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In conclusion, the disposal of endogenous bilirubin in the bile duct obstructed rat appears to be influenced by the development of cirrhosis.
For the first time in Turkey, we presented a patient with cardiac cirrhosis and high bilirubin levels who was successfully treated with bilirubin absorption column method.
A diagnosis of comorbid hemolysis must always be considered in context with anemia and serum bilirubin levels that rise out of proportion to the severity of the primary biliary cirrhosis.
Our results suggest that the biochemical methods of choice in the follow-up of patients with primary biliary cirrhosis are determination of total serum bilirubin by conventional diazo technique and determination of serum alkaline phosphatase activity.
A drop in bilirubin should be monitored in steroid treated patients.
The bilirubin and albumin levels, age, prothrombin time, and the presence of cirrhosis are the independent variables with the best prognostic value.
The presence of bilirubin conjugates and 'bilirubin-albumin' in serum suggests liver disease.

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How long have injectable lipid emulsion used for clinical use?
5 answers
Injectable lipid emulsions have been utilized in clinical practice for over 60 years, with the first product, Intralipid, introduced as a soybean oil-in-water emulsion for intravenous administration. These emulsions serve as essential sources of fatty acids and calories, particularly for patients with gastrointestinal dysfunction requiring long-term parenteral nutrition. Over the years, advancements have been made to enhance the safety and efficacy of lipid emulsions, leading to the development of various generations of lipid injectable emulsions, including fish oil-containing emulsions. Recent studies have also highlighted the therapeutic efficacy of intravenous lipid emulsions in reversing acute lipid-soluble drug intoxication in pediatric patients, further emphasizing their longstanding presence and evolving applications in clinical settings.
Can NLR ratio detect responders vs non responders to corticosteroid therapy in alcoholic hepatitis?
6 answers
The Neutrophil-to-Lymphocyte Ratio (NLR) has been investigated as a potential marker for distinguishing responders from non-responders to corticosteroid therapy in patients with alcoholic hepatitis (AH). Research indicates that the NLR, when assessed at baseline, can provide prognostic insights into the likely efficacy of corticosteroid treatment in these patients. Specifically, a study found that a baseline NLR was modestly effective in predicting 90-day outcomes in severe alcoholic hepatitis, with certain NLR thresholds indicating a differential response to corticosteroids. This suggests that NLR could be a useful tool in identifying patients most likely to benefit from corticosteroid therapy at the outset. Further analysis supports the utility of combining NLR with other prognostic models to enhance the prediction of treatment outcomes. For instance, integrating day-4 NLR with the day-4 Lille score, a widely used prognostic model in AH, resulted in a "modified" Lille score that outperformed each individual marker in predicting 90-day mortality. This combined approach suggests a more nuanced application of NLR, enhancing its predictive value when used alongside established prognostic scores. However, it's important to note that while NLR shows promise as part of a composite marker, reliance on a single parameter like NLR for decision-making in the management of AH may be insufficient. The complexity of AH necessitates a multifaceted approach to prognosis and treatment planning. Other studies have emphasized the importance of comprehensive metabolic and proteomic profiling, liver biopsy features, and the exploration of alternative therapies for non-responders or those ineligible for steroid treatment. Moreover, the overall management of AH, including the use of corticosteroids, remains a subject of ongoing research and debate, with studies highlighting the need for more accurate prognostic tools and alternative treatments. In summary, while NLR can contribute to the identification of responders versus non-responders to corticosteroid therapy in alcoholic hepatitis, it should be considered as part of a broader diagnostic and prognostic strategy rather than a standalone marker.
What is the clinical manifestations of SevAlcoholic Hepatitis?
6 answers
Severe Alcoholic Hepatitis (SevAH) presents with a spectrum of clinical manifestations, reflecting the acute inflammatory response to prolonged alcohol abuse on a previously damaged liver. Patients typically exhibit jaundice, a hallmark of the condition, alongside signs of chronic alcoholism and progressive liver failure. The clinical features can also include fever, diarrhea, ascites, and hepatic encephalopathy, indicating a more severe disease course. Laboratory findings often reveal leukocytosis, hyperbilirubinemia, and a mild elevation of liver enzymes, which are critical for diagnosis and management. Moreover, the condition can lead to complications such as renal failure, metabolic acidosis, and electrolytic abnormalities, further complicating the patient's prognosis. The incidence of clinical symptoms like fever, diarrhea, ascites, and hepatic encephalopathy is notably higher in patients with SevAH compared to those with less severe forms of alcoholic hepatitis. Additionally, white blood cell counts, prothrombin time, and serum levels of total bilirubin, blood urea nitrogen, creatinine, and discriminant function on admission are significantly elevated in SevAH, indicating the severity of the disease. Histologically, SevAH can be differentiated from chronic active hepatitis induced by alcohol abuse, with the latter showing features like perilobular "piecemeal" necrosis and dense portal and septal lymphoid infiltrates, contrasting the fatty change and Mallory bodies typical of alcoholic hepatitis. Furthermore, SevAH can lead to extrahepatic manifestations, including cutaneous changes such as xerosis and pigmentary changes, which may sometimes be the first sign of liver disease. The condition also poses a risk of severe hepatitis and liver failure in the context of other liver diseases, underscoring the importance of comprehensive management and treatment strategies. In summary, SevAH is characterized by a range of clinical and histological features that underscore the severe impact of alcohol on the liver, necessitating prompt and effective treatment to mitigate its progression and associated complications.
What is the prevalence of Primary Biliary Cholangitis in individuals with systemic sclerosis?
5 answers
The prevalence of Primary Biliary Cholangitis (PBC) in individuals with systemic sclerosis (SSc) ranges from about 10% to 25%. PBC is characterized by the presence of specific autoantibodies, such as antimitochondrial antibodies (AMA) and anti-centromere antibodies (ACA). Studies have shown that PBC-specific autoantibodies are found in approximately 25% of SSc patients, with overt PBC disease described in about 10% of cases. Additionally, the presence of PBC-specific serology in SSc patients was reported to be around 13%, with a significant correlation with centromere antibodies. These findings highlight the importance of actively seeking PBC in individuals with SSc to enable early diagnosis and prompt treatment, which can significantly impact disease progression and patient outcomes.
How NLR ration helps predicting corticosteroid response in alcoholic hepatitis?
5 answers
The Neutrophil-to-Lymphocyte Ratio (NLR) has been identified as a significant prognostic and therapeutic marker in predicting the response to corticosteroid treatment in patients with severe alcoholic hepatitis (AH). Research indicates that a baseline NLR can identify patients most likely to benefit from corticosteroids, particularly when the NLR is within the range of 5-8. Patients with an NLR within this range showed reduced mortality when treated with prednisolone compared to those with higher or lower NLR values. This suggests that NLR can serve as a useful tool in tailoring corticosteroid therapy for individual patients, potentially improving outcomes by identifying those who are more likely to respond positively to treatment. Moreover, the integration of NLR into a modified Glasgow Alcoholic Hepatitis Score (mGAHS) improved the predictive value for 28- and 90-day outcomes, indicating that NLR adds significant prognostic information to existing scoring systems. This is further supported by studies showing that other markers, such as plasma metabolomics and meta-proteomics, can stratify pre-therapy steroid response, highlighting the complexity of predicting treatment outcomes in AH. Additionally, gene expression analysis in peripheral blood mononuclear cells (PBMCs) has shown differences between steroid responders and non-responders, suggesting that molecular profiling could complement NLR in predicting corticosteroid efficacy. The prognostic ability of NLR, both as a standalone model and in conjunction with other scores like the day-4 Lille score, has been evaluated, demonstrating its utility in predicting mortality and treatment response. However, the effectiveness of corticosteroids in AH remains a subject of ongoing research, with studies exploring various prognostic models and their ability to predict outcomes in AH patients. The collective evidence underscores the potential of NLR as a key factor in guiding the management of AH, particularly in the context of corticosteroid therapy, by identifying patients who are more likely to benefit from treatment and thereby optimizing therapeutic strategies.
What are the effects of Herbalife nutrition club products?
5 answers
Herbalife nutrition club products have shown diverse effects based on research findings. Studies have highlighted potential benefits such as improved cardio-metabolic health markers, including lower fasting insulin and HbA1c levels, higher vitamin D levels, and a lower prevalence of metabolic syndrome among members. However, concerns have been raised regarding hepatotoxicity associated with Herbalife products, with reported cases of liver injury linked to their consumption. Additionally, research has focused on developing recommendation systems for Herbalife products based on customer health parameters, utilizing Mamdani Fuzzy Logic to enhance product selection accuracy. These findings underscore the importance of further research and regulation to ensure the safety and efficacy of Herbalife nutrition club products.
Is Bilicheck the same device as JM-105?
4 answers
The Bilicheck and JM-105 are not the same device, but both are transcutaneous bilirubinometers used for measuring bilirubin levels in neonates. Studies have shown that there are differences between these devices in terms of accuracy and performance. The JM-105 has been found to provide values much lower than those obtained with the Bilicheck, with underestimation increasing as total serum bilirubin levels rise. Additionally, the accuracy of the JM-105 can be affected by factors like post-natal age and ethnicity, while the Bilicheck is less influenced by such confounding variables. Both devices have shown strong correlations with serum bilirubin levels when used on specific areas like the sternum. Therefore, while they are not the same device, both the Bilicheck and JM-105 serve as valuable tools for assessing neonatal jaundice.
Can bile salt mixture and crystal violet inhibit the growth of gram negative bacteria?
5 answers
Bile salts, specifically deoxycholate and cholate, have been shown to inhibit the growth of gram-negative bacteria by causing protein unfolding and aggregation, leading to disulfide stress within the bacterial cytosol. Additionally, bile salts like glycocholate and taurocholate have the potential to degrade lipopolysaccharide (LPS), an endotoxic component of gram-negative bacteria, thereby protecting the host from an inflammatory immune response. On the other hand, crystal violet-neutral red bile salt agar promotes fast bacterial growth and reduces variation rates, aiding in observation and analysis. Therefore, while bile salts have antimicrobial effects on gram-negative bacteria, crystal violet in the agar medium does not directly inhibit bacterial growth but rather supports their proliferation.
How to know the cause of hypalbuminemia?
5 answers
The causes of hypoalbuminemia can be determined through various means, including laboratory tests and genetic analysis. In cases like congenital analbuminemia (CAA), which is characterized by extremely low serum albumin levels, the cause can be identified through DNA sequencing to detect mutations in the ALB gene. Additionally, in patients with hypoalbuminemia of unknown origin, biochemical studies such as albumin measurements and protein electrophoresis can help confirm conditions like analbuminaemia. It is crucial to rule out common causes of hypoalbuminemia before considering rare genetic disorders like CAA, emphasizing the importance of thorough diagnostic procedures to pinpoint the underlying cause of low serum albumin levels.
What is the relationship in the pathogenesis of non-alcoholic fatty liver disease and lichen planus?
5 answers
The pathogenesis of non-alcoholic fatty liver disease (NAFLD) and lichen planus (LP) involves inflammatory processes and immune responses. NAFLD is linked to metabolic syndrome, characterized by factors like obesity, insulin resistance, and inflammation. LP, an immune-mediated inflammatory disease, shows associations with viral infections like hepatitis C virus (HCV). Toll-like receptors (TLRs) play a role in autoimmune diseases like LP, interacting with endogenous ligands and intensifying autoimmune responses. LP patients with HCV infection exhibit variations in TLR-7 expression, potentially impacting disease pathogenesis. Moreover, LP patients show a higher prevalence of metabolic syndrome, indicating a possible relationship between metabolic complications and LP severity. In summary, the interplay of immune responses, viral infections, and metabolic factors contributes to the pathogenesis of both NAFLD and LP.
What are the diagnostic Approaches for DPD Deficiency?
4 answers
Diagnostic approaches for DPD deficiency include genetic screening of DPYD variants, measurement of uracilemia levels in plasma, and functional testing for DPYD variants. Genetic screening before fluoropyrimidine treatment can identify potentially deleterious mutations like c.2087G>A and c.2324T>G. Uracilemia measurement is a common surrogate for DPD phenotype determination, with hyperuracilemia rates decreasing over time and influenced by factors like liver function and renal impairment. A simple and robust UPLC-UV method has been developed for routine screening, detecting uracil and dihydrouracil levels in plasma effectively. Functional testing for DPYD variants can identify individuals at risk of severe toxicity, allowing for personalized dosing strategies to improve treatment safety. These approaches collectively aid in identifying DPD deficiency and guiding personalized treatment decisions.