Interferencia entre NIRS cerebral y bilirrubina conjugada en neonatos de extremado bajo peso / Interference between cerebral NIRS and conjugated bilirubin in extremely low birthweight neonates

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Ictericia congestiva desenmascarada con la ecografía clínica / Unmasking congestive jaundice with point-of-care ultrasound

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Coledocolitiasis en el embarazo. Reporte de caso / Choledocholithiasis in pregnancy. Case report

El embarazo es un estado donde se aumenta la litogenicidad y la estasis biliar, generando mayor incidencia en la formación de cálculos biliares. Aunque la colelitiasis por sí sola no es una urgencia quirúrgica en la paciente obstétrica, puede requerir de intervención si se presentan complicaciones, las cuales se dan hasta en un 10% de las pacientes obstétricas con colelitiasis sintomática. En este artículo se presentará un caso clínico de una paciente obstétrica que presentó colelitiasis con coledocolitiasis de alto riesgo que requirió manejo con colangiopancreatografía retrógrada endoscópica

Lithogenesis and biliary stasis increases during pregnancy. This generates a high incidence in the production of gallstones. Cholelithiasis is not usually a surgical emergency in pregnancy, but when there are complications, which can be in up to 10% of obstetric patients, these complications can require intervention. A case report is presented on an obstetric patient with cholelithiasis, and high risk of choledocholithiasis, that required intervention using endoscopic retrograde cholangiopancreatography

Valoración del uso del índice ictérico como parámetro para la gestión de la determinación de la bilirrubina total / Use of icteric index as a parameter for the management of the determination of total bilirubin

Introducción: El exceso de pruebas enviadas al laboratorio, en numerosas ocasiones, no aporta un valor añadido, lo que nos lleva a plantearnos su uso eficiente. La bilirrubina es una magnitud bioquímica clásica para el estudio de la alteración hepática, y el índice ictérico es una medida indirecta para la determinación semicuantitativa de la bilirrubina. Objetivos: Evaluar la utilidad del índice ictérico para detectar a pacientes con concentraciones de bilirrubina en suero superiores o inferiores a 1,20mg/dL, de manera que interese valorar la determinación de bilirrubina, y calcular el ahorro que supondría la aplicación de este algoritmo. Material y métodos: Se realizó un estudio retrospectivo para determinar la correlación entre el índice ictérico y la bilirrubina, y un análisis de regresión. La eficacia diagnóstica del índice ictérico se estudió mediante una curva Receiver Operating Characteristic, determinando el valor de corte del índice ictérico que permite discriminar valores de bilirrubina superiores e inferiores a 1,20mg/dL. Se calculó la sensibilidad, especificidad, valor predictivo positivo y valor predictivo negativo. Resultados y discusión: El análisis estadístico indicó una buena correlación entre ambas variables. El estudio de eficacia diagnóstica mostró que el punto de corte índice ictérico=2 tiene un alto valor predictivo negativo y una alta sensibilidad y especificidad. Conclusiones: Los valores de índice ictérico correlacionan bien con la bilirrubina, permitiendo el cribado de la hiperbilirrubinemia. Así se evitaría realizar el 89,72% de las bilirrubinas, informándose como<1,20mg/dL aquellas muestras con índice ictérico≤1, suponiendo un ahorro importante al laboratorio

Introduction: As too many laboratory tests may not represent significant improvements, their efficient use should be considered. Bilirubin is a classical biochemical marker of hepatic alterations, and the icteric index is an indirect measure for the semi-quantitative determination of jaundice. Objectives: To evaluate the use of the icteric index in the identification of patients with serum bilirubin concentrations with values higher or lower than 1.20mg/dL, as well as to assess the determination of bilirubin, and to evaluate the savings that the application of this algorithm would represent. Material and methods: A retrospective study was performed to determine the relationship between icteric index and total bilirubin. A regression analysis was also performed. The diagnostic efficiency of the index was studied using a Receiver Operating Characteristic curve to determine the cut-off value that would allow to distinguish bilirubin values higher and lower than 1.20mg/dL. The sensitivity and specificity, positive predictive value and negative predictive value were also calculated. Results and discussion: The statistical analysis showed a high correlation between both variables. The study of diagnostic efficacy showed that to use an icteric index equal to 2 as a cut-off point yields a high negative predictive value, sensitivity and specificity. Conclusions: Icteric index values are well correlated with bilirubin, which allows filtering for hyperbilirubinaemia. Therefore, 89.72% of bilirubin requests would not be needed. With those samples with icteric index ≤ 1 subsequently being reported as<1.20mg/dL, thus representing a savings to the laboratory

Estratificación del riesgo y tratamiento de la colangitis biliar primaria / Risk stratification and treatment of primary biliary cholangitis

La colangitis biliar primaria es una enfermedad hepática crónica caracterizada por colestasis progresiva que puede evolucionar hacia cirrosis hepática. El tratamiento de elección es el ácido ursodesoxicólico, aunque en torno al 30% de los pacientes no responde. Estos pacientes presentan un peor pronóstico, por lo que deben ser detectados precozmente para ofrecerles alternativas terapéuticas. En esta línea, el mejor conocimiento de la fisiopatología de la enfermedad ha permitido el desarrollo de nuevos fármacos, como el ácido obeticólico y los fibratos. Esta revisión ofrece una perspectiva sobre la estratificación del riesgo de los pacientes y del tratamiento de esta enfermedad, desde el ácido ursodesoxicólico a las terapias de segunda línea

Primary biliary cholangitis is a chronic liver disorder characterized by progressive cholestasis that may evolve to liver cirrhosis. While ursodeoxycholic acid is the treatment of choice, around 30% of patients do not respond to this therapy. These patients have a poorer prognosis, hence should be identified early in order to be offered therapy options. Along these lines, improved understanding of the condition's pathophysiology has allowed the development of newer drugs, including obeticholic acid and fibrates. This review offers a perspective on risk stratification and treatment for these patients, from ursodeoxycholic acid to second-line treatments

Diagnòstic diferencial de la icterícia en el lactant / No disponible

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Hiperbilirrubinemia conjugada tras cirugía. Sospecha de síndrome de Dubin-Johnson y confirmación mediante estudio genético / Conjugated hyperbilirubinemia after surgery. A diagnosis of Dubin-Johnson syndrome confirmed by genetic testing

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Múltiples nódulos hepáticos / Multiple hepatic nodules

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Effect of phototherapy on B and T lymphocytes in Egyptian infants suffering from neonatal jaundice

BACKGROUND: Neonatal jaundice is one of the most common problems that affect newborn infants, and phototherapy is usually used for treatment. OBJECTIVES: Evaluation of the effect of phototherapy on neonatal immune system through measuring the percentage of B and T lymphocytes and determining the frequency of development of infections and need for hospitalisation during the first six months of life. METHODS: A prospective cohort study was conducted on 50 full term new-borns; 25 with indirect hyperbilirubinaemia and treated with conventional phototherapy and 25 healthy matched neonates as untreated controls. The percentages of CD19+, CD4+ and CD8+ lymphocytes were measured by flow cytometry before phototherapy and 72h after exposure. Follow-up of the study group for the occurrence of infections for a period of six months after phototherapy. RESULTS: The study showed a significant difference in CD19+ lymphocytes percentage between patients before phototherapy and controls (P value<0.01), also a significant correlation between serum levels of total bilirubin in patients and CD19+ lymphocytes percentage (P value<0.05). There was no significant difference between the percentages of CD19+, CD4+ and CD8+ lymphocytes in patients before or after 72h of exposure to phototherapy (P value>0.05). Also, there was no correlation between the percentages of CD19+, CD4+ and CD8+ lymphocytes after 72h of exposure to phototherapy and the occurrence of infections (Gastrointestinal tract and Respiratory tract infection) after six months of follow-up (P value>0.05). More studies are needed with larger number of patients to determine the effect of phototherapy on immune system

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Peritonitis meconial, una complicación no descrita de la hepatitis E durante la gestación / Meconium peritonitis, a non-described complication of hepatitis E during pregnancy

La infección por el virus de la hepatitis E es una causa clásica de hepatitis fulminante en la gestación que puede acarrear graves consecuencias materno-fetales. Las complicaciones fetales se derivan fundamentalmente de la transmisión vertical durante la gestación o el parto (hipotermia, hipoglucemia, hepatitis aguda, necrosis masiva hepática) y de un aumento de la prematuridad que conllevaría una mayor mortalidad neonatal. La peritonitis meconial se ha descrito como complicación de la infección materno-fetal por parvovirus B19, citomegalovirus, rubeola, virus de la hepatitis A y virus de la hepatitis B, sin que hayan sido comunicados en la bibliografía casos secundarios a la infección por virus de la hepatitis E. Presentamos el caso de una gestante de 19 semanas que ingresa por un cuadro de hepatitis aguda E, con diagnóstico fetal ecográfico prenatal compatible con peritonitis meconial (AU)

Hepatitis E virus infection is a classical cause of fulminant hepatitis during pregnancy, which can lead to severe maternal and fetal complications. Fetal complications are mainly derived from the vertical transmission during pregnancy or delivery (hypothermia, hypoglycaemia, acute hepatitis, massive liver necrosis) and from and increase in prematurity that would lead on to a greater neonatal mortality. Meconium peritonitis has been described as a complication of maternal and fetal infection by parvovirus B19, cytomegalovirus, rubella, hepatitis A virus and hepatitis B virus. There have been no published cases relating meconium peritonitis and hepatitis E virus infection. We present the case of a 19 week pregnant woman admitted with an acute hepatitis E, with a fetal prenatal ultrasound diagnosis of meconium peritonitis (AU)

Derrame pleural izquierdo secundario a infartos esplénicos en una paciente con cirrosis hepática / Left pleural effusion secondary to splenic infarctions in a patient with liver cirrhosis

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Hiperbilirrubinemia asintomática como forma de presentación de hepatitis autoinmune en una paciente anciana / Hyperbilirubinemia asymptomatic as presentation of autoimmune hepatitis in an elderly patient

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Fenobarbital en el síndrome de Crigler-Najjar tipo 1: una opción terapéutica / Phenobarbital in Crigler-Najjar syndrome type 1: A therapeutic option

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Unusual presentation of Gilbert disease with high levels of unconjugated bilirubin. Report of two cases

Gilbert’s syndrome is a benign condition characterized by asymptomatic sporadic episodes of jaundice, due to a mild unconjugated hyperbilirubinemia caused by a deficiency in bilirubin glucoronidation. Under certain physiologic or pathologic events, bilirubin level rises but according to literature it does not reach out more than 3 mg/dl. We report 2 cases of Gilbert’s syndrome, genetically tested, which presented with bilirubin levels above 6 mg/dl without any trigger or coexisting condition. In conclusion, bilirubin levels higher than 6 mg/dl in Gilbert syndrome are rare, hemolytic and other metabolism diseases must be ruled out, and enetic testing may be necessary in some cases (AU)

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Eculizumab en recién nacido con síndrome hemolitico urémico atípico: a propósito de un caso / Eculizumab for atypical hemolytic uremic syndrome in newborn: a case report

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Tratamiento del fallo hepático después de hepatectomía mediante sistema de diálisis hepática MARS / Treatment of hepatic failure after hepatectomy by the MARS hepatic dialysis system

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Interferencia de la bilirrubina en la medición del paracetamol por el método del indofenol en el analizador Dimension (R) EXL(TM) / Bilirubin interference in the measurement of paracetamol by the indophenol method on the Dimension (R) EXL(TM)

Introducción. Los niveles de paracetamol se miden habitualmente en los laboratorios de urgencias ante la evidencia o sospecha de una intoxicación para predecir la posible hepatotoxicidad aguda por este fármaco. Sin embargo varios estudios han reportado un falso incremento en la concentración de paracetamol medida por métodos enzimáticos en plasmas ictéricos, circunstancia que ocurre frecuentemente en casos de fracaso hepático. Material y métodos. Para evaluar la influencia de la bilirrubina en la medición de paracetamol en el analizador Dimension(R) EXL(TM) (Siemens Healthcare Diagnostics Inc.(R)) se preparó una solución primaria de interferente a una concentración de 800 mg/dl (13.680 μmol/l) que se añadió a una solución de control comercial con altos niveles de paracetamol hasta obtener una mezcla con una concentración de bilirrubina de 40 mg/dl (684 μmol/l) realizando la medición de paracetamol en esta mezcla y en una de referencia. Comprobada la existencia de interferencia se procedió a cuantificarla diluyendo la solución primaria hasta obtener mezclas con 20; 10; 5; 2,5; 1,25 y 0,625 mg/dl de bilirrubina (342; 171; 85,5; 42,75; 21,37 y 19,69 μmol/l). Se obtuvo el interferograma representando la desviación de la medida frente a la mezcla de referencia frente a las distintas concentraciones de interferente. Resultados. Las distribuciones fueron gaussianas, por lo que se pudo aplicar la t de Student para el cálculo de las significaciones estadísticas. Se demostró la existencia de una interferencia significativa negativa a partir de 5 mg/dl (85,5 μmol/l) de bilirrubina, lo que muestra que las mediciones de paracetamol deben interpretarse con cautela en casos de hiperbilirrubinemia (AU)

Background. Blood levels of acetaminophen (paracetamol) are measured routinely in large acetaminophen overdoses or when poisoning is suspected, in order to predict the likelihood of hepatotoxicity. However some cases of spurious acetaminophen levels have been reported in jaundiced patients. Material and methods. The interference of bilirubin in acetaminophen measurements was studied on the Dimension(R) EXL(T)M by preparing a primary mixture of bilirubin at 800 mg/dL, which was spiked to a quality control solution with high acetaminophen concentration in order to get a bilirrubin concentration of 40 mg/dl on the mixture. Acetaminophen concentration was measured in the mixture with bilirubin and in reference solution without bilirubin. Interference was assessed and quantified by diluting the bilirubin solution to achieve final concentrations of 20, 10, 5, 2.5, 1.25 and 0.625 mg/dl (342, 171, 85.5, 42.75, 21.37 and 19.69 μmol/l). A graph of the interference was obtained showing the bias of acetaminophen concentrations with reference solution vs. increasing bilirubin concentrations. Results. Acetaminophen concentrations in both solutions followed Gaussian distributions. The t test showed significant negative interference at bilirubin concentrations higher to 5 mg/dl (85.5 μmol/l), which means that blood acetaminophen concentrations must be interpreted with caution in cases of hyperbilirubinemia (AU)