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Article in Chinese | WPRIM | ID: wpr-928752


OBJECTIVE@#To investigate the titer of IgG anti-A/B erythrocyte antibody in vivo of the neonate with hemolytic disease of newborn(HDN), and explore its clinical valua in evaluating the severity of HDN.@*METHODS@#300 neonates with HDN, 50 neonates with neonatal hyperbilirubinemiain and 50 healthy neonates were selected as research object and Microtubes Gel Test was used to detect the titer of IgG anti-A/B erythrocyte antibody in vivo. Their clinical data and their mothers' prenatal examination data were retrospectively analyzed. Three hemolysis tests (direct antiglobulin test, free antibody test and release test), irregular antibody screening, and the titer of IgG anti-A/B blood group antibody was determined by serological method. Red blood cells(RBC), hemoglobin(Hb), reticulocytes(Ret) and nucleated red cells were detected by hematology analyzer. Indirect bilirubin and albumin(Alb) were detected by biochemical analyzer. The relationship between the titer of IgG anti-A/B erythrocyte antibody in vivo and the severity of HDN was analyzed.@*RESULTS@#There were six serological diagnosis modes in the HDN group,the difference between modes was statistically significant (P<0.05). The antibody titer relationship between HDN neonates and pregnant women was positive correlation(r=0.8302). The highest antibody titer of release test and free antibody test were 1∶32 and 1∶2, and the difference was statistically significant(P<0.05). RBC, Hb and Alb in HDN patients were lower than those in neonatal hyperbilirubinemia patients and healthy neonates (P<0.05), and were negatively relevant with antibody titer in vivo (r=-0.8016). Bilirubin content in HDN patients were higher than those in neonatal hyperbiliru binemia patients and healthy neonates group(P<0.05), and was positively relevant with antibody titer in vivo (r=0.8731). The hospital day in HDN patients was significantly relevant with the antibody titer in vivo (r=0.8547), but not with the age, sex, weight and ABO blood types (P>0.05).@*CONCLUSION@#The detection of antibody titer in HDN patients can be used to evaluate the antibody concentration in vivo, predict the ability of antibody to induce erythrocyte hemolysis, and help to judge the serenrity and prognosis of HDN.

ABO Blood-Group System , Bilirubin , Blood Group Incompatibility , Erythroblastosis, Fetal , Erythrocytes , Female , Hematologic Diseases , Hemolysis , Humans , Immunoglobulin G , Infant, Newborn , Pregnancy , Retrospective Studies
Article in Chinese | WPRIM | ID: wpr-939702


OBJECTIVE@#To analyze and evaluate the efficacy of Rh phenotype matched blood transfusion.@*METHODS@#The increasing of hemoglobin (Hb) and hemolysis tests in the patients treated by Rh matched red blood cells or not, as well as the first time unmatched transfusions and the unmatched transfusions happened again after a period (≥10 d) were retrospectively analyzed.@*RESULTS@#A total of 674 times transfusions in 120 patients were evaluated. The increasing of Hb in each unit was higher in the patients treated by Rh matched blood transfusion (vs unmatched) [(33.397±1.475) g/U vs (29.951±1.304) g/U, P=0.033], while the increasing of Hb at first time unmatched transfusion and the second time unmatched transfusion was not statistically different[ (28.942±2.083) g/U vs (30.686±1.737) g/U, P=0.589]. The level of lactate dehydrogenase were related to erythrocyte washing, irradiation, period of validity and the second time unmatched transtusion (all P<0.05); the levels of total bilirubin (TBil), direct bilirubin (DBil) and indirect bilirubin (IBil) between the first time unmatched transfusion and the second time unmatched transfusion were statistically different (all P<0.05).@*CONCLUSION@#For the patients need multiple blood transfusions, Rh phenotype matched blood transfusion can reduce the exposure to Rh allogenic antigens, improve the efficacy and ensure the safety of blood transfusion.

Bilirubin , Blood Transfusion , Erythrocyte Transfusion/adverse effects , Hemoglobins/analysis , Humans , Phenotype , Retrospective Studies
Chinese Journal of Hepatology ; (12): 331-334, 2022.
Article in Chinese | WPRIM | ID: wpr-935948


There exists a complex relationship between liver and thyroid hormones. Liver plays an important role in the activation, inactivation, transportation, and metabolism of thyroid hormones. At the same time, thyroid hormones also affect hepatocytes activity and liver metabolism, such as lipid and bilirubin metabolism. Importantly, thyroid hormone levels often change abnormally in patients with liver cirrhosis. Therefore, studying the change of thyroid hormone levels in patients with liver cirrhosis has a certain clinical value for assessing the severity, prognosis, diagnosis and treatment. This paper reviews the research progress on the relationship between liver cirrhosis and thyroid hormone.

Bilirubin , Humans , Liver/metabolism , Liver Cirrhosis/metabolism , Thyroid Hormones/metabolism
Hepatología ; 3(2): 176-190, 2022. ilus, tab
Article in Spanish | LILACS, COLNAL | ID: biblio-1396099


Los niveles de bilirrubina sérica normal en el adulto varían entre 0,3 mg/dL y 1,2 mg/dL, y su valor está determinado por la tasa de captación hepática, conjugación y excreción. La ictericia se hace evidente cuando los niveles de bilirrubina sérica se elevan por encima de 2,5 mg/dL a 3 mg/dL, siendo un indicador de enfermedad subyacente. La bilis es producida por los hepatocitos y fluye desde los canalículos, canales de Hering, conductos biliares intrahepáticos, conductos hepáticos derechos e izquierdos hasta llegar al duodeno. A nivel histopatológico, cualquier entidad que lleve a la acumulación intrahepática de bilis por disfunción hepatocelular u obstrucción biliar genera colestasis, que se observa en la biopsia hepática como la acumulación de tapones de color marrón verdoso de pigmento biliar en los hepatocitos, y secundariamente se observan los canalículos dilatados. Las causas de colestasis intrahepática son diversas e incluyen enfermedades como colangitis biliar primaria, colangitis esclerosante primaria, hepatitis autoinmune, hepatitis virales y toxicidad medicamentosa. Esta revisión tiene como objetivo analizar algunos tipos de hiperbilirrubinemia, resaltando sus características histopatológicas.

Normal serum bilirubin levels in adults range from 0.3 mg/dL to 1.2 mg/dL, and its value is determined by the rate of hepatic uptake, conjugation, and excretion. Jaundice becomes apparent when serum bilirubin levels rise above 2.5 mg/dL to 3.5 mg/dL and is an indicator of underlying disease. Bile is produced by hepatocytes and flows from the canaliculi, Hering's canals, intrahepatic bile ducts, and right and left hepatic ducts to the duodenum. Pathologically, any condition that leadsto intrahepatic accumulation of bile due to hepatocellular dysfunction or biliary obstruction, generates cholestasis, which is observed in liver biopsy as the accumulation of greenish-brown deposits of bile pigment in hepatocytes, with dilated canaliculi. The causes of intrahepatic cholestasis are diverse and include diseases such as primary biliary cholangitis and primary sclerosing cholangitis, autoimmune hepatitis, viral hepatitis, and drug toxicity. This review aims to analyze some types of hyperbilirubinemia, highlighting their histopathological characteristics.

Humans , Pathologists , Hyperbilirubinemia , Jaundice , Bile , Bile Ducts, Intrahepatic , Bile Pigments , Bilirubin , Biopsy , Cholangitis, Sclerosing , Cholestasis , Cholestasis, Intrahepatic , Hepatitis, Autoimmune , Hepatitis , Liver , Liver Cirrhosis, Biliary
J. pediatr. (Rio J.) ; 97(4): 440-444, July-Aug. 2021. tab
Article in English | LILACS | ID: biblio-1287036


Abstract Objective To assess the accuracy of umbilical cord bilirubin values to predict jaundice in the first 48 h of life and neonatal infection. Method Newborn infants treated at a regional well-baby nursery born at ≥36 weeks of gestation were included in this retrospective cohort study. All infants born in a 3-year period from mothers with O blood type and/or Rh-negative were included and had the umbilical cord bilirubin levels measured. Hyperbilirubinemia in the first 48 h was defined as bilirubin levels above the phototherapy threshold. Neonatal infection was defined as any antibiotic treatment before discharge. Results A total of 1360 newborn infants were included. Two hundred and three (14.9%) newborn infants developed hyperbilirubinemia in the first 48 h of life. Hyperbilirubinemic infants had smaller birth weight, higher levels of umbilical cord bilirubin, a higher rate of infection and were more often direct antiglobulin test positive. Umbilical cord bilirubin had a sensitivity of 76.85% and a specificity of 69.58% in detecting hyperbilirubinemia in the first 48 h, with the cut-off value at 34 µmol/L. The area under the receiver operating characteristic curve was 0.80 (95% CI: 0.78-0.82). Umbilical cord bilirubin had a sensitivity of 27.03% and specificity of 91.31% in detecting perinatal infection. The area under the receiver operating characteristic (ROC) curve was 0.59 (95% CI: 0.57-0.63). Conclusions A positive correlation was found between umbilical cord bilirubin and hyperbilirubinemia in the first 48 h of life. Umbilical cord bilirubin is a poor marker for predicting neonatal infection.

Humans , Female , Infant, Newborn , Infant , Bilirubin , Hyperbilirubinemia, Neonatal/diagnosis , Predictive Value of Tests , Retrospective Studies , Fetal Blood , Hemolysis
An. Fac. Cienc. Méd. (Asunción) ; 54(1): 101-108, 20210000.
Article in Spanish | LILACS | ID: biblio-1178954


La litiasis vesicular sintomática puede presentarse asociada a litiasis de la vía biliar principal, siendo necesaria la utilización de medios diagnósticos adecuados para su posterior tratamiento. En este trabajo, se sugiere la evaluación mediante las guías de la Sociedad Americana para Endoscopia Gastrointestinal (American Society for Gastrointestinal Endoscopy ASGE), usando factores como la edad, pruebas hepáticas y hallazgos ecográficos, categorizando a los pacientes en baja, intermedia y alta probabilidad de coledocolitiasis. Estudio de diseño retrospectivo, observacional, descriptivo, de corte transversal, con un muestreo no probabilístico de casos consecutivos, sobre pacientes con diagnóstico de litiasis vesicular sintomática y sospecha de litiasis de la via biliar principal internados en la II Cátedra de Clínica Quirúrgica, del Hospital de Clínicas de San Lorenzo, entre los años 2017 a 2019. Con los siguientes resultados, de un total de 339 pacientes con diagnóstico de litiasis vesicular sintomática, el 6,64% tuvo el diagnóstico de coledocolitiasis asociada. En cuanto a los predictores muy fuertes de coledocolitiasis el más frecuentemente (68,6%,) encontrado fue el nivel de la bilirrubina total ≥ 4mg/dl; de los predictores fuertes el 70,6% presentaba la vía biliar principal dilatada; de los predictores moderados, el 84,3% presentó las enzimas hepáticas alteradas. En conclusión, se pudo identificar que la mayoría de los pacientes presentó alta probabilidad de coledocolitiasis y la conducta tomada fue realizar en primer lugar una colangiografía retrógrada endoscópica, con fines terapéuticos y luego colecistectomía, correspondiente al manejo correcto establecido por las guías actuales internacionales.

Symptomatic gallstones can occur associated with lithiasis of the main bile duct, requiring the use of adequate diagnostic tools for subsequent treatment. In this paper, we suggest using the guidelines of the American Society for Gastrointestinal Endoscopy (ASGE), that uses factors such as age, liver tests, and ultrasound findings, categorizing patients as those with low, intermediate, and high probability. of choledocholithiasis. A Retrospective, observational, descriptive, cross-sectional design study, with a non-probabilistic sampling of consecutive cases, on patients with a diagnosis of symptomatic gallstones and suspected stones of the main bile duct admitted to the the 2nd Surgical Department and Service of Clinica´s Hospital of San Lorenzo, between the years 2017 to 2019. With the following results; of a total of 339 patients with the diagnosis of symptomatic gallstones, 6.64% had associated choledocholithiasis. Regarding the very strong predictors of choledocholithiasis, the most frequent (68.6%) was the total bilirubin level ≥ 4mg / dl; 70.6% had a dilated main bile duct as a strong predictor; as a moderate predictor, 84.3% had altered liver enzymes. In conclusion, it was possible to identify that most of the patients presented a high probability of choledocholithiasis and the action taken was to first perform an endoscopic retrograde cholangiography, for therapeutic purposes, and then cholecystectomy, corresponding to the correct management established by current international guidelines.

Bile Ducts , Bilirubin , Cholangiography , Cholecystectomy , Gallstones , Lithiasis , Liver , Sampling Studies , Endoscopy, Gastrointestinal , Endoscopy
Arch. argent. pediatr ; 119(1): e18-e25, feb. 2021. ilus
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1147188


La hiperbilirrubinemia es el motivo más frecuente de consulta e internación en el período neonatal. Requiere la instauración oportuna de un tratamiento eficiente, ya que los recién nacidos son especialmente vulnerables a los daños que la bilirrubina puede causar en el sistema nervioso central, debido a características propias de esta etapa de la vida.La bilirrubina en altas concentraciones produce neurotoxicidad y estrés oxidativo. Sin embargo, estudios de biología molecular demuestran que la misma molécula se comporta como un potente antioxidante.El objetivo de esta actualización es revisar cuáles son los procesos por los que la bilirrubina genera daño celular y cuáles son sus efectos antioxidantes beneficiosos. Conocer estos mecanismos facilitaría una indicación más precisa de luminoterapia individualizada, eficaz y oportuna. Hasta nuevos avances científicos, la prescripción de este tratamiento debe ser orientada por consenso de expertos

Hyperbilirubinemia is the most common reason for consultation and hospitalization in the neonatal period. It requires a timely initiation of an effective treatment because newborn infants are especially vulnerable to damage caused by bilirubin in the central nervous system due to the characteristics typical of this stage of life.High bilirubin levels result in neurotoxicity and oxidative stress. However, molecular biology studies have demonstrated that bilirubin itself acts as a potent antioxidant.The objective of this update is to review the processes whereby bilirubin causes cell damage and determine its beneficial antioxidant effects. Knowing these mechanisms may facilitate a more accurate indication of a customized, effective, and timely phototherapy. Until new scientific advances are made, phototherapy should be prescribed based on expert consensus.

Humans , Male , Female , Infant, Newborn , Bilirubin , Oxidative Stress , Neurotoxicity Syndromes , Antioxidants
Article in Chinese | WPRIM | ID: wpr-879884


OBJECTIVE@#To study brainstem auditory evoked potential (BAEP) in neonates with hyperbilirubinemia using short auditory stimuli (60 dBnHL), and to investigate the differences in the inter-aural latency difference (ILD) of wave V between neonates with different total serum bilirubin (TSB) levels.@*METHODS@#A prospective study was conducted in neonates with hyperbilirubinemia who were admitted to the Department of Neonatology, Yuhuan People's Hospital of Zhejiang Province, from May 2019 to October 2020. The neonates were divided into a severe group (@*RESULTS@#Compared with the mild group, the severe group had significantly higher proportions of neonates with abnormal hearing threshold and abnormal ILD (@*CONCLUSIONS@#Serum bilirubin in neonates affects the ILD of BAEP wave V, especially in those with severe hyperbilirubinemia. ILD at the optimal cut-off value of ≥0.4 ms shows potential value in the diagnosis of hearing impairment caused by neonatal hyperbilirubinemia.

Bilirubin , Evoked Potentials, Auditory, Brain Stem , Hearing Loss , Humans , Hyperbilirubinemia , Hyperbilirubinemia, Neonatal , Infant, Newborn , Prospective Studies
Article in Chinese | WPRIM | ID: wpr-887959


A determination method for bilirubin in cultured cow-bezoar was developed in this study, with which the bilirubin in 15 batches of samples was quantified. The samples were first processed with 10% oxalic acid solution for the conversion of bilirubin from conjugated to unconjugated, followed by the extraction with dichloromethane. Then the obtained sample solutions were analyzed at 450 nm by HPLC[chromatographic column: Agilent TC-C_(18)(4.6 mm × 250 mm, 5 μm); mobile phase: acetonitrile and 1% glacial acetic acid aqueous solution(95∶5); flow rate: 1.0 mL·min~(-1)]. The bilirubin content in the 15 batches of cultured cow-bezoar was ranged from 21.9% to 41.7% with the average of 32.4%. The proposed method is accurate and reliable, thus making it suitable for the quantitation of bilirubin in cultured cow-bezoar and its quality assessment and control.

Animals , Bezoars , Bilirubin , Cattle , Chromatography, High Pressure Liquid , Drugs, Chinese Herbal , Female
Rev. Soc. Bras. Clín. Méd ; 19(3): 176-180, set 2021.
Article in Portuguese | LILACS | ID: biblio-1391950


A busca pelo corpo perfeito pode gerar graves consequências para a população que faz uso indiscriminado de substâncias visando a resultados rápidos. O caso relatado se refere a um pa- ciente de 21 anos, do sexo masculino, na cidade de São Paulo (SP), que apresentou quadro de síndrome colestática 15 dias após uso do anabolizante estanazolol para fins estéticos na ativi- dade física, evoluindo com hepatite medicamentosa grave, com aumento de transaminases, hiperrubilinemia às custas de bilirrubina direta e fatores de coagulação, sem resposta satis- fatória ao tratamento de suporte convencional, com melhora significativa após introdução de corticoterapia.

Searching for the perfect body image can cause severe conse- quences to the population using substances indiscriminately to reach results fast. The case reported refers to a male patient, 21 years old, from the city of São Paulo (SP), who developed choles- tatic syndrome 15 days after the use of the steroid Stanazol for aesthetic purposes during physical activity, progressing with se- vere drug-induced hepatitis, transaminases, bilirubin, and coagu- lation factors increase with no satisfactory response to the con- ventional support treatment, and significant improvement after the introduction of corticotherapy.

Humans , Male , Adult , Young Adult , Stanozolol/toxicity , Chemical and Drug Induced Liver Injury/drug therapy , Glucocorticoids/therapeutic use , Anabolic Agents/toxicity , Ursodeoxycholic Acid/administration & dosage , Bilirubin/blood , Biopsy , Cholagogues and Choleretics/therapeutic use , Prednisone/administration & dosage , Cholestasis/diagnosis , Cholestasis/pathology , Cholesterol/blood , Cholestyramine Resin/administration & dosage , Catastrophic Illness , Chemical and Drug Induced Liver Injury/diagnosis , Chemical and Drug Induced Liver Injury/pathology , Transaminases/blood , Hydroxyzine/administration & dosage , Liver/pathology , Anticholesteremic Agents/therapeutic use , Antipruritics/therapeutic use
Rev. cuba. cir ; 59(3): e893, jul.-set. 2020. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1144430


RESUMEN Introducción: La apendicitis aguda es la urgencia quirúrgica más frecuente en cualquier hospital del mundo. Aunque la mayoría de las veces se trata de un proceso intrabdominal banal, en ocasiones presenta una no desdeñable morbilidad y todavía en la época actual. Esta morbimortalidad se asocia, en la mayoría de los casos, a estados avanzados de afección apendicular. Objetivo: Predecir, con la cifra de bilirrubina, la proteína C reactiva y el recuento leucocitario, el estado del proceso apendicular agudo que presentaban los pacientes. Métodos: Se realizó un estudio observacional descriptivo en el que se han incluido aquellos pacientes intervenidos por sospecha de apendicitis aguda durante un periodo de 3 años (2017-2019) que cumplían los criterios de inclusión. Se analizó, como datos de laboratorio, la cifra de leucocitos, proteína C reactiva y bilirrubina. Resultados: Se observó un aumento de las cifras de proteína C reactiva y bilirrubina en los casos apendiculares avanzados, al igual que otros autores han evidenciado en la literatura. Así mismo, estos dos valores han resultado ser un factor de riesgo para presentar formas graves. El nivel de leucocitos sin embargo no ha demostrado relacionarse con la gravedad del proceso. Conclusiones: Vemos relevante el uso de los biomarcadores estudiados para predecir la gravedad apendicular con el objetivo de mejorar la asistencia en estos enfermos y disminuir las complicaciones derivadas del retraso terapéutico(AU)

ABSTRACT Introduction: Acute appendicitis is the most frequent surgical emergency in any hospital worldwide. Although most of the time it is a trivial intraabdominal process, sometimes it presents an unneglectable morbidity. This morbidity and the subsequent mortality are associated, in most cases, with advanced stages of an appendicular disease. Objective: To predict, using the value corresponding to bilirubin, C-reactive protein and leukocyte count, the state of acute appendicular process presented by patients. Methods: A descriptive observational study was carried out, including patients operated on for suspected acute appendicitis during a period of three years (2017-2019) and who met the inclusion criteria. The values for leukocyte count, C-reactive protein, and bilirubin were analyzed as laboratory data. Results: An increase in the values of C-reactive protein and bilirubin levels was observed in advanced appendicular cases, as other authors have shown in the medical literature. Likewise, these two values ​​have turned out to be a risk factor for presenting severe forms. However, the level of leukocytes has not been shown to be related to the severity of the process. Conclusions: We consider the use of the biomarkers studied as relevant to predict appendicular severity in view of improving care of these patients and reducing complications derived from therapeutic delay(AU)

Humans , Appendicitis/surgery , Bilirubin/adverse effects , C-Reactive Protein/adverse effects , Risk Factors , Leukocyte Count/methods , Epidemiology, Descriptive , Observational Studies as Topic
Rev. colomb. gastroenterol ; 35(3): 304-310, jul.-set. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1138787


Resumen Introducción: la patología biliar litiásica es una de las entidades más frecuentes en el área de cirugía general y en gastroenterología. El tratamiento varía según el lugar donde se alojen los cálculos. Para esto, se han definido diversas escalas de estratificación del riesgo de presentar coledocolitiasis, pero son los criterios planteados por la Sociedad Americana de Endoscopia Gastrointestinal (American Society for Gastrointestinal Endoscopy, ASGE) los más usados a nivel mundial, ya que tienen una precisión diagnóstica definida del 70 %. Los procedimientos o ayudas diagnósticas establecidas por estos criterios, en ocasiones, prolongan el tiempo de hospitalización, aumentan los costos y pueden tener complicaciones. Metodología: se realizó un estudio observacional analítico, de tipo transversal retrospectivo, con datos obtenidos a partir de las historias clínicas de pacientes sometidos a colecistectomía laparoscópica, en la Clínica CES de Medellín, entre julio y diciembre de 2017. Resultados y conclusiones: se analizaron 424 historias clínicas de pacientes sometidos a colecistectomia laparoscópica. De ellos, 254 (56,76 %) se categorizaron como de riesgo bajo, mientras que 94 (22,11 %) fueron de riesgo intermedio y 76 (17,88 %) de riesgo alto. Se encontró una frecuencia de coledocolitiasis del 90,8 % en aquellos categorizados como de riesgo alto y del 26,6 % en los pacientes de riesgo intermedio. En la categoría de riesgo intermedio se hallaron diferencias estadísticamente significativas entre ambos grupos para los valores de bilirrubina total, bilirrubina directa y aspartato aminotransferasa (AST) (p = 0,001; p = 0,014; p = 0,007, respectivamente). La baja frecuencia de coledocolitiasis en la categoría de riesgo intermedio puede ser explicada por cálculos menores a 5 mm no visibles en la colangiorresonancia. A partir de este estudio, se propone ajustar los rangos de valores de los criterios de la ASGE para la categoría de riesgo intermedio, permitiendo tener una mayor precisión a la hora de clasificar los pacientes con patología litiásica y disminuir costos y estancia hospitalaria.

Abstract Introduction: Biliary lithiasis is one of the most frequent diseases in the area of general surgery and gastroenterology. Treatment varies depending on the location of the gallstones. Several stratification scales of the risk of choledocholithiasis have been defined, being the criteria proposed by the American Society of Gastrointestinal Endoscopy (ASGE) the most used worldwide, with a diagnostic accuracy of 70%. However, the procedures or diagnostic aids defined by these criteria, sometimes, increase hospital stay, costs, and may lead to the development of complications. Methodology: An observational, analytical, retrospective, cross-sectional study was conducted with data obtained from the clinical records of patients undergoing laparoscopic cholecystectomy at the CES Clinic in Medellín, Colombia, between July and December of 2017. Results and conclusions: 424 medical records were analyzed, of which 254 (56.76%) were classified as low-risk, 94 (22.11%) as intermediate-risk and 76 (17.88%) as high-risk. The frequency of choledocholithiasis was 90.8% in high-risk patients and 26.6% in intermediate-risk patients. For the intermediate-risk category, statistically significant differences were found between the two groups for the total bilirubin, direct bilirubin, and AST values (p: 0.001, p: 0.014, p:0.007, respectively). The low frequency of choledocholithiasis in the intermediate-risk category can be explained by less than 5mm gallstones not identified by the cholangioresonance. Based on this study, we propose to adjust the ranges of the ASGE criteria variables for the intermediate-risk category for better accuracy when classifying patients with biliary lithiasis and, thus, reduce costs and hospital stay.

Humans , Male , Female , Adult , Middle Aged , Disease , Cholecystectomy, Laparoscopic , Choledocholithiasis , Patients , Aspartate Aminotransferases , Bilirubin , Risk , Cross-Sectional Studies , Lithiasis
Arch. argent. pediatr ; 118(4): e414-e417, agosto 2020. tab, ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1118595


La hemorragia de las glándulas suprarrenales en el período neonatal se produce secundariamente a traumatismos del parto y a modificaciones de la presión venosa. La ictericia neonatal tiene como causa infrecuente la presencia de un hematoma suprarrenal. Los casos sintomáticos son poco frecuentes y, si se manifiestan, suele ser como ictericia prolongada.Se presenta el caso de un neonato que ingresó a las 20 horas de vida por ictericia isoinmune anti-A. Por aumento de bilirrubina directa, se solicitó una ecografía abdominal a los 10 días de vida, que mostró una masa suprarrenal derecha no vascularizada, de 50 x 21 mm, con imágenes quísticas en su interior, compatible con hemorragia de glándula suprarrenal derecha. La ecografía seriada mostró una resolución progresiva hasta desaparecer, y el paciente se mantuvo asintomático y sin ictericia. Cuando persiste una ictericia en el período neonatal, hay que evaluar la posibilidad de una hemorragia suprarrenal significativ

Hemorrhage of the adrenal glands in the neonatal period happens secondarily to birth trauma and to changes in venous pressure. Neonatal jaundice has as an infrequent etiology the presence of an adrenal gland hematoma. Symptomatic cases are rare, and if they manifest, it is usually as prolonged jaundice.We present the case of a neonate who was admitted at 20 hours of life due to isoimmune jaundice. Due to an increase in conjugated bilirubin, an abdominal ultrasound was requested at 10 days of life, which showed a non-vascularized right adrenal mass, 50 x 21 mm, with cystic images inside, compatible with bleeding of the right adrenal gland. Serial ultrasound showed a progressive resolution until its disappearance, keeping the baby asymptomatic and without jaundice. In cases of prolonged jaundice in the neonatal period, the possibility of significant adrenal hemorrhage must be assessed.

Humans , Male , Infant, Newborn , Adrenal Glands , Hemorrhage/diagnostic imaging , Jaundice, Neonatal , Bilirubin
Braz. j. otorhinolaryngol. (Impr.) ; 86(3): 339-342, May-June 2020. tab, graf
Article in English | LILACS | ID: biblio-1132587


Abstract Introduction: Bilirubin levels have been associated with risk of several malignancies. The association between pretreatment serum bilirubin levels and overall survival of patients with parotid gland carcinoma is unclear. Objectives: In this study, we assessed the effect of serum bilirubin levels to overall survival in malignant parotid tumors. Methods: This study included a total of 35 patients, 15 female and 20 male. The mean age of these patients was 60.7 ± 14.5 years. All patients who were diagnosed with parotid gland carcinoma and underwent total parotidectomy between 2008 and 2018, were retrospectively assessed. The relationship between the overall survival of patients and total bilirubin, direct bilirubin, and indirect bilirubin levels was estimated. The receiver operating characteristic (ROC) curve analysis was performed to determine the optimal cut-off points. Results: Patients with low direct bilirubin, total bilirubin and indirect bilirubin had significantly longer overall survival than those with high levels. Cut-off values for total bilirubin, direct bilirubin and indirect bilirubin were detected as 0.545 mg/dL, 0.175 mg/dL and 0.435 mg/dL, respectively. Conclusion: In our study, we observed that increased preoperative bilirubin levels are associated with reduced survival time in the postoperative period of patients with parotid gland carcinoma.

Resumo Introdução: Os níveis de bilirrubina têm sido associados ao risco de várias lesões malignas. A associação entre os níveis séricos de bilirrubina pré-tratamento e a sobrevida global dos pacientes com carcinoma da glândula parótida ainda não é clara. Objetivos: Neste estudo, avaliamos o efeito dos níveis séricos de bilirrubina na sobrevida global em tumores malignos de parótida. Método: Este estudo avaliou 35 pacientes, 15 do sexo feminino e 20 do masculino. A média de idade foi de 60,7 ± 14,5 anos. Pacientes diagnosticados com carcinoma da glândula parótida e submetidos a parotidectomia total entre 2008 e 2018 foram avaliados retrospectivamente. A relação entre a sobrevida global dos pacientes e os níveis de bilirrubina total, bilirrubina direta e bilirrubina indireta foi estimada. A análise da curva Receiver Operating Characteristic foi realizada para determinar os pontos de corte ideais. Resultados: Pacientes com níveis mais baixos de bilirrubina direta, bilirrubina indireta e bilirrubina total tiveram sobrevida global significantemente maior do que aqueles com valores mais altos. Valores de corte para bilirrubina total, bilirrubina direta e bilirrubina indireta foram estabelecidos como 0,545 mg/dL, 0,175 mg/dL e 0,435 mg/dL, respectivamente. Conclusão: Em nosso estudo, verificamos que níveis de bilirrubina aumentados no pré-operatório estão associados à redução do tempo de sobrevida no período pós-operatório em pacientes com carcinoma da glândula parótida.

Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Bilirubin/blood , Parotid Neoplasms/mortality , Parotid Neoplasms/blood , Biomarkers, Tumor/blood , Survival Analysis , Retrospective Studies , Risk Factors , ROC Curve , Sensitivity and Specificity
Braz. j. biol ; 80(1): 102-111, Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1089304


Abstract The present study was designed to evaluate the protective effects of echinochrome (Ech) on intrahepatic cholestasis in rats induced by a single (i.p.) injection of alpha-naphthylisothiocyanate (ANIT) (75 mg/kg body weight). The rats were pre-treated orally for 48hr (one dose / 24hr) with Ech (1, 5 and 10 mg/kg body weight) or ursodeoxycholic acid (UDCA) 80 mg/kg body weight drug then, injected with ANIT. ANIT markedly increased serum activities of alanine amino transaminase (ALT), aspartate amino transaminase (AST) and alkaline phosphatase (ALP), which was accompanied by a massive inflammation of epithelial cells on bile duct at 24h after ANIT injection. ANIT also increased the levels of total protein (TP), total bilirubin (TB), direct bilirubin (DB), indirect bilirubin (IB), however decrease albumin content (ALB). In addition ANIT increased hepatic MDA and NO level and decreased GSH level and GST activity. The Ech exerted hepatoprotective and anticholestatic effects as assessed by a significant decrease in the activities of serum AST, ALT and ALP, and the levels of TP, TB, DB and IB as well as liver MDA level and NO level. In conclusion, Ech was found to possess hepatoprotective effect against intrahepatic cholestasis induced by hepatotoxin such as ANIT.

Resumo O presente estudo destinou-se a avaliar os efeitos protetores do Ech na colestase intra-hepática em ratos induzidos por uma única injeção (i.p.) de alfa-naftilisotiocianato (ANIT) (75 mg / kg de peso corporal). Os ratos foram pré-tratados oralmente durante 48 horas (uma dose / 24 horas) com cada (1, 5 e 10 mg / kg de peso corporal) e ácido ursodeoxicólico (UDCA) 80 mg / kg de peso corporal, em seguida, injetado com ANIT. ANIT atividades de soro marcadamente aumentadas de alanina amino transaminasa (ALT), aspartato de amino transaminases (AST) e fosfatase alcalina (ALP), que foi acompanhada por uma inflamação maciça de células epiteliais no ducto biliar às 24h após a injeção de ANIT. A ANIT também aumentou os níveis de proteína total (TP), bilirrubina total (TB), bilirrubina direta (DB), bilirrubina indireta (IB), no entanto, diminuem o teor de albumina (ALB). Além disso, a ANIT aumentou o nível de MDA hepático e NO e diminuiu o nível de GSH e a atividade de GST. O Ech exerceu efeitos hepatoprotectores e anticolestáticos como avaliado por uma diminuição significativa nas atividades de AST sérica, ALT e ALP e os níveis de TP, TB, DB e IB, bem como o nível de MDA no fígado e o nível de NO. Ech foi encontrado para possuir efeito protetor no fígado contra a colestase intra-hepática induzida por hepatotoxina, como a ANIT.

Animals , Rats , Cholestasis , Cholestasis, Intrahepatic , Bilirubin , 1-Naphthylisothiocyanate
Article in English | WPRIM | ID: wpr-786071


OBJECTIVE: This study investigated whether serum bilirubin levels can predict the progression of carotid atherosclerosis in individuals with type 2 diabetes mellitus (T2DM).METHODS: This observational study included 1,381 subjects with T2DM in whom serial measurements of carotid intima-media thickness (CIMT) were made at 1- to 2-year intervals for 6–8 years. The progression of carotid atherosclerosis was defined as newly detected plaque lesions on repeat ultrasonography. After dividing total serum bilirubin levels into tertiles, the association between total serum bilirubin at baseline and plaque progression status was analyzed.RESULTS: Among 1,381 T2DM patients, 599 (43.4%) were categorized as having plaque progression in their carotid arteries. Those with plaque progression were significantly older; showed a higher prevalence of hypertension, abdominal obesity, and chronic kidney disease; and had a longer duration of T2DM, higher levels of total cholesterol (TC), triglycerides, and insulin resistance, and lower total bilirubin concentrations than those with no plaque progression. When total serum bilirubin levels were divided into tertiles, the highest tertile group was younger than the lowest tertile group, with higher levels of TC and high-density lipoprotein cholesterol. Multiple logistic regression analysis demonstrated that higher serum bilirubin levels were associated with a significantly lower risk of CIMT progression (odds ratio, 0.584; 95% confidence interval, 0.392–0.870; p=0.008). Age (p<0.001), body mass index (p=0.023), and TC (p=0.019) were also associated with the progression of carotid atherosclerosis in T2DM patients.CONCLUSION: Total serum bilirubin is independently associated with progression of atherosclerosis in the carotid arteries in T2DM patients.

Atherosclerosis , Bilirubin , Body Mass Index , Carotid Arteries , Carotid Artery Diseases , Carotid Intima-Media Thickness , Cholesterol , Diabetes Mellitus, Type 2 , Humans , Hypertension , Insulin Resistance , Lipoproteins , Logistic Models , Obesity, Abdominal , Observational Study , Prevalence , Renal Insufficiency, Chronic , Triglycerides , Ultrasonography
Article in Chinese | WPRIM | ID: wpr-879927


OBJECTIVE@#To explore the feasibility of remote monitoring of neonatal jaundice in newborns with ABO hemolytic disease.@*METHODS@#Forty six neonates of gestational age >35 weeks with ABO hemolytic disease admitted to Women's Hospital, Zhejiang University School of Medicine from January 20th, 2020 to February 29th, 2020 were enrolled in the study (study group). The newborns were followed up at home after discharge, the transcutaneous bilirubin (TCB) levels were measured by parents using the provided device and the results were sent to the doctor by smart phone using the installed APP. Fifty six newborns with ABO hemolytic disease admitted in 2018 who received conventional outpatient follow-up after discharge served as the control group. The demographic characteristics, total serum bilirubin (TSB) level during hospitalization, number of outpatient visit and rate of re-admission due to rebound hyperbilirubinemia were compared between the two groups.@*RESULTS@#There were no significant differences between the two groups in gestational age, birth weight, delivery mode, gender, length of the first hospitalization, TSB level before phototherapy and before discharge, and the managements during the first hospitalization (all @*CONCLUSIONS@#The remote follow-up for neonatal jaundice at home can effectively reduce the number of outpatient visits without increasing the risk of readmission and severe neonatal hyperbilirubinemia for newborns with ABO hemolytic disease.

Bilirubin , Erythroblastosis, Fetal/diagnosis , Female , Humans , Hyperbilirubinemia, Neonatal/diagnosis , Infant, Newborn , Jaundice, Neonatal/diagnosis , Monitoring, Physiologic/methods , Phototherapy
Chinese Medical Journal ; (24): 655-661, 2020.
Article in English | WPRIM | ID: wpr-878088


BACKGROUND@#The antioxidant effects of bilirubin in Parkinson's disease (PD) have recently gained much attention from the research community. However, results from these studies have been conflicting. This meta-analysis is conducted to assess the relationship between the serum bilirubin concentration and the risk of PD.@*METHODS@#Two reviewers performed a systematic literature search across five databases (MEDLINE, PubMed, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials). The case-control studies regarding bilirubin levels in PD patients published up to April 2020 were included. These studies were subjected to rigorous scrutiny and data extraction to determine the standard mean difference (SMD) and the 95% confidence interval (CI), which were analyzed using the Stata V.12.0 statistical software.@*RESULTS@#A total of eight studies which included 1463 PD cases and 1490 controls were incorporated into our meta-analysis. SMD analysis showed that there was a higher total bilirubin (TBIL) and direct bilirubin (DBIL) levels in PD patients compared with controls (for TBIL, SMD: 0.300, 95% CI: 0.050-0.549, P = 0.018; for DBIL, SMD: 0.395, 95% CI: 0.102-0.688, P = 0.008). However, no significant relationship was found between the serum indirect bilirubin and PD patients (SMD: -0.223, 95% CI: -0.952-0.505, P = 0.548). A subgroup analysis based on ethnicity indicated that the serum TBIL was higher in PD patients of Caucasian descent in contrast to matched healthy controls (SMD: 0.511, 95% CI: 0.324-0.698, P = 0.000, I2 = 58.0%).@*CONCLUSION@#Higher serum bilirubin levels in PD patients suggest that bilirubin might play a role in the pathogenesis of PD and have the potential to be utilized as a biochemical marker for PD diagnosis and treatment.

Bilirubin , Case-Control Studies , Whites , Humans , Parkinson Disease
Article in Chinese | WPRIM | ID: wpr-828640


OBJECTIVE@#To investigate the current status of readmission of neonates with hyperbilirubinemia and risk factors for readmission.@*METHODS@#From January 2017 to December 2019, a total of 85 infants who were readmitted due to hyperbilirubinemia were enrolled as the study group. A total of 170 neonates with hyperbilirubinemia but without readmission during the same period of time were randomly selected as the control group. The medical data were compared between the two groups. Multivariate logistic regression was used to assess the risk factors for readmission due to hyperbilirubinemia.@*RESULTS@#The readmission rate was 2.30%, and the interval between readmission and initial admission was 5 days. Compared with the control group, the study group had significantly higher levels of total bilirubin and indirect bilirubin at discharge (P<0.05) and a significantly longer duration of phototherapy during the first hospitalization (P<0.05). The univariate analysis showed that compared with the control group, the study group had significantly lower birth weight, gestational age, and age on initial admission (P<0.05) and a significantly higher proportion of infants with glucose-6-phosphate dehydrogenase (G-6-PD) deficiency or hemolytic disease (P<0.05). The multivariate analysis showed that low gestational age (OR=1.792, P<0.05), young age on initial admission (OR=1.415, P<0.05), and G-6-PD deficiency (OR=2.829, P<0.05) were independent risk factors for readmission of neonates with hyperbilirubinemia.@*CONCLUSIONS@#The infants with hyperbilirubinemia who have lower gestational age, younger age on initial admission, and G-6-PD deficiency have a higher risk of readmission due to hyperbilirubinemia. It is thus important to strengthen the management during hospitalization and after discharge for these infants to prevent the occurrence of readmission.

Bilirubin , Glucosephosphate Dehydrogenase Deficiency , Humans , Hyperbilirubinemia, Neonatal , Infant, Newborn , Patient Readmission , Risk Factors
Article in Chinese | WPRIM | ID: wpr-828626


OBJECTIVE@#To study whether pyroptosis is involved in the bilirubin-induced injury of primary cultured rat cortical microglial cells.@*METHODS@#Primary cultured rat cortical microglial cells were randomly administered with 30 μmol/L bilirubin (bilirubin group), 30 μmol/L bilirubin following 30 μmol/L VX-765 pretreatment (VX-765+bilirubin group), or an equal volume of dimethyl sulfoxide (control group). Modified MTT assay was used to measure the viability of microglial cells. Western blot was used to measure the expression of the pyroptosis-related proteins Caspase-1 and gasdermin D (GSDMD). Lactate dehydrogenase (LDH)-release assay was used to evaluate the cytotoxicity of microglial cells. EtBr/EthD2 with different molecular weights (394 Da/1 293 Da) was used to measure the size of plasma membrane pores. ELISA was used to measure the level of the inflammatory factor interleukin-1β (IL-1β) in culture supernatant.@*RESULTS@#After bilirubin stimulation, the viability of microglial cells decreased and LDH release increased, both in a time-dependent manner. Compared with the control group, the bilirubin group had a significantly higher positive rate of small-molecule EtBr passing through the cell membrane (P0.05). The expression of activated Caspase-1 significantly increased at 0.5 hour after bilirubin stimulation (P<0.05), and that of activated GSDMD significantly increased at 6 hours after bilirubin stimulation (P<0.05). The release of IL-1β significantly increased at 6 hours after bilirubin stimulation and reached the peak at 24 hours (P<0.001). Compared with the bilirubin group, the VX-765+bilirubin group had a significant increase in cell viability (P<0.05) and significant reductions in the expression of activated GSDMD, the pass rate of EtBr, and the release of LDH and IL-1β (P<0.05).@*CONCLUSIONS@#Pyroptosis is involved in bilirubin-induced injury of primary cultured microglial cells.

Animals , Bilirubin , Caspase 1 , Cell Survival , Interleukin-1beta , Pyroptosis , Rats