Jaundice

Background: Neonatal jaundice is the most common cause of newborns' hospitalization. This study aimed to examine various maternal, childbirth, and neonatal factors affecting the neonatal skin bilirubin level and severe jaundice. Methods: This cross-sectional study was conducted on 1066 healthy neonates with a gestational age of 35 weeks or over and birth weight of ≥2000 g at teaching hospitals of Alzahra and Taleghani in Tabriz, Iran, during 2016-2017. The participants were selected using convenience sampling. Data were collected using a three-part researcher-made questionnaire assessing maternal, childbirth, and neonatal characteristics based on the medical histories of mothers and newborns as well as interviews with mothers. Neonatal jaundice was measured utilizing the Kj-8000 device on days 3-6 after birth by measuring the skin bilirubin level. Moreover, the need to phototherapy (severe jaundice) was determined based on the American Academy of Pediatrics guideline. The genera...

Laparoscopy is the visualization of the peritoneal cavity through the anterior abdominal wall with the use of an endoscope after the induction of a pneumoperitoneum. The value of the information obtained is undisputed. In the last seven years since its reintroduction to North America, laparoscopy has become increasingly popular. The procedure has been primarily embraced by the gynecdogist. Other specialities have been relatively slow in recognizing the value of this procedure.

A series of 25 sera were assayed with the proposed system, in duplicate, each day for five days; the standard deviation of the results was ± 2.5 mg/dl. Correlation results for 33 sera assayed with the proposed system and with an automated o-toluidine one

Phototherapy is the treatment indicated for the management of neonatal jaundice. There are different technologies to provide this treatment, including LED devices. For this study, a LED phototherapy lamp is developed to be used in neonatal jaundice. Its efficacy is compared with other devices by measuring the speed in reducing bilirubin levels. This lamp is built with an LED light source composed of a 15×25 LED array that generates 460nm. This device is characterized by being a very compact source of low energy consumption, long duration, and low cost. The obtained results are comparable with industrial manufacturing devices, but less expensive, therefore, more efficient in terms of health costs.

Purpose: We reviewed post-portoenterostomy (PE) biliary atresia (BA) patients who became "jaundicefree" (JF; total bilirubin (T-bil) ≤ 1.2 mg/dL) to determine factors associated with survival with the native liver (SNL). Methods: We reviewed 76 BA patients treated by PE at our institute between 1989, when liver transplantation (LTx) became available in Japan, and 2012, prospectively. Of these, 60 who became JF and remained JF were divided into two groups, SNL (n = 44) and LTx (n = 16). Age and weight at PE, pre-and post-PE T-bil, AST, γ-GT, time taken to become JF, corticosteroid requirements, incidence of cholangitis, and micro-bile duct size were compared between the two groups. Results: The SNL patients became JF significantly earlier: 58 vs. 115 days (p b .05). Corticosteroid requirement, cholangitis, and postoperative AST/γ-GT were significantly lower in the SNL patients (p b .05). SNL was significantly higher if patients became JF ≤ 60 days post-PE (p b .01). LTx was performed from 0.5 to 11 years post-PE (mean = 3.4). All patients who had cholangitis within 3 months of PE eventually required LTx (p b .05). Conclusions: Becoming JF ≤ 60 days post-PE would appear to be a factor associated with SNL, while cholangitis within 3 months of PE would appear to be associated with LTx. Elevation of AST and γ-GT would also appear to be early indicators of risk for LTx during follow-up of JF patients after successful PE.

The total testing process develops through a broad series of operations and activities, wherein the analytical phase is only the central portion, being respectively preceded and followed by the preanalytical and postanalytic phases, but all of which contribute to complete the so-called "brain-to-brain loop." 1,2

Trinidad and Tobago ranks high in the world in the incidence of Hepatitis C, of which one of the symptoms is jaundice. A preliminary study on the treatment of neonatal and adult jaundice by traditional healers was conducted in September 2002. The objectives of the research were (1) to compare and contrast the beliefs and practices of healers with clinicians, (2) to determine the clinical validity of the healers' therapeutic claims, (3) and to present information on the type of patients who seek treatment from these healers. Interviews were conducted with 38 patients at a healer's home/clinic about their experience with jaundice. Ethnographic studies were done on eight healers, one of whom was selected for participant observation. Many overlapping and linked explanations were found that were consistent with clinical research findings. The research found, however, that the treatment of jaundice by healers were more symbolic than physiological in its clinical efficacy.

Background: Hyperbilirubinemia, or jaundice, is a life threatening disorder in newborns. It is a multifactorial disorder with many symptoms. Generally, the physiological jaundice is the most prevalent type however in some regions pathological jaundice is also common. This review article focuses on a brief introduction to jaundice, its types and causes, measuring the bilirubin level, clinical approaches towards hyperbilirubinemia, different precautionary measures for the parents of babies suffering from hyperbilirubinemia and different remedial therapeutic measures for its treatment. Methods: The main databases including Scopus, Pubmed, MEDLINE, Google scholar and Science Direct were researched to obtain the original papers related to the newborns' hyperbilirubinemia. The main terms used to literature search were "newborns' hyperbilirubinemia‖, -newborns' jaundice‖, -Physiological Jaundice‖ and -Patholigical Jaun-dice‖. The timeframe included the obtained articles was from 1952 to 2015. Results: Neonatal jaundice due to breast milk feeding is also sometimes observed. Hemolytic jaundice occurs because of the incompatibility of blood groups with ABO and Rh factors, when the fetus and mother blood groups are not compatible and the fetus blood crosses the barrier of the umbilical cord before birth causing fetus blood hemolysis owing to severe immune response. Conclusion: Jaundice is easily diagnosable however require quick and on the spot treatment. If not treated properly, it leads to many complications. Currently the treatment options for jaundice include photo therapy, chemotherapy, and vaccinations.

Jaundice is yellowish discolouration of the skin, sclera and mucous membranes. [1] Neonatal jaundice (NNJ) is so common that it can be regarded as a normal physiologic adaptation of the newborn infant to extrauterine life. However, it may also be a symptom or sign of an underlying disease. Neonatal jaundice is due to increased serum levels of bilirubin, a pigment derived mainly from the breakdown of haemoglobin. It becomes clinically visible when serum bilirubin level exceeds 5 mg/dL. Worldwide NNJ is an obsession of neonatologists because of the association between raised unconjugated bilirubin levels and permanent neurological damage. [2-6] New-borns produce bilirubin at a rate of 6-8 mg/kg/ day which is more than twice the production rate in adults. [7,8] This is due to relatively large red cell mass, shorter red cell life span causing increased red cell turnover in neonates. [9] Bilirubin production in neonates however declines to adult level within 10 to 14 days after delivery. [7] The prevalence of neonatal jaundice in clinical practice range between 23-60%. [1] Jaundice is noticed during the first week of life in about 60% of term infants and 80% of preterm infants with only a few signifying underlying disease. [7] BILIRUBIN METABOLISM

Present study represents unknown utilizations of traditional medicinal plants used by the yanadi tribes of Seshachalam hill region in Andhra Pradesh. Yanadi tribes of this area brought to light unrevealed therapeutic uses of 70 medicinal plants their parts like roots, tubers, stem barks, leaves, flowers, fruits and seeds. They have been using these medicinal plants in the form of paste, powder, juice, decoction, infusion and also in crude form, with other additives like ghee, sesame oil and goat milk to relieve from different ailments. Present study discloses ethnic practices (Yanadi) of 70 plant species belonging to 44 families to relieve different ailments like Skin

The majority of patients who require palliation for jaundice and pruritus resulting from malignant hilar obstruction are treated by stenting. Stenting is usually achieved from below after performing an endoscopic retrograde cholangiopancreatography. In some cases the rendezvous technique is employed, negotiating the passage through a malignant stricture from above and stenting from below. A minority of cases, such as those who had a previous polyagastrectomy and those in whom attempts at stenting have failed, are considered to be suitable for a Segment 111 cholangiojejunostomy. We have investigated the anatomical basis for Segment 111 duct bypass and have critically analysed the results in 13 patients. Ten patients were treated by Segment 111 duct bypass alone, and three patients had a Segment 111 duct bypass combined with stenting of the right liver. Methods: The anatomy of the biliary tree was investigated by dissection of 54 normal livers removed at autopsy. Clinical details of the 13 patients who had Section 111 cholangiojejunostomy were obtained from hospital records and by contacting treating practitioners. Results: In 64.8% of the anatomical dissections, the findings were favourable for a Section I11 cholangiojejunostomy. In these specimens the Segment 111 duct bypass would have drained Segments 11,111 and IV. In 35.2% of the specimens the anatomical disposition was potentially unfavourable, mainly due to the Segment I1 or IV ducts joining close to the confluence and therefore liable to obstruction by the tumour. In nine of the 54 specimens the true left hepatic duct was less than 6 mm in length, making it unsuitable for a bypass procedure to drain the left hemi liver. Of the 10 patients who were subjected to a palliative Section 111 cholangiojejunostomy only, there was one postoperative death. Of the nine patients who survived, six obtained excellent palliation of jaundice and pruritus. Conclusions: In carefully selected cases, Section III cholangiojejunostomy achieves excellent palliation in patients with unresectable hilar malignancies that have been unable to be stented pre-operatively or who have unresectable tumours at the time of laparotomy .

Acute liver failure (ALF) in children differs from that observed in adults in both the etiologic spectrum and the clinical picture. Children, particularly very young ones, do not demonstrate classical features of encephalopathy and the definition of ALF has been revised to include patients with advanced coagulopathy, regardless of mental status. A significant number of these children will go on to require transplant or die. Etiologies vary by age with metabolic and infectious diseases prominent in the first year of life and acetaminophen overdose and Wilson's disease occurring in adolescents. In almost 50% of cases, however, the child has an indeterminate cause for ALF. Management requires a multidisciplinary approach and is directed at establishing the etiology where possible and monitoring, anticipating, and managing the multisystem complications that occur in children with ALF. Overall, short-term outcomes are better in children than adults but are dependent upon the degree of encephalopathy and diagnosis.

Jaundiced Gunn rats, treated with phenobarbital (60 mg per kg i.p. for 7 to 10 days) showed 25 and 36% decreases in mean plasma bilirubin levels in two experiments (p < 0.01). Kinetic studies with tracer 14C-bilirubin revealed that there was no change in bilirubin turnover or total pool size due to phenobarbital, but a 49% increase in the hepatic pool and a 27% decrease in the cutaneous pool of bilirubin. The increase in the hepatic pool accounted for over 90% of the bilirubin lost from the plasma. Such pretreatment with phenobarbital did not alter the decline in plasma bilirubin or total bilirubin pool due to subsequent phototherapy. Phenobarbital followed by phototherapy produced a significantly greater reduction in plasma bilirubin levels than either treatment alone. These studies demonstrate that phenobarbital does decrease plasma bilirubin in Gunn rats primarily by shifting the pigment to the liver, and suggests that combined treatment with phenobarbital and phototherapy might be of value in patients with congenital hyperbilirubinemia due to glucuronyl transferase deficiency. ~

6 Domzdravqa"Starigrad",Beograd KRATAK SADRŽAJ Uvod Ari a sovik te rus(Ari as ic te rus)seja vqakod1-2%zdra veno vo ro đen ča diiodoj ča dinais hra nimaj či nimmlekom.Na sta jekaore zul tatne zre lo stije treiin hi bi tor nogefek tamaj či nogmle kanakli rensne konjugova nogbi liru bi na. Ciq rada Ura dujeana li zi ra napro men qi vostni voaidu ži nene konjugova nehi per bi li ru bi ne mi jekododoj ča di sAri a so vimik te ru som. Metod rada Is pi ta noje19odoj ča dimu škogi10odoj ča dižen skogpo lasAri a so vimik te ru som.Svaodoj čadsurođe nanavre me,pri rod nimpu temibezkom pli ka ci ja.Svasubi lasa monapri rod nojis hra niiop ti mal nosuna predo va la.Nikodjed nogis pi ta ni kani jedi jag no sti ko va nahe mo li zailidru goobo qe wepra će none konjugova nomhiper bi li ru bi ne mi jom. Rezultati Svade casubo lo va laodraz voj nežu ti ceupr vojne de qiporo đe wu,svred no šćune konjugova nogbi li rubi na166-260µmol/l(201,50±36,37).Naj ve ćini vone konjugova nogbi li ru bi naupost ne o na tal nompe ri o duza be le ženje upe tojne de qiporo đe wuura spo nu87-273µmol/l(166,82±45,06),aza timsespon ta noipo ste pe nosma wi vao.Sma we we ne konjugova nefrak ci jebi li ru bi nause ru muiz me đuče tvr teipe tene de qebiojesta ti stič kizna ča jan,apo sleto ga vi so kosta ti stič kizna ča jan.Ni vobi li ru bi nause ru musenormalizovaoiz me đuse damitri na estne de qa(10,41±1,68). Nikodjed nogde te tani suuoče nitok sič niefek tihi per bi li ru bi ne mi je. Zakqučak Ari a sovik te rusjebe za zlenipro la zanpo re me ćajme ta bo li zmabi li ru bi na.Ja vqasekodzdra veno vo rođen ča diiodoj ča dinais hra nimaj či nimmle kom.Žu ti cajena gla še ni jaura nomno vo ro đe nač kompe ri o du,aliposte pe noiš če za vaiz me đused meitri na e stene de qe.

Une compression de la voie biliaire principale par une adénopathie n'est observée que dans 3 % seulement des cholestases extrahépatiques. La maladie de Castleman peut en être une étiologie. Nous en rapportons une observation et décrivons les caractéristiques principales de ce type de tumeur. Un homme âgé de 76 ans présentait une altération fébrile de l'état général avec sueurs diurnes et nocturnes, prurit et amaigrissement important. L'abdomen était sensible, il n'existait ni hépatomégalie, ni splénomégalie, ni adénopathies palpables. Les examens biologiques révélaient un syndrome inflammatoire, une hyperleucocytose associée à un syndrome de cholestase. L'exploration peropératoire permettait de découvrir une adénopathie rétrocholédocienne de 3 cm qui comprimait la voie biliaire principale et le canal cystique, et dont l'examen anatomopathologique était en faveur d'une lymphadénite hyperplasique compatible avec la forme plasmocytaire de la maladie de Castleman. Dans le cadre du bilan d'extension, un scanner thoracoabdominal retrouvait des adénopathies thoracoabdominales diffuses. La sérologie VIH était négative. Le diagnostic de maladie de Castleman multicentrique était posé et le patient traité par corticothérapie avec une amélioration partielle de la symptomatologie.

The xanthodermatoses consist of a heterogeneous group of cutaneous disorders characterized by the macroscopic yellow hue seen on examination. This hue is attributable to the chemical structure of the accumulating substances within the skin or surrounding tissues. The most common culprits are lipids (cholesterol and triglycerides), elastin, and bilirubin. Exogenous sources of yellow pigment include yellow dyes (including hennas) and metal salts. This article will focus on recognition of these entities, classified in terms of morphology and the site of initial eruption, in order to support the recognition and diagnosis of these widely variable conditions.

Background: Annually 30,000 Afghans attend the Hajj in Saudi Arabia that is one of the largest mass gathering events in the world. We aimed to determine the prevalence of three syndromes of interest diarrhea, acute respiratory infections (ARI) and jaundice-among Hajjis gathering at the four transit sites in Afghanistan before, during, and after their voyage. Methods: A total of 1659 Hajjis at four transit sites were selected and included a cross-sectional study. Information was collected prior Hajjis departure and upon their return from Saudi Arabia regarding demographics and experience of diarrhea, ARI and jaundice. Standardized case definitions were used for the three health outcomes of interest. Results: The occurrence of diarrhea and jaundice remained constant over time. However, ARI increased from 1.4% at pre-transit to 4% at transit area and 37% during the Hajj. ARI rates among residents from the Central and Northern regions of Afghanistan were significantly higher at the post-Hajj stage, at 50% and 69%, respectively. There was no difference in ARI by sex among Hajjis. Conclusions: There is a need to review the quality and effectiveness of the flu vaccine. Authorities should come up with the sound strategies to overcome ARI problems during Hajj. ª 2012

P sychiatric symptoms reported in hyperparathyroidism include depression, anxiety, psychosis, lethargy, apathy, delirium, and dementia. Manic symptoms have been rarely reported. We report a case of treatment-resistant depression and parathyroid crisis-induced mania with delirium, whose psychiatric symptoms resolved after parathyroid adenomectomy.

The long-term (5-week) evolution of two experimental models of extrahepatic cholestasis, i.e., macrosurgical by bile duct ligation (n = 20) and microsurgical by biliary tract resection (n = 13), is studied. All cholestatic animals showed jaundice, choluria, and portosystemic collateral circulation. Macrosurgical cholestasis causes greater hepatosplenomegaly, hilar biliary pseudocysts, and ascites. Microsurgical extrahepatic cholestasis occurs with a lower degree of hepatosplenomegaly as well as with serum increase (P < 0.001) of γ-GT and alkaline phosphatase. The bile ductular proliferation in the four hepatic lobes is very intense (P < 0.001) in both experimental models. The differences between both experimental models may be considered secondary to the increase of the predisposition to infection in rats with bile duct ligation, that complicates their evolution. The microsurgical cholestasis model could be useful in studying cholestasis secondary to biliary atresia. © 2004 Wiley-Liss, Inc. Microsurgery 24:442–447, 2004.

Background & Aims: Dubin-Johnson syndrome is recessively inherited, conjugated hyperbilirubinemia induced by mutations in the ABCC2/MRP2 gene encoding the canalicular transporter for conjugated bilirubin. Gilbert's syndrome is recessively inherited, unconjugated hyperbilirubinemia caused by decreased conjugation rate of bilirubin associated mostly with homozygous A(TA) 7 TAA variant of the TATAA-box in the UGT1A1 gene promoter. Our aim was to establish the molecular diagnosis in a 3-year-old male with atypical, intermittent, predominantly unconjugated, hyperbilirubinemia. Methods: 99m Tc-HIDA cholescintigraphy was used for imaging the biliary tree. Expression of ABCC2/MRP2 protein in hepatocytes was investigated immunohistochemically. UGT1A1 and ABCC2/MRP2 genes were sequenced from genomic DNA, and the mutations were verified by fragment analysis, sequencing the cloned exons, and restriction fragment length polymorphism. Results: Cholescintigraphy revealed delayed visualization of the gallbladder. A brown granular lipopigment differing from melanin-like pigment reported in Dubin-Johnson syndrome was present in hepatocytes, but, otherwise, liver histology was normal. ABCC2/ MRP2 protein was not detected on the canalicular membrane of hepatocytes, and 2 novel mutations were found in the ABCC2/MRP2 gene: a heterozygous in-frame insertiondeletion mutation 1256insCT/delAAACAGTGAACCTGATG in exon 10 inherited from the father and a heterozygous deletion 4292delCA in exon 30 inherited from the mother. In addition, the patient was homozygous for ؊3279T>G and A(TA) 7 TAA mutations in the UGT1A1 gene promoter. Conclusions: Our patient represents a case of digenic mixed hyperbilirubinemia-a distinct type of constitutive jaundice resulting from coinherited defects in ABCC2/MRP2 and UGT1A1 genes.

Background : A low birth weight baby is a clinical
and diagnostic challenge. The neonatologists are faced with
numerous neonatal intensive care unit protocols. This study was
designed to review the policies of management of neonatal
jaundice, sepsis, anemia, hypoglycemia, jaundice and hypoxic
encephalopathy in a low birth weight newborn.
      Methods: Care of newborns in was done in intensive care
unit after numerous research papers on low birth weight
management were referred.

Introduction: Epilepsy is a major public health concern in low-income countries (LIC) as they contain 80% of total cases worldwide. Syria has been in war since 2011 which made it difficult to prevent epilepsy risk factors which made this the first study on that matter. Methods: This is a case-control study from 3 medical centers in Damascus, Syria. Data were collected using questionnaires introduced by trained doctors. The control group included patients from a general practice clinic while the cases were taken from the three pediatric neurology clinics. Results: The sample consisted of 334 patients with 167 cases and 167 controls. Multivariable analysis confirmed the association between positive family history (FH) in 1st degree (OR, 3.37, 95%CI 1.2-9.47) and 2nd degree relatives (OR, 3.98, 95%CI 1.84-8.62), febrile seizures whether they were simple (OR, 15.08, 95%CI 3.27-69.5) or complex (OR, 13.32, 95%CI 1.58-112.32), developmental delay/regression (OR, 14.31, 95%CI 6.3-32.49), and central nervous system (CNS) infection (OR, 34.05, 95%CI 2.02-573.92). Head trauma, parental factors, consanguinity, asphyxia parameters, and other risk factors were not found to be significantly associated with epilepsy (P > 0.05). Conclusion: While some results were similar to other studies, others were not. Efforts should be made to facilitate healthcare access and proper diagnosis.

Introduction: Jaundice, because of prejudice on its support in modern medicine leads people to  traditional healers The objective of this study was to investigate the knowledge, attitudes and pratices of these healers facing jaundice.
Methodology: This is a descriptive cross-acted study that took place from February the 1st to April the 30th 2015 inBobo-Dioulasso. The survey was conducted using an individual questionnaire with 100 traditional healers from the two associations of traditional healers in the city.
Results   The average age of traditional healers was 48.51 (± 14) years old and the sex ratio 1.9. More than half (59%) was not literate. The average number of years of exercise was 18.28 (± 11.4) years old and the majority (73%) had received a family type of training for the exercise of the function. Only a minority (18%) had a license to practice. Despite the fact that all (100%) knew jaundice, the level of knowledge on the causes appeared unsufficient in 91% of them. Only 10% cited hepatitis unlike malaria (69%). Literacy has been associated with a good knowledge of the causes of jaundice (p = 0.003) opposed to ancientness in practice (p = 0, 5). For the pricking up, only the plants remedies were mainly used (86.5%) and the most cited were Cochlospermumtinctorium,Terminaliamacroptera,Commiphoraafricana,AnogeissusleiocarpusCombretummicranthum,Cassia sieberiana, Entadaafricana. the form of the most common presentation was the decoction (74.7%) and the most recommended administration was the oral route (92.7%). Still 9.1% continuously have to believe that the modern treatment is harmful, or even fatal at the stage of jaundice. The medical tests were the main reason to refer cases to modern medicine (48.7%).
Conclusion This study showed anunsufficient knowledge of TP on jaundice including its etiology. Plants have an important place in the therapeutic arsenal of traditional healers, some found in our study should be the subject of pharmacological studies.

A 50-year-old White man with noncirrhotic portal hypertension presented with bleeding from gastric varices. Bleeding was initially managed with band ligation and subsequent transjugular intrahepatic portosystemic shunt (TIPS). Over the next few months, the patient had recurrent episodes of anemia, jaundice, fever and polymicrobial bacteremia. Computed tomography (CT) of the abdomen and chest, upper and lower endoscopy, endoscopic retrograde cholangiopancreatography (ERCP), and echocardiography failed to explain the bacteremia and anemia. Followup CT scan and Doppler sonography 9 months after placement showed TIPS was occluded. Repeat ERCP showed a bile leak with free run-off of contrast from the left hepatic duct into a vascular structure. The patient's status was upgraded for liver transplantation with Regional Review Board agreement and subsequently received a liver transplant. Gross examination of the native liver demonstrated a fistula between the left bile duct and the middle hepatic vein. Pathologic evaluation confirmed focal necrosis of the left hepatic duct communicating with an occluded TIPS and nodular regenerative hyperplasia consistent with noncirrhotic portal hypertension. Infection is rarely reported in a totally occluded TIPS. Biliary fistulas in patent TIPS have been treated by endoluminal stent graft and endoscopic sphincterotomy with biliary stent placement. Liver transplantation may be the preferred treatment if TIPS becomes infected following its complete occlusion.

Question: An 88-yearold man presented with a 1-week history of left upper quadrant abdominal pain and jaundice on a background of a 2month history of back pain and malaise. His background medical history was notable for hypertension, hypercholesterolemia, and melanoma. On examination, his pulse rate was 76 bpm and blood pressure, 112/64 mmHg. He was febrile (101.8 F; 38.8 C). Peripherally, there was no palmar erythema or clubbing, but spider angiomas were noted ( . He was not encephalopathic, but had diffuse abdominal tenderness, hepatomegaly with a firm liver edge, and ascites. Laboratory investigations revealed a bilirubin of 108 mmol/L, gamma-glutamyl transferase of 774 U/L, alkaline phosphatase of 418 U/L, alanine aminotransferase of 234 U/L, aspartate aminotransferase of 202 U/L, and a prothrombin time of 15 seconds. Ultrasonography demonstrated a dilated common bile duct to 13 mm and 2 hypoechoic lesions in the right lobe of the enlarged liver with a span of 20 cm. Magnetic resonance imaging of the liver showed several signal abnormalities ( .

1. Int J Infect Dis. 2005 Sep;9(5):286-7. Acute hepatitis E virus infection in a Cuban patient. de la Caridad Montalvo Villalba M, Aválos AT, de Los Angeles Rodríguez Lay L, de Jesús Goyenechea Hernández A, Corredor MB, Moreno AG, Frometa SS. ...

A case of mixed infection due to leptospira, dengue and hepatitis E is reported. Similar clinical presentation and simultaneous transmission of these diseases during rainy season can cause substantial misdiagnosis. Serological tests play a mainstay in diagnosis. Early detection by appropriate serological tests and institution of therapy is crucial and life saving.

A clinical and epidemiological study of 267 cases of envenomation by Loxosceles spp. (loxoscelism), notified to Centro de Informaqdes Toxicol6gicas de Florian6polis (Santa Catarina State, Brazil), was conducted between January 1985 and December 1995. Most of the incidents occurred along the coast of the mid-southern region of the state, during the warmest months. L. Zaeta and L. intermedia were identified as the causative agents. Cutaneous loxoscelism was clinically diagnosed in 232 (86.9%) patients with local pain (86.5%), oedema (80.5%), hyperaemia (79.8%) and necrosis (56.9%). Cutaneous-visceral loxoscelism was detected in 35 patients (13.1%) with intravascular haemolysis, manifested by jaundice (68.6%), oliguria (45.7%), dark urine (28.6%), haemorrhage (25.7%), anuria (8.6%) and shock (2.9%), besides the cutaneous effects. Specific antivenom was given to 125 patients (46.8%) and only 8(6.5%) had mild reactions. Acute renal failure was observed in 17 cases (6.4%); 4 patients (1.5%) died, all of whom were children under 14 years old.

"Background: The aim of this study was to investigate the relationship between congeni-tal hypothyroidism and several variables using two different adjustment methods.
Methods: This matched case-control study was conducted in Hamadan Province, the west of Iran, in 2012 enrolling neonates born between 2005 and 2011 and covered by screening program for congenital hypothyroidism. The neonates with TSH titer more than 10 mU/l or T4 titer less than 6.4 μg/dl were considered as cases. Each case was individually matched for birth place and year with four neonates with normal TSH and T4 titers as controls. The data were analyzed using two different approaches including pro-pensity score and multiple conditional logistic regression model.
Results: Of 1313 enrolled neonates, 277 (159 girls) were cases and 1036 (531 girls) were controls. The most important prognostic factors which had significant effect on congenital hypothyroidism included twin, birth season, maturity, jaundice at birth, birth weight, age at pregnancy, maternal anemia and goiter, gestational age, delivery type, father’s education and smoking status, and consanguinity. The associations reported by logistic regression were stronger that of than propensity score analysis in most items, although the differences were not statistically significant.
Conclusions: We addressed the effect of numerous potential risk factors on congenital hypothyroiditis and the impact of these factors on the disease occurrence. However, future prospective studies are needed to test these findings and hypothesis and to inves-tigate the true effect of these potential risk factors on congenital hypothyroiditis."

Coronavirus disease 2019 (COVID-19) is a highly infectious pandemic caused by a novel coronavirus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It frequently presents with unremitting fever, hypoxemic respiratory failure, and systemic complications (e.g., gastrointestinal, renal, cardiac, and hepatic involvement), encephalopathy, and thrombotic events. The respiratory symptoms are similar to those accompanying other genetically related beta-coronaviruses (CoVs) such as severe acute respiratory syndrome CoV (SARS-CoV) and Middle East Respiratory Syndrome CoV (MERS-CoV). Hypoxemic respiratory symptoms can rapidly progress to Acute Respiratory Distress Syndrome (ARDS) and secondary hemophagocytic lymphohistiocytosis, leading to multi-organ system dysfunction syndrome. Severe cases are typically associated with aberrant and excessive inflammatory responses. These include significant systemic upregulation of cytokines, chemokines, and pro-inflammatory mediators, associated with increased acute-phase proteins (APPs) production such as hyperferritinemia and elevated C-reactive protein (CRP), as well as lymphocytopenia. The neurological complications of SARS-CoV-2 infection are high among those with severe and critical illnesses. This review highlights the central nervous system (CNS) complications associated with COVID-19 attributed to primary CNS involvement due to rare direct neuroinvasion and more commonly secondary CNS sequelae due to exuberant systemic innate-mediated hyper-inflammation. It also provides a theoretical integration of clinical and experimental data to elucidate the pathogenesis of these disorders. Specifically, how systemic hyper-inflammation provoked by maladaptive innate immunity may impair neurovascular endothelial function, disrupt BBB, activate CNS innate immune signaling pathways, and induce parainfectious autoimmunity, potentially contributing to the CNS complications associated with SARS-CoV-2 infection. Direct viral infection of the brain parenchyma causing encephalitis, possibly with concurrent neurovascular endotheliitis and CNS renin angiotensin system (RAS) dysregulation, is also reviewed.

Pregnancy with jaundice is regarded as high risk pregnancy so it is considered very important sign during antenatal check up. Incidence of jaundice in pregnancy is 0.4-0.9/1000 in India. It complicates 3-5% of pregnancies and is one of the important causes of maternal and neonatal morbidity and mortality worldwide. The normal physiological and hormonal profiles may alter throughout the pregnancy. The present retrospective study was carried out in the Department of Obstetrics and Gynecology, KLE's Dr. Prabhakar Kore Hospital and research centre from September 2011 to August 2012 to determine the causative factors responsible for jaundice in pregnant women and to assess its consequences in pregnancy. During this retrospective study of 3 years, 9,612 deliveries were conducted. Among them 9,167 were live birth and 445 were stillbirth. Overall 37(0.4%) women had clinical and biochemical evidences of jaundice. Their mean age was 24.78±3.66 years and the mean period of gestation (34.7±3.42 weeks). Among them predominant cause of jaundice was HELLP 24(64.86%) followed by acute viral hepatitis and Leptospirosis 5(13.51%) of each. Severe PIH was the most common co-morbid conditions observed in 20(54.05%) of the pregnant women. And the commonest cause of maternal mortality 15(53.57%) was HELP followed by severe . Among 37 births, 53.85% were live births, 28.21% were fresh still births and 17.95% were macerated still births. Among the 53.85% of live births, foetal mortality was seen in 4.76%. Pregnancy with liver disorder results in very high foetal as well as maternal morbidity and mortality. HELLP was found to be the predominant cause of Jaundice and associated mortality in pregnancy. It might cause mild to severe complication in pregnancy. Pregnancy with liver disorder results in high foetal as well as maternal morbidity and mortality. Thus early diagnosis and proper management is essential to reduce the high maternal mortality in pregnant women with jaundice.

We have compiled information about the medicinal plants used in folk medicine in the district of Antakya. Since its establishment by King Seleucus I in 300 B.C., Antakya (old Antioch) has hosted nearly twenty civilizations. Antakya, neighboring Northwestern Syria, is located on the western end of the "Silk Road" and was one of the great centers of Graeco-Roman world. Today, Antakya is a cosmopolitan city in which Arabic and Turkish are widely spoken, and where distinct ethnic and religious communities, such as Arab Alawite, Arab Christian, Arab Sunni, Turk Sunni, Armenian, and Jewish, have been living together in harmony for centuries. In addition, the rich flora in the vicinity of Antakya also renders the area interesting in terms of ethnobotanical fieldwork. Aim of the study: This study aimed to compile the information about plants used for medicinal purposes by local people in the district of Antakya. This city is a significant region in terms of ethnobotanical fieldwork, owing to its cosmopolitan structure, long history, relatively preserved traditional community structure, and rich flora. Furthermore, we sought to compare the ethnomedicinal data geographically, cross-culturally, and historically. Materials and methods: The ethnobotany of medicinal plants used in the district of Antakya has been investigated through two separate studies; one was conducted in 1975, interviewing 29 people, and the other was conducted in 2011-2013, interviewing 182 people. The Use Value (UV) and Informant Consensus Factor (FIC) values of the plants were calculated. In order to interpret the authenticity and sources of the compiled ethnomedicinal information, previous publications that contain information about the similar medicinal uses of plants identified in our region were reviewed and evaluated meticulously. A comparison with the data obtained from other regions of Turkey and from other Mediterranean regions, as well as a cross-cultural analysis between the ethnic groups within the study area, was performed by implementation of the Jaccard index (JI) Results: Throughout the study, information about 202 medicinal plant taxa was compiled. Among these plants, 39 have either not yet been mentioned in ethnobotanical or medicinal studies, or have been used for a medicinal purpose other than those encountered in the literature review. The ethnomedicinal information we gathered from the study area exhibits close similarities to the ethnomedicinal information of other Southern and Eastern Mediterranean countries where Arabic is spoken, as well as to that of Northern and Western Mediterranean countries where Latin languages are spoken. In addition to these similarities, in most cases, this ethnomedicinal information shows hybrid features of ethnomedicinal knowledge from Eastern and Western Mediterranean countries. Conclusion: Based on a literature survey, we found that the cited medicinal uses for 43 plants have also been corroborated by other various biological testings. This finding strongly suggests the importance of ethnobotanical studies in the development of new medicines. We believe that this study has compiled rich ethnomedicinal information that reflects the cosmopolitan structure of Antakya in a very good way.

Objective: The goals of this study were to describe the clinical and anatomic features of infants undergoing Kasai portoenterostomy (KPE) for biliary atresia (BA) and to examine associations between these parameters and outcomes. Methods: Infants enrolled in the prospective Childhood Liver Disease Research and Education Network, who underwent KPE were studied. Patients enrolled in a blinded, interventional trial were excluded from survival analysis. Primary endpoints were successful surgical drainage (total bilirubin less than 2 mg/dL within the first 3 months), transplant-free survival (Kaplan-Meier), and time to transplant/death (Cox regression). Results: KPE was performed in 244 infants (54% female; mean age: 65 ± 29 days). Transplant-free survival was 53.7% and 46.7% at 1 and 2 years post-KPE. The risk of transplant/death was significantly lower in the 45.6% of patients who achieved successful bile drainage within 3 months post-KPE (HR: 0.08, P < 0.001). The risk of transplant/death was increased in patients with porta hepatis atresia (Ohi type II and III vs type I; HR: 2.03, P = 0.030), nonpatent common bile duct (Ohi subtype: b, c, and d vs a; HR: 4.31, P = 0.022), BA splenic malformation syndrome (HR: 1.92, P = 0.025), ascites > 20 mL (HR: = 1.90, P = 0.0230), nodular liver appearance compared to firm (HR: = 1.61, P = 0.008), and age at KPE ≥ 75 days (HR: 1.73, P < 0.002). Outcome was not associated with gestational age, gender, race, ethnicity, or extent of porta hepatis dissection.