 mg/dL, respectively (P < 0.001). Furthermore, serum aspartate aminotransferase (AST) was detected <21 U/L in the ROC analysis after UDCA treatment (P = 0.04). Conclusion The study outcomes indicated that an efficient reduction in total bilirubin levels may be achieved, and outpatient clinic follow-up period may be reduced in patients whom UDCA was administrated. Moreover, it may be speculated that AST can be used to evaluate the efficacy after treatment. However, studies with larger sample sizes are needed for the routine use of UDCA in the treatment of prolonged jaundice.
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Affiliation(s)
- A Ozdemir
- Department of Neonatalogy, University of Health Sciences, Kayseri City Hospital, Turkey
| | - S Kurtoglu
- Department of Pediatric Endocrinology, Memorial Kayseri Hospital, Kayseri, Turkey
| | - H Halis
- Department of Neonatalogy, Irmet Hospital, Tekirdag, Turkey
| | - O Bastug
- Department of Neonatalogy, University of Health Sciences, Kayseri City Hospital, Turkey
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Zhang H, Ma X, Xu J, Jin P, Yang L, Pan Y, Yin F, Zhang J, Wang J, Yu D, Wang X, Zhang M, Wang X, Wang D, Sheng J. Serum metabolomics of hyperbilirubinemia and hyperuricemia in the Tibetan plateau has unique characteristics. Sci Rep 2023; 13:12772. [PMID: 37550384 PMCID: PMC10406831 DOI: 10.1038/s41598-023-40027-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 08/03/2023] [Indexed: 08/09/2023] Open
Abstract
Few studies have provided data on the metabolomics characteristics of metabolic diseases such as hyperuricemia and hyperbilirubinemia in the Tibetan plateau. In the current study, we sought to investigate the serum metabolomics characteristics of hyperbilirubinemia and hyperuricemia in the Tibetan plateau, with the aim to provide a basis for further research on their pathogenesis, prevention, and treatment. The study participants were born in low-altitude areas below 1000 m and had no prior experience living in a high-altitude area before entering Golmud, Tibet (average elevation: 3000 m) and Yushu, Qinghai (average elevation: 4200 m). Thirty-four participants with hyperbilirubinemia (18 in Golmud and 16 in Yushu), 24 participants with hyperuricemia, and 22 healthy controls were enrolled. The serum samples of subjects were separated and then sent to a local tertiary hospital for biochemical examination. Serum widely targeted technology, based on the ultra-performance liquid chromatography tandem mass spectrometry (UPLC-MS/MS) platform, was used to detect serum metabolites and differential metabolites. Compared to the healthy controls, hyperbilirubinemia patients from Golmud showed 19 differential metabolites, hyperbilirubinemia patients from Yushu showed 12 differential metabolites, and hyperuricemia patients from Yushu showed 23 differential metabolites. Compared to the hyperbilirubinemia patients from Golmud that is at a low altitude, the Yushu groups had 33 different metabolites. Differential metabolites are primarily classified into amino acids and their derivatives, nucleotides and their derivatives, organic acids and their derivatives, and lipids/fatty acids. These are related to metabolic pathways such as caffeine metabolism, arachidonic acid metabolism, and tyrosine metabolism. Hyperbilirubinemia and hyperuricemia in the Tibetan plateau have unique serum metabolomics characteristics. Glycine derivatives and arachidonic acid and its derivatives were associated with plateau hyperbilirubinemia, and vanillic acid and pentadecafluorooctanoic acid were associated with plateau hyperuricemia.
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Affiliation(s)
- Heng Zhang
- Medical School of Chinese PLA, Beijing, 100853, China
- Department of Gastroenterology, The Seventh Medical Center of Chinese PLA General Hospital, No.5 Nanmencang, Beijing, 100700, China
| | - Xianzong Ma
- Medical School of Chinese PLA, Beijing, 100853, China
- Department of Gastroenterology, The Seventh Medical Center of Chinese PLA General Hospital, No.5 Nanmencang, Beijing, 100700, China
| | - Junfeng Xu
- Senior Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Peng Jin
- Medical School of Chinese PLA, Beijing, 100853, China
- Senior Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Lang Yang
- Medical School of Chinese PLA, Beijing, 100853, China
- Senior Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Yuanming Pan
- Department of Gastroenterology, The Seventh Medical Center of Chinese PLA General Hospital, No.5 Nanmencang, Beijing, 100700, China
| | - Fumei Yin
- Medical School of Chinese PLA, Beijing, 100853, China
- Department of Gastroenterology, The Seventh Medical Center of Chinese PLA General Hospital, No.5 Nanmencang, Beijing, 100700, China
| | - Jie Zhang
- Department of Gastroenterology, The Seventh Medical Center of Chinese PLA General Hospital, No.5 Nanmencang, Beijing, 100700, China
| | - Jiheng Wang
- Medical School of Chinese PLA, Beijing, 100853, China
- Senior Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Dongliang Yu
- Department of Gastroenterology, The Seventh Medical Center of Chinese PLA General Hospital, No.5 Nanmencang, Beijing, 100700, China
| | - Xiaoying Wang
- Department of Gastroenterology, The Seventh Medical Center of Chinese PLA General Hospital, No.5 Nanmencang, Beijing, 100700, China
| | - Mingjie Zhang
- Department of Gastroenterology, The Seventh Medical Center of Chinese PLA General Hospital, No.5 Nanmencang, Beijing, 100700, China
| | - Xin Wang
- Department of Gastroenterology, The Seventh Medical Center of Chinese PLA General Hospital, No.5 Nanmencang, Beijing, 100700, China.
| | - Dezhi Wang
- Medical School of Chinese PLA, Beijing, 100853, China.
- Department of Gastroenterology, The Seventh Medical Center of Chinese PLA General Hospital, No.5 Nanmencang, Beijing, 100700, China.
| | - Jianqiu Sheng
- Medical School of Chinese PLA, Beijing, 100853, China.
- Department of Gastroenterology, The Seventh Medical Center of Chinese PLA General Hospital, No.5 Nanmencang, Beijing, 100700, China.
- Senior Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China.
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Liao P, Wang X, Dong H, Chai D, Yue Z, Lyu L. HYPERBILIRUBINEMIA AGGRAVATES RENAL ISCHEMIA REPERFUSION INJURY BY EXACERBATING PINK1-PARKIN-MEDIATED MITOPHAGY. Shock 2023; 60:262-271. [PMID: 37278995 DOI: 10.1097/shk.0000000000002160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
ABSTRACT Background: Hyperbilirubinemia is a common perioperative complication, which is associated with acute kidney injury. Bilirubin permeabilizes mitochondrial membranes leading to mitochondrial swelling and dysfunction. In this study, we aimed to determine the association between PINK1-PARKIN-mediated mitophagy and renal ischemia-reperfusion (IR) injury aggravated by hyperbilirubinemia. Methods: A C57BL/6 mouse hyperbilirubinemia model was induced via intraperitoneal injection of bilirubin solution. In addition, a hypoxia/reoxygenation (H/R) injury model of TCMK-1 cells was established. In these models, we determined the effects of hyperbilirubinemia on oxidative stress, apoptosis, mitochondrial damage, and fibrosis. Results:In vitro , colocalization of GFP-LC3 puncta and Mito-Tracker Red showed that the number of mitophagosomes increased in TCMK-1 cells under H/R and bilirubin condition. Silencing of PINK1 or inhibition of autophagy alleviated mitochondrial damage, oxidative stress, and apoptosis in H/R injury aggravated by bilirubin and decreased cell death detected by methyl-thiazolyl-tetrazolium. In vivo , hyperbilirubinemia increased serum creatinine level in the renal IR injury mice model. Hyperbilirubinemia enhanced apoptosis induced by renal IR. In addition, hyperbilirubinemia increased mitophagosomes and autophagosomes and disrupted mitochondrial cristae in the IR kidney. Inhibition of PINK1 or autophagy reduced histological damages by alleviating apoptosis in renal IR injury, aggravated by hyperbilirubinemia. 3-MA or PINK1-shRNA-AAV9 treatment decreased the area of collagen and proteins related to fibrosis in renal IR injury, aggravated by hyperbilirubinemia. Conclusions: We have demonstrated that hyperbilirubinemia aggravated oxidative stress, apoptosis, mitochondrial damage, and fibrosis in renal IR injury by exacerbating PINK1-PARKIN-mediated mitophagy.
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Affiliation(s)
- Pingping Liao
- Department of Geriatric Medicine, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiaoyu Wang
- Department of Anesthesiology, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - He Dong
- Department of Anesthesiology, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Dongyue Chai
- Department of Anesthesiology, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Ziqi Yue
- Department of Anesthesiology, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lin Lyu
- Department of Anesthesiology, the Affiliated Hospital of Qingdao University, Qingdao, China
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Páez-Guillán EM, Campos-Franco J, Alende R, Lázare H, Beceiro C, Gonzalez-Quintela A. Jaundice in relation to immune activation during Epstein-Barr virus-induced infectious mononucleosis. Am J Med Sci 2023; 365:270-278. [PMID: 36526005 DOI: 10.1016/j.amjms.2022.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 10/15/2022] [Accepted: 12/09/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Liver involvement during infectious mononucleosis is common, but jaundice is considered rare. This study aimed to investigate serum bilirubin concentrations in patients with infectious mononucleosis and immune abnormalities associated with jaundice. METHODS We report on an adult patient with monoclonal B lymphocytosis and IgM-lambda gammopathy who developed a severe icteric hepatitis during infectious mononucleosis. We then reviewed the clinical records of 389 patients admitted to the hospital with infectious mononucleosis between 1995 and 2018 (51.7% male patients; median age, 19 years; range, 15-87 years) with focus on liver abnormalities and associated factors. RESULTS Fifty-nine patients (15.1%) had serum bilirubin concentrations between 1.5 and 3 mg/dL, and 47 patients (12.0%) had serum bilirubin >3 mg/dL. Patients with increased bilirubin concentrations had a distinct clinical presentation, with more frequent abdominal pain, nausea and vomiting, and less frequent sore throat than patients with normal bilirubin. Age and sex were not significantly different for the patients with increased and normal serum bilirubin concentrations. The patients with increased serum bilirubin concentrations showed higher levels of immune activation markers than the patients with normal bilirubin, including blood lymphocyte counts, serum IgM, and β2-microglobulin concentrations. Heterophile antibody-positive patients (88.6%) showed similar bilirubin concentrations but higher aspartate aminotransferase and alkaline phosphatase levels than their heterophile-negative counterparts. Serum bilirubin elevations normalized quickly during follow-up. CONCLUSIONS Transient hyperbilirubinemia is common during severe (in-hospital) infectious mononucleosis in adult patients. Patients with hyperbilirubinemia have less frequent pharyngitis symptoms and more frequent abdominal symptoms. Hyperbilirubinemia during infectious mononucleosis is associated with immune activation markers.
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Affiliation(s)
- Emilio-Manuel Páez-Guillán
- Department of Internal Medicine, Complejo Hospitalario Universitario, University of Santiago de Compostela, Spain
| | - Joaquín Campos-Franco
- Department of Internal Medicine, Complejo Hospitalario Universitario, University of Santiago de Compostela, Spain
| | - Rosario Alende
- Department of Internal Medicine, Complejo Hospitalario Universitario, University of Santiago de Compostela, Spain
| | - Héctor Lázare
- Department of Pathology, Complejo Hospitalario Universitario, University of Santiago de Compostela, Spain
| | - Carmen Beceiro
- Department of Internal Medicine, Complejo Hospitalario Universitario, University of Santiago de Compostela, Spain
| | - Arturo Gonzalez-Quintela
- Department of Internal Medicine, Complejo Hospitalario Universitario, University of Santiago de Compostela, Spain.
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Gunduz BO, Atas E. Indirect hyperbilirubinemia because of eltrombopag in two cases after autologous hematopoetic stem cell transplantation. J Cancer Res Ther 2023; 19:S970-S972. [PMID: 38384093 DOI: 10.4103/jcrt.jcrt_262_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 08/01/2022] [Indexed: 02/23/2024]
Abstract
ABSTRACT The oral thrombopoietin receptor agonist eltrombopag has some side effects. One of them is related to bilirubin metabolism. Two patients with neuroblastoma in remission underwent stem cell transplantation with the Busulfan-melphalan regimen. Eltrombopag was started because of platelet engraftment failure. Indirect hyperbilirubinemia was detected after eltrombopag treatment. Laboratory and radiological investigations were all normal. The drugs and their side effects they used were examined. After eltombopag cutting, bilirubin levels of them returned to normal. These cases are presented to emphasize that eltrombopag can cause liver toxicity with hypertransaminesemia and hyperbilirubinemia. Drug side effects should be considered in the differential diagnosis of the patients. The significance of this case is that testing for serum aminotransferase and bilirubin levels should be monitored before and after eltrombopag use.
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Affiliation(s)
- Bahar Oztelcan Gunduz
- Department of Pediatrics, University of Health, Gulhane Training and Research Hospital, Pediatrics, Ankara, Turkey
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Abstract
Neonatal hyperbilirubinemia (NH) is a common phenomenon. In most cases, NH is benign and transient. However, in severe NH cases, neonates can develop encephalopathy and kernicterus. With appropriate screening and treatment, these adverse sequelae can be prevented. This article aims to provide the reader with an in-depth understanding of (1) bilirubin metabolism, (2) risk factors for severe NH, (3) NH screening and treatment, (4) various etiologies of severe NH, and (5) consequences of severe, untreated NH. [Pediatr Ann. 2022;51(6):e219-e227.].
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Luo X, Yan P, Zhang N, Wang M, Deng Y, Wu T, Wu X, Liu Q, Wang H, Wang L, Kang Y, Duan S. Early recovery status and outcomes after sepsis-associated acute kidney injury in critically ill patients. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2022; 47:535-545. [PMID: 35753723 PMCID: PMC10929915 DOI: 10.11817/j.issn.1672-7347.2022.210368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Acute kidney injury (AKI) is one of the common complications in critically ill septic patients, which is associated with increased risks of death, cardiovascular events, and chronic renal dysfunction. The duration of AKI and the renal function recovery status after AKI onset can affect the patient prognosis. Nevertheless, it remains controversial whether early recovery status after AKI is closely related to the prognosis in patients with sepsis-associated AKI (SA-AKI). In addition, early prediction of renal function recovery after AKI is beneficial to individualized treatment decision-making and prevention of severe complications, thus improving the prognosis. At present, there is limited clinical information on how to identify SA-AKI patients at high risk of unrecovered renal function at an early stage. The study aims to investigate the association between early recovery status after SA-AKI, identify risk factors for unrecovered renal function, and to improve patients' quality of life. METHODS We retrospectively analyzed clinical data of septic patients who were admitted to the intensive care unit (ICU) and developed AKI within the first 48 hours after ICU admission in the Second Xiangya Hospital and the Third Xiangya Hospital of Central South University from January 2015 to March 2017. Sepsis was defined based on the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). AKI was diagnosed and staged according to the 2012 Kidney Disease: Improving Global Outcomes (KDIGO) guideline. SA-AKI patients were assigned into 3 groups including a complete recovery group, a partial recovery group, and an unrecovered group based on recovery status at Day 7 after the diagnosis of AKI. Patients' baseline characteristics were collected, including demographics, comorbidities, clinical and laboratory examination information at ICU admission, and treatment within the first 24 hours. The primary outcome of the study was the composite of death and chronic dialysis at 90 days, and secondary outcomes included length of stay in the ICU, length of stay in the hospital, and persistent renal dysfunction. Multivariate regression analysis was performed to evaluate the prognostic value of early recovery status after AKI and to determine the risk factors for unrecovered renal function after AKI. Sensitivity analysis was conducted in patients who still stayed in hospital on Day 7 after AKI diagnosis, patients without premorbid chronic kidney disease, and patients with AKI Stage 2 to 3. RESULTS A total of 553 SA-AKI patients were enrolled, of whom 251 (45.4%), 73 (13.2%), and 229 (41.4%) were categorized as the complete recovery group, the partial recovery group, and the unrecovered group, respectively. Compared with the complete or partial recovery group, the unrecovered group had a higher incidence of 90-day mortality (unrecovered vs partial recovery or complete recovery: 64.2% vs 26.0% or 22.7%; P<0.001) and 90-day composite outcome (unrecovered vs partial recovery or complete recovery: 65.1% vs 27.4% or 22.7%; P<0.001). The unrecovered group also had a shorter length of stay in the hospital and a larger proportion of progression into persistent renal dysfunction than the other 2 groups. After adjustment for potential confounders, patients in the unrecovered group were at an increased risk of 90-day mortality (HR=3.50, 95% CI 2.47 to 4.96, P<0.001) and 90-day composite outcome (OR=5.55, 95% CI 3.43 to 8.98, P<0.001) when compared with patients in the complete recovery group, but patients in the partial recovery group had no significant difference (P>0.05). Male sex, congestive heart failure, pneumonia, respiratory rate >20 beats per minute, anemia, hyperbilirubinemia, need for mechanical ventilation, and AKI Stage 3 were identified as independent risk factors for unrecovered renal function after AKI. The sensitivity analysis further supported that unrecovered renal function after AKI remained an independent predictor for 90-day mortality and composite outcome in the subgroups. CONCLUSIONS The early recovery status after AKI is closely associated with poor prognosis in critically ill patients with SA-AKI. Unrecovered renal function within the first 7 days after AKI diagnosis is an independent predictor for 90-day mortality and composite outcome. Male sex, congestive heart failure, pneumonia, tachypnea, anemia, hyperbilirubinemia, respiratory failure, and severe AKI are risk factors for unrecovered renal function after AKI. Therefore, timely assessment for the renal function in the early phase after AKI diagnosis is essential for SA-AKI patients. Furthermore, patients with unrecovered renal function after AKI need additional management in the hospital, including rigorous monitoring, avoidance of nephrotoxin, and continuous assessment for the renal function, and after discharge, including more frequent follow-up, regular outpatient consultation, and prevention of long-term adverse events.
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Affiliation(s)
- Xiaoqin Luo
- Department of Nephrology, Second Xiangya Hospital, Central South University, Changsha 410011.
| | - Ping Yan
- Department of Nephrology, Second Xiangya Hospital, Central South University, Changsha 410011
| | - Ningya Zhang
- Information Center, Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Mei Wang
- Department of Nephrology, Second Xiangya Hospital, Central South University, Changsha 410011
| | - Yinghao Deng
- Department of Nephrology, Second Xiangya Hospital, Central South University, Changsha 410011
| | - Ting Wu
- Department of Nephrology, Second Xiangya Hospital, Central South University, Changsha 410011
| | - Xi Wu
- Department of Nephrology, Second Xiangya Hospital, Central South University, Changsha 410011
| | - Qian Liu
- Department of Nephrology, Second Xiangya Hospital, Central South University, Changsha 410011
| | - Hongshen Wang
- Department of Nephrology, Second Xiangya Hospital, Central South University, Changsha 410011
| | - Lin Wang
- Department of Nephrology, Second Xiangya Hospital, Central South University, Changsha 410011
| | - Yixin Kang
- Department of Nephrology, Second Xiangya Hospital, Central South University, Changsha 410011
| | - Shaobin Duan
- Department of Nephrology, Second Xiangya Hospital, Central South University, Changsha 410011.
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Kamate M, Detroja M. Which is the Most Common Physiologic Type of Cerebral Palsy? Neurol India 2022; 70:1048-1051. [PMID: 35864637 DOI: 10.4103/0028-3886.349640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Spastic cerebral palsy (CP) is the commonest physiological type according to literature which comes mainly from the developed countries where prematurity is a common cause for cerebral palsy. In developing countries like India, the leading causes of cerebral palsy are birth asphyxia, infections, and hyperbilirubinemia and, hence, the physiological type of CP is likely to be different. However, the data from our country is scant. METHODS 103 consecutive treatment-naive CP patients attending pediatric neurology clinic were evaluated in detail using an objective tool, hypertonia assessment tool (HAT) over a period of 6months. Based on the predominant tone, the cases were classified as spastic, dyskinetic, ataxic/hypotonic, and mixed. The type of cerebral palsy was correlated with perinatal details and neuroimaging findings. RESULTS Out of 103 children, the most common physiological type of CP seen was of dyskinetic type [54 (52.4%)], followed by spastic CP in 30 (29.1%) and mixed (dyskinetic+spastic) CP in 19 (18.4%) children. The most common cause for dyskinetic CP was perinatal asphyxia 33 (61%); for spastic CP was prematurity 17 (56.7%) and; for mixed CP, the main cause was perinatal asphyxia 12 (63.2%). The main neuroimaging finding in predominant dyskinetic CP was basal ganglia/thalamus involvement followed by pericentral and perirolandic gliosis, whereas in spastic CP, it was periventricular leucomalacia. In mixed CP, there was multicystic encephalomalacia. CONCLUSIONS Dyskinetic CP either as predominant type or along with spasticity is the most common physiological type of CP in India and is due to birth-asphyxia, hyperbilirubinemia, hypoglycemia, and infections.
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Affiliation(s)
- Mahesh Kamate
- Professor of Pediatric Neurology and In-Charge of Child Development Clinic, KAHER's J N Medical College, Belgaum, Karnataka, India
| | - Mayank Detroja
- Fellow in Pediatric Neurology, Senior Resident, Child Development Center, KLE Prabhakar Kore Hospital, Belgaum, Karnataka, India
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Juschten J, Bos LDJ, de Grooth HJ, Beuers U, Girbes ARJ, Juffermans NP, Loer SA, van der Poll T, Cremer OL, Bonten MJM, Schultz MJ, Tuinman PR. Incidence, Clinical Characteristics and Outcomes of Early Hyperbilirubinemia in Critically Ill Patients: Insights From the MARS Study. Shock 2022; 57:161-167. [PMID: 34238904 PMCID: PMC8757589 DOI: 10.1097/shk.0000000000001836] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 05/19/2021] [Accepted: 06/29/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the incidence, clinical characteristics and outcomes of early hyperbilirubinemia in critically ill patients. DESIGN AND SETTING This is a post hoc analysis of a prospective multicenter cohort study. PATIENTS Patients with measured bilirubin levels within the first 2 days after ICU admission were eligible. Patients with liver cirrhosis were excluded. ENDPOINTS The primary endpoint was the incidence of early hyperbilirubinemia, defined as bilirubin ≥33 μmol/L within 2 days after ICU admission. Secondary endpoints included clinical characteristics of patients with versus patients without early hyperbilirubinemia, and outcomes up to day 30. RESULTS Of 4,836 patients, 559 (11.6%) patients had early hyperbilirubinemia. Compared to patients without early hyperbilirubinemia, patients with early hyperbilirubinemia presented with higher severity of illness scores, and higher incidences of sepsis and organ failure. After adjustment for confounding variables, early hyperbilirubinemia remained associated with mortality at day 30 (odds ratio, 1.31 [95%-confidence interval 1.06-1.60]; P = 0.018). Patients with early hyperbilirubinemia and thrombocytopenia (interaction P-value = 0.005) had a higher likelihood of death within 30 days (odds ratio, 2.61 [95%-confidence interval 2.08-3.27]; P < 0.001) than patients with early hyperbilirubinemia and a normal platelet count (odds ratio, 1.09 [95%-confidence interval 0.75-1.55]; P = 0.655). CONCLUSIONS Early hyperbilirubinemia occurs frequently in the critically ill, and these patients present with higher disease severity and more often with sepsis and organ failures. Early hyperbilirubinemia has an association with mortality, albeit this association was only found in patients with concomitant thrombocytopenia.
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Affiliation(s)
- Jenny Juschten
- Department of Anesthesiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Intensive Care, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Research VUmc Intensive Care (REVIVE), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Lieuwe D. J. Bos
- Department of Intensive Care, Amsterdam UMC, Universiteit van Amsterdam, Amsterdam, The Netherlands
- Department of Pulmonology, Amsterdam UMC, Universiteit van Amsterdam, Amsterdam, The Netherlands
| | - Harm-Jan de Grooth
- Department of Intensive Care, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Research VUmc Intensive Care (REVIVE), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ulrich Beuers
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Universiteit van Amsterdam, Amsterdam, The Netherlands
| | - Armand R. J. Girbes
- Department of Intensive Care, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Research VUmc Intensive Care (REVIVE), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Nicole P. Juffermans
- Department of Intensive Care Medicine, OLVG Hospital, Amsterdam, The Netherlands
| | - Stephan A. Loer
- Department of Anesthesiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Tom van der Poll
- Division of Infectious Diseases, Amsterdam UMC, Universiteit van Amsterdam, Amsterdam, The Netherlands
- Center for Experimental and Molecular Medicine (CEMM), Amsterdam UMC, Universiteit van Amsterdam, Amsterdam, The Netherlands
| | - Olaf L. Cremer
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marc J. M. Bonten
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marcus J. Schultz
- Department of Intensive Care, Amsterdam UMC, Universiteit van Amsterdam, Amsterdam, The Netherlands
- Mahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Pieter Roel Tuinman
- Department of Intensive Care, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Research VUmc Intensive Care (REVIVE), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Ahrendsen JT, Varma H. Green Discoloration of Human Postmortem Brains: Etiologies and Mechanisms of Discoloration. Am J Forensic Med Pathol 2021; 42:135-140. [PMID: 33346981 DOI: 10.1097/paf.0000000000000641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT A variety of gross discolorations of human postmortem brains is occasionally encountered and can have diagnostic implications. We describe 3 cases of green discoloration of the human brain observed on postmortem examination. Two patients who succumbed shortly after administration of methylene blue (MB) showed diffuse green discoloration that was detectable as early as 24 hours and was seen for at least 48 hours after MB administration. Green discoloration was largely in cortical and deep gray matter structures with relative sparing of the white matter. In contrast, a patient with severe hyperbilirubinemia who died after intracerebral hemorrhage showed localized bright green bile stained brain parenchyma in the areas surrounding the hemorrhage. We highlight the distinct patterns of discoloration in different causes of green brain discoloration, including MB, bile staining, and hydrogen sulfide poisoning. Recognition of these patterns by practicing pathologists can be used to differentiate between these etiologies and allow correct interpretation in both the medical and forensic autopsy settings.
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Affiliation(s)
- Jared T Ahrendsen
- From the Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School. Boston, MA
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Abstract
Recent research on bilirubin, a historically well-known waste product of heme catabolism, suggests an entirely new function as a metabolic hormone that drives gene transcription by nuclear receptors. Studies are now revealing that low plasma bilirubin levels, defined as "hypobilirubinemia," are a possible new pathology analogous to the other end of the spectrum of extreme hyperbilirubinemia seen in patients with jaundice and liver dysfunction. Hypobilirubinemia is most commonly seen in patients with metabolic dysfunction, which may lead to cardiovascular complications and possibly stroke. We address the clinical significance of low bilirubin levels. A better understanding of bilirubin's hormonal function may explain why hypobilirubinemia might be deleterious. We present mechanisms by which bilirubin may be protective at mildly elevated levels and research directions that could generate treatment possibilities for patients with hypobilirubinemia, such as targeting of pathways that regulate its production or turnover or the newly designed bilirubin nanoparticles. Our review here calls for a shift in the perspective of an old molecule that could benefit millions of patients with hypobilirubinemia.
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Affiliation(s)
- Justin F Creeden
- Department of Neurosciences, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio
| | - Darren M Gordon
- Department of Neurosciences, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio
| | - David E Stec
- Department of Physiology & Biophysics, Cardiorenal and Metabolic Diseases Research Center, University of Mississippi Medical Center, Jackson, Mississippi
| | - Terry D Hinds
- Department of Pharmacology and Nutritional Sciences, University of Kentucky College of Medicine, Lexington, Kentucky
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Cheng F, Kang L, Zhang F, Ma H, Wang X, Dong Y, An H. Analysis of hyperbilirubinemia in patients with Kawasaki disease. Medicine (Baltimore) 2020; 99:e21974. [PMID: 32899036 PMCID: PMC7478457 DOI: 10.1097/md.0000000000021974] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 07/21/2020] [Accepted: 07/26/2020] [Indexed: 12/19/2022] Open
Abstract
The present study attempted to analyze the clinical characteristics and pathogenesis of Kawasaki disease (KD) in children with hyperbilirubinemia.A total of 390 children with KD hospitalized in our hospital from September 2018 to July 2019 were selected and divided into control (270 cases) and hyperbilirubinemia (120 cases) groups based on the total, direct, and indirect bilirubin values after admission. Clinical data of the inflammatory index and fever process of the 2 groups were analyzed and compared.The difference in sex and age between the 2 groups was statistically nonsignificant (P > .05). In the hyperbilirubinemia group, the white blood cell count, C-reactive protein, hemoglobin, platelet count, erythrocyte sedimentation rate, alanine aminotransferase, aspartate aminotransferase, albumin, and routine urine leucocyte; and incidence of coronary artery expansion, heart injury, and unreactive gamma globulin treatment were higher than those in the control group and the differences were statistically significant (P < .05). In the hyperbilirubinemia group, the mean fever duration before admission was shorter than that in the control group, whereas the fever duration after gamma globulin treatment was longer than that in the control group; these differences were statistically significant (P < .05).Hyperbilirubinemia incidence in children with KD was approximately 30.77% (120 cases), of which increased direct bilirubin was observed in 70.83% (85 cases) and increased indirect bilirubin in 29.17% (35 cases). Children with KD combined with hyperbilirubinemia exhibited a strong inflammatory reaction, which may be due to liver damage or biliary block.
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Wu YH, Wu CY, Cheng CY, Tsai SF. Severe hyperbilirubinemia is associated with higher risk of contrast-related acute kidney injury following contrast-enhanced computed tomography. PLoS One 2020; 15:e0231264. [PMID: 32294106 PMCID: PMC7159198 DOI: 10.1371/journal.pone.0231264] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 03/19/2020] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Contrast-induced acute kidney injury (CI-AKI) is associated with high risks of morbidity and mortality. Hyperbilirubinemia might have some renal protection but with no clear cutoff value for protection. Related studies are typically on limited numbers of patients and only in conditions of vascular intervention. METHODS We performed this study to elucidate CI-AKI in patients after contrast-enhanced computed tomography (CCT). The outcomes were CI-AKI, dialysis and mortality. Patients were divided to three groups based on their serum levels of total bilirubin: ≤1.2 mg/dl, 1.3-2.0 mg/dl, and >2.0 mg/dl. RESULTS We enrolled a total of 9,496 patients who had received CCT. Patients with serum total bilirubin >2.0 mg/dl were associated with CI-AKI. Those undergoing dialysis had the highest incidence of PC-AKI (p<0.001). No difference was found between the two groups of total bilirubin ≤1.2 and 1.3-2.0 mg/dl. Patients with total bilirubin >2mg/dl were associated with CI-AKI (OR = 1.89, 1.53-2.33 of 95% CI), dialysis (OR = 1.40, 1.01-1.95 of 95% CI) and mortality (OR = 1.63, 1.38-1.93 of 95% CI) after adjusting for laboratory data and all comorbidities (i.e., cerebrovascular disease, coronary artery disease, peripheral arterial disease, and acute myocardial infarction, diabetes mellitus, hypertension, gastrointestinal bleeding, cirrhosis, peritonitis, ascites, hepatoma, shock lung and colon cancer). We concluded that total bilirubin level >2 mg/dl is an independent risk factor for CI-AKI, dialysis and mortality after CCT. These patients also had high risks for cirrhosis or hepatoma. CONCLUSION This is the first study providing evidence that hyperbilirubinemia (total bilirubin >2.0 mg/dl) being an independent risk factor for CI-AKI, dialysis and mortality after receiving CCT. Most patients with total bilirubin >2.0mg/dl had cirrhosis or hepatoma.
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Affiliation(s)
- Yu-Hsien Wu
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Chun-Yi Wu
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ching-Yao Cheng
- Department of Pharmacy, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Pharmacy, China Medical University, Taichung, Taiwan
| | - Shang-Feng Tsai
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Life Science, Tunghai University, Taichung, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- * E-mail:
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Abstract
To establish a clinical prediction rule for acute bilirubin encephalopathy (ABE) in term/near-term neonates with extreme hyperbilirubinemia.A retrospective cohort study was conducted between January 2015 and December 2018. Six hundred seventy-three out of 26,369 consecutive neonates with extreme hyperbilirubinemia were enrolled in this study. Data included demographic characteristics, total serum bilirubin (TSB), albumin, bilirubin/albumin ratio (B/A), direct antiglobulin test, glucose-6-phosphate deficiency, asphyxia, sepsis, acidosis. ABE was defined as a bilirubin induced neurological dysfunction score of 4 to 9. We used stepwise logistic regression to select predictors of ABE and devised a prediction score.Of the 673 eligible infants, 10.8% suffered from ABE. Our prediction score consisted of 3 variables: TSB (as a continuous variable; odds ratio [OR] 1.16; 95% confidence interval [CI], 1.02-1.31; logistic coefficient 0.15), B/A (as a continuous variable; OR 1.88; 95% CI, 1.19-2.97; logistic coefficient 0.67), and sepsis (OR 3.78; 95% CI, 1.40-10.21; logistic coefficient 1.19). Multiplying the logistic coefficients by 10 and subtracting 75, resulted in the following equation for the score: Score = 12 × (if sepsis) + 1.5 × (TSB) + 7 × (B/A) - 75. The model performed well with an area under the curve of 0.871.The risk of ABE can be quantified according to TSB, B/A, and sepsis in term/near-term neonates with extreme hyperbilirubinemia.
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Affiliation(s)
| | | | - Shiqiang Shang
- Department of Laboratory, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Kewen Jiang
- Department of Laboratory, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Sims ME. Legal Briefs: Multiple Missteps and System Failures Cause Kernicterus in 2 Infants. Neoreviews 2019; 20:e683-e686. [PMID: 31676745 DOI: 10.1542/neo.20-11-e683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Maureen E Sims
- Department of Pediatrics, University of California, Los Angeles, Los Angeles, CA
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25
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Shi HB, Li CY. [Clinical characteristics and treatment options of hearing impairment caused by hyperbilirubinemia]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2019; 33:685-687. [PMID: 31446717 DOI: 10.13201/j.issn.1001-1781.2019.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Indexed: 06/10/2023]
Abstract
SummaryNeonatal hyperbilirubinemia is the most common clinical symptom in neonates. When the concentration of free bilirubin in blood is too high, it crosses through the blood-brain barrier and selectively deposits in specific brain nuclei to cause neurotoxicity and bilirubin neurological dysfunction. The auditory nervous system is highly sensitive to bilirubin. Therefore, auditory neuropathy is the most important or even the only clinical symptom of bilirubin neurological dysfunction. Chronic bilirubin encephalopathy can be classified to three types as mild, moderate and severe,according to the audiological manifestations and other neurological sequelae. Early recognition and intervention of bilirubin-induced hearing impairment is of great significance to improve the speech recognition rate of the referred children. This article reviews the most important studies about the clinical characteristics, pathogenesis and treatment of bilirubin-induced hearing impairment.
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Valaskova P, Dvorak A, Lenicek M, Zizalova K, Kutinova-Canova N, Zelenka J, Cahova M, Vitek L, Muchova L. Hyperbilirubinemia in Gunn Rats is Associated with Decreased Inflammatory Response in LPS-Mediated Systemic Inflammation. Int J Mol Sci 2019; 20:ijms20092306. [PMID: 31075981 PMCID: PMC6539717 DOI: 10.3390/ijms20092306] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 05/02/2019] [Accepted: 05/02/2019] [Indexed: 12/20/2022] Open
Abstract
Decreased inflammatory status has been reported in subjects with mild unconjugated hyperbilirubinemia. However, mechanisms of the anti-inflammatory actions of bilirubin (BR) are not fully understood. The aim of this study is to assess the role of BR in systemic inflammation using hyperbilirubinemic Gunn rats as well as their normobilirubinemic littermates and further in primary hepatocytes. The rats were treated with lipopolysaccharide (LPS, 6 mg/kg intraperitoneally) for 12 h, their blood and liver were collected for analyses of inflammatory and hepatic injury markers. Primary hepatocytes were treated with BR and TNF-α. LPS-treated Gunn rats had a significantly decreased inflammatory response, as evidenced by the anti-inflammatory profile of white blood cell subsets, and lower hepatic and systemic expressions of IL-6, TNF-α, IL-1β, and IL-10. Hepatic mRNA expression of LPS-binding protein was upregulated in Gunn rats before and after LPS treatment. In addition, liver injury markers were lower in Gunn rats as compared to in LPS-treated controls. The exposure of primary hepatocytes to TNF-α with BR led to a milder decrease in phosphorylation of the NF-κB p65 subunit compared to in cells without BR. In conclusion, hyperbilirubinemia in Gunn rats is associated with an attenuated systemic inflammatory response and decreased liver damage upon exposure to LPS.
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Affiliation(s)
- Petra Valaskova
- Institute of Medical Biochemistry and Laboratory Diagnostics, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague 12108, Czech Republic.
| | - Ales Dvorak
- Institute of Medical Biochemistry and Laboratory Diagnostics, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague 12108, Czech Republic.
| | - Martin Lenicek
- Institute of Medical Biochemistry and Laboratory Diagnostics, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague 12108, Czech Republic.
| | - Katerina Zizalova
- Institute of Medical Biochemistry and Laboratory Diagnostics, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague 12108, Czech Republic.
| | - Nikolina Kutinova-Canova
- Institute of Pharmacology, First Faculty of Medicine, Charles University and General University Hospital in Prague, 12800 Prague, Czech Republic.
| | - Jaroslav Zelenka
- Department of Biochemistry and Microbiology, University of Chemistry and Technology, 16628 Prague, Czech Republic.
| | - Monika Cahova
- Department of Experimental Diabetology, Institute of Clinical and Experimental Medicine, 14021 Prague, Czech Republic.
| | - Libor Vitek
- Institute of Medical Biochemistry and Laboratory Diagnostics, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague 12108, Czech Republic.
- 4th Department of Medicine-Department of Gastroenterology and Hepatology, First Faculty of Medicine, Charles University and General University Hospital in Prague, 12808 Prague, Czech Republic.
| | - Lucie Muchova
- Institute of Medical Biochemistry and Laboratory Diagnostics, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague 12108, Czech Republic.
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27
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Ali Q, McCallion N. Down Syndrome with Transient Neonatal Hepatitis. Ir Med J 2019; 112:922. [PMID: 31245964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Q Ali
- Department of Paediatrics, The Rotunda Hospital, Dublin
| | - N McCallion
- Department of Paediatrics, The Rotunda Hospital, Dublin
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28
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Santucci N, Facy O, Ortega-Deballon P, Lequeu JB, Rat P, Rat P. CA 19-9 predicts resectability of pancreatic cancer even in jaundiced patients. Pancreatology 2018; 18:666-670. [PMID: 30153902 DOI: 10.1016/j.pan.2018.07.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 06/28/2018] [Accepted: 07/03/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Surgical resection remains the only curative option for pancreatic adenocarcinoma. Despite recent improvements in medical imaging, unresectability is still often discovered at the time of surgery. It is essential to identify unresectable patients preoperatively to avoid unnecessary surgery. High serum CA 19-9 levels have been suggested as a marker of unresectability but considered inaccurate in patients with hyperbilirubinemia. AIM OF THE STUDY To evaluate CA 19-9 serum levels as a predictor of unresectability of pancreatic adenocarcinomas with a special focus on jaundiced patients. METHODS All patients presenting with histologically-confirmed pancreatic adenocarcinoma and having serum CA 19-9 levels available prior to any treatment were included in this retrospective study. The relationship between serum concentrations of CA 19-9 and resectability was studied by regression analysis and theROC curves obtained. A cut-off value of CA 19-9 was calculated. In jaundiced patients, a CA 19-9 adjusted for bilirubinemia was also evaluated. RESULTS Of the 171 patients included, 49 (29%) were deemed resectable and 122 (71%) unresectable. Altogether, 93 patients (54%) had jaundice. The area under the ROC curve for CA 19-9 as a predictor of resectability was 0.886 (95%CI:[0.832-0.932]); in jaundiced patients it was 0.880 (95% CI [0.798-0.934]. A cut-off in CA 19-9 at 178 UI/mlyielded 85% sensitivity, 81% specificity and 91% positive predictive value for resectability. There was no correlation between the levels of bilirubin and CA 19-9 (r = 0.149). CONCLUSION Serum CA 19-9 is a good predictive marker of unresectability of pancreatic adenocarcinoma, even in jaundiced patients. CA 19-9 levels over 178 UI/ml strongly suggest unresectable disease.
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Affiliation(s)
- Nicolas Santucci
- Department of Digestive Surgical Oncology, University Hospital of Dijon, France.
| | - Olivier Facy
- Department of Digestive Surgical Oncology, University Hospital of Dijon, France; INSERM Unit 866, Dijon, France
| | - Pablo Ortega-Deballon
- Department of Digestive Surgical Oncology, University Hospital of Dijon, France; INSERM Unit 866, Dijon, France
| | | | - Paul Rat
- Department of Digestive Surgical Oncology, University Hospital of Dijon, France
| | - Patrick Rat
- Department of Digestive Surgical Oncology, University Hospital of Dijon, France; INSERM Unit 866, Dijon, France
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Schiavon E, Smalley JL, Newton S, Greig NH, Forsythe ID. Neuroinflammation and ER-stress are key mechanisms of acute bilirubin toxicity and hearing loss in a mouse model. PLoS One 2018; 13:e0201022. [PMID: 30106954 PMCID: PMC6091913 DOI: 10.1371/journal.pone.0201022] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 07/07/2018] [Indexed: 12/01/2022] Open
Abstract
Hyperbilirubinemia (jaundice) is caused by raised levels of unconjugated bilirubin in the blood. When severe, susceptible brain regions including the cerebellum and auditory brainstem are damaged causing neurological sequelae such as ataxia, hearing loss and kernicterus. The mechanism(s) by which bilirubin exerts its toxic effect have not been completely understood to date. In this study we investigated the acute mechanisms by which bilirubin causes the neurotoxicity that contributes to hearing loss. We developed a novel mouse model that exhibits the neurological features seen in human Bilirubin-Induced Neurological Dysfunction (BIND) syndrome that we assessed with a behavioural score and auditory brainstem responses (ABR). Guided by initial experiments applying bilirubin to cultured cells in vitro, we performed whole genome gene expression measurements on mouse brain tissue (cerebellum and auditory brainstem) following bilirubin exposure to gain mechanistic insights into biochemical processes affected, and investigated further using immunoblotting. We then compared the gene changes induced by bilirubin to bacterial lipopolysaccharide (LPS), a well characterized inducer of neuroinflammation, to assess the degree of similarity between them. Finally, we examined the extent to which genetic perturbation of inflammation and both known and novel anti-inflammatory drugs could protect hearing from bilirubin-induced toxicity. The in vitro results indicated that bilirubin induces changes in gene expression consistent with endoplasmic reticulum (ER) stress and activation of the unfolded protein response (UPR). These gene changes were similar to the gene expression signature of thapsigargin–a known ER stress inducer. It also induced gene expression changes associated with inflammation and NF-κB activation. The in vivo model showed behavioural impairment and a raised auditory threshold. Whole genome gene expression analysis confirmed inflammation as a key mechanism of bilirubin neurotoxicity in the auditory pathway and shared gene expression hallmarks induced by exposure to bacterial lipopolysaccharide (LPS) a well-characterized inducer of neuroinflammation. Interestingly, bilirubin caused more severe damage to the auditory system than LPS in this model, but consistent with our hypothesis of neuroinflammation being a primary part of bilirubin toxicity, the hearing loss was protected by perturbing the inflammatory response. This was carried out genetically using lipocalin-2 (LCN2)-null mice, which is an inflammatory cytokine highly upregulated in response to bilirubin. Finally, we tested known and novel anti-inflammatory compounds (interfering with NF-κB and TNFα signalling), and also demonstrated protection of the auditory system from bilirubin toxicity. We have developed a novel, reversible, model for jaundice that shows movement impairment and auditory loss consistent with human symptoms. We used this model to establish ER-stress and inflammation as major contributors to bilirubin toxicity. Because of the rapid and reversible onset of toxicity in this novel model it represents a system to screen therapeutic compounds. We have demonstrated this by targeting inflammation genetically and with anti-inflammatory small molecules that offered protection against bilirubin toxicity. This also suggests that anti-inflammatory drugs could be of therapeutic use in hyperbilirubinemia.
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Affiliation(s)
- Emanuele Schiavon
- Department Neuroscience, Psychology & Behaviour, University of Leicester, Leicester, Leicestershire, United Kingdom
| | - Joshua L. Smalley
- Department Neuroscience, Psychology & Behaviour, University of Leicester, Leicester, Leicestershire, United Kingdom
| | - Sherylanne Newton
- Department Neuroscience, Psychology & Behaviour, University of Leicester, Leicester, Leicestershire, United Kingdom
| | - Nigel H. Greig
- Translational Gerontology Branch, Intramural Research Program, National Institute on Aging, NIH, Baltimore, MD, United States of America
| | - Ian D. Forsythe
- Department Neuroscience, Psychology & Behaviour, University of Leicester, Leicester, Leicestershire, United Kingdom
- * E-mail:
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30
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Culleton S, Kok HK, Barras C, Looby S, Brennan P, Asadi H. Kernicterus with abnormal high-signal changes bilaterally in the globus pallidus: A case report. Ir Med J 2018; 111:739. [PMID: 30488686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Kernicterus is a relatively rare consequence of hyperbilirubinemia. There is an important role for MRI imaging for this entity in the appropriate clinical context as there are distinct signal changes in the globus pallidus. A case report and image findings are presented
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Affiliation(s)
- S Culleton
- Department of Neuroradiology, Galway University Hospital, Ireland
| | - H K Kok
- Department of Neuroradiology, Beaumont Hospital, Dublin 9, Ireland
| | - C Barras
- Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - S Looby
- Department of Neuroradiology, Beaumont Hospital, Dublin 9, Ireland
| | - P Brennan
- Department of Neuroradiology, Beaumont Hospital, Dublin 9, Ireland
| | - H Asadi
- Department of Neuroradiology, Beaumont Hospital, Dublin 9, Ireland
- School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, VIC, Australia
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31
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Taylor T, Wheatley M, Gupta N, Nusbaum J. Jaundice in the emergency department: meeting the challenges of diagnosis and treatment [digest]. Emerg Med Pract 2018; 20:1-2. [PMID: 29634896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
There are approximately 52,000 visits a year to emergency departments for patients presenting with jaundice. While many of these patients will not have immediately life-threatening pathology, it is essential that the emergency clinician understands the pathophysiology of jaundice, as this will guide the appropriate workup to detect critical diagnoses. Patients who present with jaundice could require intravenous antibiotics, emergent surgery, and, in severe cases, organ transplantation. This issue will focus on the challenge of evaluating and treating the jaundiced patient in the ED using the best available evidence from the literature. [Points & Pearls is a digest of Emergency Medicine Practice.].
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Affiliation(s)
- Todd Taylor
- Assistant Professor of Emergency Medicine, Department of Emergency Medicine, Emory School of Medicine, Atlanta, GA
| | - Matthew Wheatley
- Assistant Professor of Emergency Medicine, Department of Emergency Medicine, Emory School of Medicine, Atlanta, GA
| | - Nachi Gupta
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jeffrey Nusbaum
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
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32
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Taylor T, Wheatley M. Jaundice in the emergency department: meeting the challenges of diagnosis and treatment. Emerg Med Pract 2018; 20:1-24. [PMID: 29565526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 12/10/2017] [Indexed: 06/08/2023]
Abstract
There are approximately 52,000 visits a year to emergency departments for patients presenting with jaundice. While many of these patients will not have immediately life-threatening pathology, it is essential that the emergency clinician understands the pathophysiology of jaundice, as this will guide the appropriate workup to detect critical diagnoses. Patients who present with jaundice could require intravenous antibiotics, emergent surgery, and, in severe cases, organ transplantation. This issue will focus on the challenge of evaluating and treating the jaundiced patient in the ED using the best available evidence from the literature.
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Affiliation(s)
- Todd Taylor
- Assistant Professor of Emergency Medicine, Department of Emergency Medicine, Emory School of Medicine, Atlanta, GA
| | - Matthew Wheatley
- Assistant Professor of Emergency Medicine, Department of Emergency Medicine, Emory School of Medicine, Atlanta, GA
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33
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Foshat M, Ruff HM, Fischer WG, Beach RE, Fowler MR, Ju H, Aronson JF, Afrouzian M. Bile Cast Nephropathy in Cirrhotic Patients: Effects of Chronic Hyperbilirubinemia. Am J Clin Pathol 2017; 147:525-535. [PMID: 28398539 DOI: 10.1093/ajcp/aqx030] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES The aim of this study was to determine the prevalence of bile cast nephropathy (BCN) in autopsied cirrhotic patients and to correlate BCN with clinical and laboratory data to direct attention to this underrecognized renal complication of liver failure. METHODS We assessed 114 autopsy cases of cirrhosis for the presence of renal intratubular bile casts using Hall stain for bile. Presence of bile casts was correlated with etiology of cirrhosis, clinical and laboratory data, and histologic findings. RESULTS Bile casts were identified in 55% of cases. The most common etiology of cirrhosis was hepatitis C virus (HCV) infection (52%), and serum creatinine ( P = .02) and serum urea nitrogen ( P = .01) were significantly higher in the Hall-positive group. Conjugated bilirubin was below 20 mg/dL in 90%, and levels below 10 mg/dL were noted in 80% of cases. CONCLUSIONS To our knowledge, this is the largest study of BCN in human subjects and a first report describing the association of BCN with HCV-related cirrhosis. We demonstrated that in the face of protracted chronic hyperbilirubinemia, bile casts are formed at much lower bilirubin levels than previously thought. Furthermore, we proposed an algorithm to assist in better identification of bile casts.
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Affiliation(s)
| | | | | | - Robert E Beach
- Office of the Chief Quality, Safety, and Clinical Information
| | | | - Hyunsu Ju
- Division of Epidemiology and Biostatistics, Office of Biostatistics, University of Texas Medical Branch, Galveston
| | | | - Marjan Afrouzian
- Department of Pathology
- Division of Nephrology, Department of Internal Medicine
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34
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Fargo MV, Grogan SP, Saguil A. Evaluation of Jaundice in Adults. Am Fam Physician 2017; 95:164-168. [PMID: 28145671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Jaundice in adults can be an indicator of significant underlying disease. It is caused by elevated serum bilirubin levels in the unconjugated or conjugated form. The evaluation of jaundice relies on the history and physical examination. The initial laboratory evaluation should include fractionated bilirubin, a complete blood count, alanine transaminase, aspartate transaminase, alkaline phosphatase, ?-glutamyltransferase, prothrombin time and/or international normalized ratio, albumin, and protein. Imaging with ultrasonography or computed tomography can differentiate between extrahepatic obstructive and intrahepatic parenchymal disorders. Ultrasonography is the least invasive and least expensive imaging method. A more extensive evaluation may include additional cancer screening, biliary imaging, autoimmune antibody assays, and liver biopsy. Unconjugated hyperbilirubinemia occurs with increased bilirubin production caused by red blood cell destruction, such as hemolytic disorders, and disorders of impaired bilirubin conjugation, such as Gilbert syndrome. Conjugated hyperbilirubinemia occurs in disorders of hepatocellular damage, such as viral and alcoholic hepatitis, and cholestatic disorders, such as choledocholithiasis and neoplastic obstruction of the biliary tree.
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Affiliation(s)
| | | | - Aaron Saguil
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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35
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Martínez-García SM, Hernández-Da Mota SE, Rubio-Rangel A, Rojas-Flores I, Vieyra-López ME, Martínez-Castellanos MA, Zavala-Martínez MT, Gómez García A. [Neurodevelopment in patients with retinopathy of prematurity treated with intravitreal bevacizumab. Case series]. CIR CIR 2017; 85:478-484. [PMID: 28110900 DOI: 10.1016/j.circir.2016.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 10/25/2016] [Accepted: 10/26/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Retinopathy of prematurity (ROP) is an eye disease caused by an alteration in retinal vasculogenesis that may lead to partial or complete vision loss with a harmful impact in terms of neurodevelopment. The purpose of the present study was to determine the neurodevelopment in patients with type i retinopathy of prematurity treated with intravitreal bevacizumab. MATERIAL AND METHODS Case series. The inclusion criteria were: patients with type I ROP treated with a dose of 0.625mg/0.025ml of intravitreal bevacizumab. Demographic data and comorbidities were documented. Neurodevelopment was evaluated with the screening test of the Bayley Scale of Infant Development (BSID) in all patients between 11 and 28 weeks of age. RESULTS Seven patients were included in the study. Four patients showed normal neurodevelopment according to the overall scores of the BSID scale. The distribution of high risk for neurodevelopmental delay in the different areas evaluated were as follows: 3 patients presented it in the cognitive area, one in the receptive communication area, one in the expressive area, one in the fine motor skills and 3 patients in the gross motor skills area. CONCLUSIONS In these case series, the majority of patients treated with intravitreal bevacizumab for ROP showed normal neurodevelopment scores.
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Affiliation(s)
| | | | | | | | | | - María Ana Martínez-Castellanos
- Servicio de Retina, Hospital Dr. Luis Sánchez Bulnes, Asociación para Evitar la Ceguera en México, Ciudad de México, México
| | | | - Anel Gómez García
- Unidad de Medicina Familiar Número 80, IMSS, Morelia, Michoacán, México
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36
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Zhang L, Zhou Y, Li X, Cheng T. Hyperbilirubinemia Influences Sleep-Wake Cycles of Term Newborns in a Non-Linear Manner. PLoS One 2017; 12:e0169783. [PMID: 28072860 PMCID: PMC5224785 DOI: 10.1371/journal.pone.0169783] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 12/21/2016] [Indexed: 12/04/2022] Open
Abstract
Hyperbilirubinemia is a common cause for irreversible neuronal influence in the brain of term newborns, while the feature of neurological symptoms associated with hyperbilirubinemia has not been well characterized yet. In the present study, we examined a total of 203 neonates suffering from hyperbilirubinemia with a bedside amplitude-integrated Electroencephalography (aEEG) device, in order to determine whether there is any special change in sleep-wake cycles (SWCs). Among these patients, 14 cases showed no recognizable SWCs with the total serum bilirubin (TSB) level at 483.9–996.2 μmol/L; 75 cases exhibited reduced SWCs with the TSB level at 311.2–688.5 μmol/L; and the rest cases had the normal SWCs. The number of the normal SWCs occurrence had a significant negative correlation with the increased TSB level in a non-linear manner (r = -0.689, p <0.001). In addition, the increased TSB reshaped the structure of SWC by narrowing down the broadband and broadening the narrowband. Spearman’s correlation analysis indicated a significant negative correlation between the TSB level and the ratio of broadband (r = -0.618, p < 0.001), a significant positive correlation between the TSB level and the narrowband ratio (r = 0.618, p < 0.001), respectively. Furthermore, the change of SWC seemed like a continuous phenomenon, and the hyperbilirubinemia caused SWC changes was fit into a loess model in this paper. In summary, the hyperbilirubinemia influenced SWC of term newborns significantly at a non-linear manner, and these results revealed the feature of the neurological sequela that is associated with TSB.
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Affiliation(s)
- Lian Zhang
- Department of Neonatology, Guangzhou Women and Children’s Medical Center, Guangzhou, P. R. China
- * E-mail:
| | - Yanxia Zhou
- Department of Neurology, Guangzhou Women and Children’s Medical Center, Guangzhou, P. R. China
| | - Xufang Li
- Department of Neonatology, Guangzhou Women and Children’s Medical Center, Guangzhou, P. R. China
| | - Tingting Cheng
- Department of Neonatology, Guangzhou Women and Children’s Medical Center, Guangzhou, P. R. China
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37
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Aiso M, Yagi M, Tanaka A, Miura K, Miura R, Arizumi T, Takamori Y, Nakahara S, Maruo Y, Takikawa H. Gilbert Syndrome with Concomitant Hereditary Spherocytosis Presenting with Moderate Unconjugated Hyperbilirubinemia. Intern Med 2017; 56:661-664. [PMID: 28321066 PMCID: PMC5410476 DOI: 10.2169/internalmedicine.56.7362] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
We experienced a case of a 19-year-old man with Gilbert syndrome with concomitant hereditary spherocytosis. The patient presented with moderate unconjugated hyperbilirubinemia, and inherited etiology was strongly suspected. The diagnosis of Gilbert syndrome was confirmed by the genetic analysis of the UGT1A1 gene, demonstrating UGT1A1*28 and compound heterozygote UGT1A1*6. In addition, since the laboratory findings and imaging studies revealed lysemia as well as gallstone and splenomegaly, a diagnosis of hereditary spherocytosis was made as a comorbidity. Both Gilbert syndrome and hereditary spherocytosis are hereditary diseases with a high frequency, and the hyperbilirubinemia may be exacerbated when these two diseases are concomitant.
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Affiliation(s)
- Mitsuhiko Aiso
- Department of Medicine, Teikyo University School of Medicine, Japan
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38
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Patel J, Walayat S, Kalva N, Palmer-Hill S, Dhillon S. Bile cast nephropathy: A case report and review of the literature. World J Gastroenterol 2016; 22:6328-6334. [PMID: 27468221 PMCID: PMC4945990 DOI: 10.3748/wjg.v22.i27.6328] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 02/29/2016] [Accepted: 03/18/2016] [Indexed: 02/06/2023] Open
Abstract
Bile cast nephropathy is a condition of renal dysfunction in the setting of hyperbilirubinemia. There are very few cases of this condition reported in the last decade and a lack of established treatment guidelines. While the exact etiology remains unknown, bile cast nephropathy is presumed to be secondary to multiple concurrent insults to the kidney including direct toxicity from bile acids, obstructive physiology from bile casts, and systemic hypoperfusion from vasodilation. Therapy directed at bilirubin reduction may improve renal function, but will likely need dialysis or plasmapheresis as well. We report our case of bile cast nephropathy and the therapeutic measures undertaken in a middle-aged male with chronic renal insufficiency that developed hyperbilirubinemia and drug-induced liver injury secondary to antibiotic use. He developed acute renal injury in the setting of rising bilirubin. He subsequently had a progressive decline in renal and hepatic function, requiring dialysis and plasmapheresis with some improvement, ultimately requiring transplantation.
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39
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Scholz P, Lenoir U, Borbély Y. Letter to the Editor regarding Adams HL, Jaunoo SS. Hyperbilirubinaemia in appendicitis: the diagnostic value for prediction of appendicitis and appendiceal perforation. Eur J Trauma Emerg Surg. 2016; 42:249-52. Eur J Trauma Emerg Surg 2016; 42:529. [PMID: 27334387 DOI: 10.1007/s00068-016-0699-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 06/16/2016] [Indexed: 11/25/2022]
Affiliation(s)
- P Scholz
- Department of Visceral Surgery and Medicine, Inselspital, University Hospital of Bern, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - U Lenoir
- Department of Visceral Surgery and Medicine, Inselspital, University Hospital of Bern, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Y Borbély
- Department of Visceral Surgery and Medicine, Inselspital, University Hospital of Bern, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland.
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40
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Mahram M, Oveisi S, Jaberi N. Trans-Cutaneous Bilirubinometery versus Serum Bilirubin in Neonatal Jaundice. Acta Med Iran 2015; 53:764-769. [PMID: 26749233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
Hyperbilirubinemia is a common problem in neonates and causes serious complications. Thus, serial measurements of bilirubin should be done. This assessment is done through two methods of laboratory measurement in serum sample and transcutaneous bilirubinometer. This descriptive study compared transcutaneous bilirubin assessment and laboratory serum bilirubin. Bilirubin level was assessed among 256 neonates admitted to the Qods Children's Hospital in Qazvin- Iran, because of neonatal indirect jaundice, through two methods of transcutaneous bilirubinometery from two sites of forehead and sternum and laboratory measurement of bilirubin in serum. The cases were non-hemolytic icteric term neonates weighing 2500 gram or more and had not received phototherapy or other treatments. Neonates with hemolytic forms of jaundice, sepsis and suspicious to metabolic disorders were excluded. Assessments by means of KJ-8000 transcutaneous bilirubinometer from two sites of forehead and sternum and through laboratory measurement of serum bilirubin were registered and analyzed. The results of the current study showed that there was a correlation of 0.82 between serum bilirubin and transcutaneous forehead bilirubin assessment and for the used device sensitivity of 0.844; specificity of 0.842, Youden Index of 0.709 and Shortest of 0.042 for a cut-off of 12.4 in bilirubin of participants. Furthermore, Likelihood Ratio positive and negative (LR) were 5.665 and 0.164, respectively and diagnostic Odds Ratio (LR+/LR-) was 34.56. Transcutaneous bilirubinometery can be considered as a reliable tool to assess bilirubin for the screening of neonatal jaundice in term neonates.
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Affiliation(s)
- Manoochehr Mahram
- Department of Pediatrics, Children Growth Research Center, Qazvin University of Medical Science, Qazvin, Iran
| | - Sonia Oveisi
- Department of Community of Medicine, Metabolic Diseases Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Najmeh Jaberi
- School of Medicine, Qazvin University of Medical Science, Qazvin, Iran
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41
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Couturier L, Jarvis C, Rousseau H, Jimenez V. Biliary atresia. Can Fam Physician 2015; 61:965-8. [PMID: 26564655 PMCID: PMC4642905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Louis Couturier
- Third-year emergency medicine resident in the CCFP(EM) program at the University of Montreal in Quebec.
| | - Catherine Jarvis
- Faculty Lecturer in the Department of Family Medicine at McGill University in Montreal and a family physician practising at the Côte-des-Neiges Local Community Service Centre
| | - Hélène Rousseau
- Assistant Dean for Rural Education in the Faculty of Medicine at McGill University and a family physician practising at the Jewish General Hospital and the Côte-des-Neiges Local Community Service Centre
| | - Vania Jimenez
- Director of Côte-des-Neiges Local Community Service Centre and Associate Professor in the Department of Family Medicine at McGill University
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42
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Nishimura T, Tanaka M, Sekioka R, Itoh H. Serum bilirubin concentration is associated with eGFR and urinary albumin excretion in patients with type 1 diabetes mellitus. J Diabetes Complications 2015; 29:1223-7. [PMID: 26234498 DOI: 10.1016/j.jdiacomp.2015.07.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 07/01/2015] [Accepted: 07/01/2015] [Indexed: 11/15/2022]
Abstract
AIMS Although relationships of serum bilirubin concentration with estimated glomerular filtration rate (eGFR) and urinary albumin excretion (UAE) in patients with type 2 diabetes have been reported, whether such relationships exist in patients with type 1 diabetes is unknown. METHODS A total of 123 patients with type 1 diabetes were investigated in this cross-sectional study. The relationship between bilirubin (total and indirect) concentrations and log(UAE) as well as eGFR was examined by Pearson's correlation analyses. Multivariate regression analyses were used to assess the association of bilirubin (total and indirect) with eGFR as well as log(UAE). RESULTS A positive correlation was found between serum bilirubin concentration and eGFR; total bilirubin (r=0.223, p=0.013), indirect bilirubin (r=0.244, p=0.007). A negative correlation was found between serum bilirubin concentration and log(UAE); total bilirubin (r=-0.258, p=0.005), indirect bilirubin (r=-0.271, p=0.003). Multivariate regression analyses showed that indirect bilirubin concentration was an independent determinant of eGFR and log(UAE). CONCLUSIONS Bilirubin concentration is associated with both eGFR and log(UAE) in patients with type 1 diabetes. Bilirubin might have a protective role in the progression of type 1 diabetic nephropathy.
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Affiliation(s)
- Takeshi Nishimura
- Division of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Masami Tanaka
- Division of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Risa Sekioka
- Division of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hiroshi Itoh
- Division of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
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Li Z, Shen J, Liang J. Scoliosis in a Patient With Gilbert Syndrome: A Case Report and Review of the Literature. Medicine (Baltimore) 2015; 94:e2147. [PMID: 26632744 PMCID: PMC5059013 DOI: 10.1097/md.0000000000002147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Gilbert syndrome (GS) is mainly characterized by intermittent unconjugated hyperbilirubinemia in the absence of hepatocellular disease or hemolysis. Little data are available on operative outcomes in GS patients with spinal deformity surgery.This study has presented a case of GS occurring in the patient with scoliosis.The patient was a 30-year-old female with scoliosis and GS. She was taken a correction form Thoracic 2 to Lumbar 1) levels by using the USS-II spinal system. At 2 years follow-up, the patient was well balanced and pain free. Plain radiographs demonstrated spine solid fusion without correction loss.Although complex scoliosis surgery can be performed safely in these patients with GS, careful perioperative managements including liver function and coagulation function are required.
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Affiliation(s)
- Zheng Li
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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44
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Shelat VG, Chia CLK, Yeo CSW, Qiao W, Woon W, Junnarkar SP. Pyogenic Liver Abscess: Does Escherichia Coli Cause more Adverse Outcomes than Klebsiella Pneumoniae? World J Surg 2015; 39:2535-42. [PMID: 26133908 DOI: 10.1007/s00268-015-3126-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND This paper aims to demonstrate if Escherichia coli pyogenic liver abscess (ECPLA) results in adverse outcomes compared to Klebsiella pneumoniae PLA (KPPLA). METHODS A retrospective review of all patients admitted at a tertiary hospital in Singapore from 2003 to 2011 was performed. Patients with age <18 years, amoebic liver abscess, infected liver cyst, culture negative abscess or ruptured liver abscess requiring urgent surgical intervention were excluded. Only patients with blood or pus culture confirmation of ECPLA (n = 24) or KPPLA (n = 264) were included. Median length of hospital stay, failure of non-operative therapy and 30-day mortality are the reported outcomes. RESULTS ECPLA affects older patients (68 vs. 62 years, p = 0.049). Ischemic heart disease was more common in ECPLA (29 vs. 14 %, p = 0.048) and there was no difference in diabetic state (42 vs. 38 %, p = 0.743). ECPLA is more commonly associated with hyperbilirubinemia (60 vs. 34 µmol/L, p = 0.003), increased gamma-glutamyl transpeptidase (236 vs. 16 IU/L, p = 0.038) and gallstones (58 vs. 30 %, p = 0.004). KPPLA are larger in size (6 vs. 4 cm, p = 0.006) and had percutaneous drainage (PD) more frequently (64 vs. 42 %, p = 0.034). There was no difference in median hospital stay (14 vs. 14 days, p = 0.110) or 30-day mortality (17 vs. 10 %, p = 0.307) between ECPLA and KPPLA. Among patients with ECPLA, antibiotic treatment with PD appeared to have higher mortality compared to antibiotic treatment alone (30 vs. 7 %) but this was not significant (p = 0.272). CONCLUSION In the setting of multimodal care, outcomes of ECPLA are comparable to KPPLA.
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Affiliation(s)
- Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, 308433, Singapore,
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45
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Edefonti A, Ghio L, Bettinelli A, Paterlini G, Giani M, Nebbia G, Aniasi A, Cattarelli D. Unconjugated hyperbilirubinemia due to ciclosporin administration in children with nephrotic syndrome. Contrib Nephrol 2015; 67:121-4. [PMID: 3208520 DOI: 10.1159/000415387] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- A Edefonti
- Clinica Pediatrica G. e D. De Marchi, Università di Milano, Italia
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46
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Jomni MT, Largueche M, Ben Kaab B, Abdelaal I, Bellakhal S, Douggui MH. La néphrotoxicite secondaire à l’hyperbilribinemie: à propos d’un cas. Pan Afr Med J 2015; 22:313. [PMID: 26977222 PMCID: PMC4769808 DOI: 10.11604/pamj.2015.22.313.8225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 11/13/2015] [Indexed: 11/11/2022] Open
Affiliation(s)
- Med Taieb Jomni
- Service de Médecine Interne, Hôpital des Forces de Sécurité Intérieures, La Marsa, Tunisie
| | - Mouna Largueche
- Service de Médecine Interne, Hôpital des Forces de Sécurité Intérieures, La Marsa, Tunisie
| | - Badreddine Ben Kaab
- Service de Médecine Interne, Hôpital des Forces de Sécurité Intérieures, La Marsa, Tunisie
| | - Imen Abdelaal
- Service de Médecine Interne, Hôpital des Forces de Sécurité Intérieures, La Marsa, Tunisie
| | - Syrine Bellakhal
- Service de Médecine Interne, Hôpital des Forces de Sécurité Intérieures, La Marsa, Tunisie
| | - Med Hédi Douggui
- Service de Médecine Interne, Hôpital des Forces de Sécurité Intérieures, La Marsa, Tunisie
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47
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So JK, Romero L. Eccrine chromhidrosis secondary to hyperbilirubinemia. Dermatol Online J 2014; 21:13030/qt6hz8s1mh. [PMID: 25780969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Revised: 10/06/2014] [Accepted: 12/14/2014] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Eccrine chromhidrosis, or colored eccrine sweating, may be caused by contamination of sweat by dyes, pigmentation from microorganisms, or more rarely, hyperbilirubinemia. Pigment usually affects the palms and soles, where abundant sweat glands are found.Purpose, Material and Methods: We report a unique case of eccrine chromhidrosis in the setting of hyperbilirubinemia and review the current literature available on PubMed of previously reported cases. RESULTS Six patients with chromhidrosis have been previously reported in the setting of significant hyperbilirubinemia, in association with fever and thickened stratum corneum. CONCLUSIONS Eccrine chromhidrosis secondary to hyperbilirubinemia is very rare, but can be diagnosed on the basis of classic clinical findings, dermoscopic examination, and negative tissue cultures.
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48
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Abstract
CONCLUSION This study suggests that hyperbilirubinemia in the neonatal rat can impair auditory function and induce peripheral nerve pathology by reducing neurofilament-positive cells in spiral ganglion neurons (SGNs). This finding indicates a potential connection between hyperbilirubinemia and auditory impairment. OBJECTIVE To establish a neonatal rat hyperbilirubinemia induced by hemolysis and assess the possible link between hyperbilirubinemia and auditory impairment. METHODS Wistar rats were divided into two groups - a bilirubin exposure group injected with phenylhydrazine hydrochloride at 7 and 28 days of age to induce hyperbilirubinemia, and a control group given saline. Auditory brainstem response (ABR) and distortion product otoacoustic emissions (DPOAEs) were determined to assess auditory function. Cochlea basilar membrane stretch preparations and cochlear frozen sections were examined for morphological changes in hair cells and SGNs. RESULTS At day 7, ABR wave I, III, and V latencies, and I-III, I-V interwave intervals (IWIs) in the experimental group were significantly prolonged compared with those in the control group. ABR thresholds were also elevated in the experimental group. We found no significant difference in DPOAEs in the bilirubin exposure group compared to the control group. The ABRs and DPOAEs in the experimental group were restored at age 28 days. Cochlear hair cells showed no signs of loss in either group; however, the total number of neurofilament-positive cells in SGNs was significantly reduced in the phenylhydrazine-treated animals.
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Affiliation(s)
- Qi Li
- Department of Otolaryngology, Nanjing Children's Hospital, Nanjing Medical University , Nanjing , Jiangsu
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49
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Du L. [Prevention and intervention strategies for hyperbilirubinemia induced brain injury]. Zhonghua Er Ke Za Zhi 2014; 52:721-723. [PMID: 25537534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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50
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Patil SB, Hugar S, Patil S. Green teeth associated with hyperbilirubinemia: a case report. Eur J Paediatr Dent 2014; 15:221-223. [PMID: 25101508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Green stain is an uncommon clinical condition associated with deposition of bilirubin in the dental hard tissues. The staining of the teeth is due to hyperbilirubinemia caused by systemic conditions. CASE REPORT The purpose of this report is to present a case of green teeth of the primary dentition in a 17-month old girl associated with hydrocephalus and Hirschprung's disease. CONCLUSION The clinical characteristics of the teeth may help in the diagnosis of current or past systemic diseases.
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Affiliation(s)
- S B Patil
- Department of Pedodontics and Preventive Dentistry, Kle Vk Institute of Dental Sciences, Belgaum, India
| | - S Hugar
- Department of Pedodontics and Preventive Dentistry, Kle Vk Institute of Dental Sciences, Belgaum, India
| | - S Patil
- Department of oral pathology, Faculty of Dental Sciences, M S Ramaiah University of applied Sciences, Bangalore, India
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