Jaundice: a basic review

Altered trace elements, antioxidant vitamin C, and malondialdehyde levels are associated with the pathophysiology and development of pre-hepatic jaundice: A case-control study

Objectives

Pre-hepatic jaundice results from an imbalance between bilirubin production and clearance, often linked to hemoglobinopathies. Antioxidant vitamin C, malondialdehyde, and trace elements play roles in jaundice, yet their specific associations remain unclear. The objective is to assess and compare these biomarkers in pre-hepatic jaundice patients and healthy controls, aiming to identify potential diagnostic markers and understand distinctive characteristics related to the disease's pathogenesis.

Methods

This case-control study enrolled 50 pre-hepatic jaundice patients and 50 healthy controls, utilizing advanced techniques for biomarker quantification. We completed blood sample collection from study participants between 1 September 2023 and 31 December 2023. This study investigates the correlation between various biomarkers and pre-hepatic jaundice using serum samples with a focus on antioxidant vitamin C, malondialdehyde, and trace elements.

Results

This study demonstrates elevated concentrations of malondialdehyde in patients with pre-hepatic jaundice, suggesting alterations in bilirubin metabolism and increased oxidative stress. We found that the serum levels of malondialdehyde were significantly higher in pre-hepatic jaundice patients compared to healthy controls. Our observations revealed a notable decrease in the average serum vitamin C levels in patients with pre-hepatic jaundice compared to healthy controls. The patients had lower serum Zn levels and higher serum Cu and Mn levels compared to the healthy controls. The correlation study demonstrates robust positive correlations among these biomarkers in pre-hepatic jaundice. As the levels of vitamin C rise, the levels of the other criteria often fall, and vice versa. There is an inverse relationship between higher levels of vitamin C and lower levels of malondialdehyde. The current investigation identifies possible changes in antioxidant vitamins, malondialdehyde levels, and trace elements, which provide significant insights for targeted interventions.

Conclusions

The present research highlights the integrated significance of vitamin C, malondialdehyde, and trace elements in the progression of the disease.

Livogena: The Ikteros Curse-A Jaundice Narrative Card and Board Game for Medical Students

Introduction

Jaundice is a common condition that requires integrating knowledge of biochemistry, physiology, pathology, and general medicine. However, medical students face difficulty in learning with passive teaching methods. To enhance their learning, an educational story game that promotes active learning and assessment with immediate feedback was implemented.

Methods

This jaundice game was named Livogena: The Ikteros Curse-denoting the liver as the principal organ and jaundice (icterus) as a problem. One hundred fifty first-year medical students were divided into small groups to play using a game board and cards. The players moved ahead on the game board by providing the correct answer and completing the activities. The first team to reach the end was the winner. Perceptions and feedback questionnaires were distributed to students at the end of the game. Individual views about the game were recorded for qualitative analysis. Also, to analyze the effectiveness of this intervention, pre- and posttests on jaundice were conducted.

Results

Livogena: The Ikteros Curse resulted in a highly significant improvement in students' knowledge and application skills in jaundice, from 5.5 (SD = 2.4) in the pretest to 11.2 (SD = 7.6) in the posttest for 20 marks (p < .001). Students perceived and rated the game exceptionally positively.

Discussion

This educational game significantly increased learners' understanding of the concepts of jaundice. Highly positive perceptions from students further affirm this to be a creative innovation to enhance their learning and application of knowledge in an active and team-based learning environment.

Developing Low-Cost Mobile Device and Apps for Accurate Skin Spectrum Measurement via Low-Cost Spectrum Sensors and Deep Neural Network Technology

In recent years, skin spectral information has been gradually applied in various fields, such as the cosmetics industry and clinical medicine. However, the high price and the huge size of the skin spectrum measurement device make the related applications of the skin spectrum unable to be widely used in practical applications. We used convolutional neural network (CNN) to achieve a satisfying accuracy of the Fitzpatrick skin-type classification by using a simple self-developed device in 2018. Leveraging on the hardware, firmware, and software app-developing experience, a low-cost miniature skin spectrum measurement system (LMSSMS) using deep neural network (DNN) technology was further studied, and the feasibility of the system is verified in this paper. The developed LMSSMS is divided into three parts: (1) miniature skin spectrum measurement device (MSSMD), (2) DNN model, and (3) mobile app. The MSSMD was developed with innovative low-cost MSSC, 3D printing, and a simple LED light source. The DNN model is designed to enhance measurement accuracy. Finally, the mobile app is used to control and show the measurement results. The developed app also includes a variety of skin-spectrum-related applications, such as erythema index and melanin index (EI/MI) measurement, Fitzpatrick skin-type classification, Pantone SkinTone classification, sun-exposure estimation, and body-fat measurement. In order to verify the feasibility of LMSSMS, we used the standard instrumentation device as a reference. The results show that the accuracy of the LMSSMS can reach 94.7%, which also confirms that this development idea has much potential for further development.

Diagnostic and conservative treatment nuances in patients with obstructive jaundice: in the wake of Russian consensus

The research was performed at the Loginov Moscow Clinical Scientific Center. It is based on Russian obstructive jaundice (OJ) consensus results, considered at the 45th annual Central Research Institute of Gastroenterology Scientific session Oncological issues in the gastroenterologist practice (1 March 2019). The article objective is to note the diagnostic and conservative treatment current issues in patients with OJ. The increase in the number of patients with OJ of different etiology provides problem actuality. In a large number of cases, medical treatment is delayed due to inadequate diagnostic and management, while correct patients routing today can be provided regardless of medical institution level. In this article the examination steps and conservative treatment role in patients with biliary obstruction management are presented.

[Russian consensus on current issues in the diagnosis and treatment of obstructive jaundice syndrome]

The Russian consensus document on topical issues of the diagnosis and treatment of obstructive jaundice syndrome was prepared by a group of experts in various fields of surgery, endoscopy, interventional radiology, radiological diagnosis and intensive care. The goal of this document is to clarify and consolidate the opinions of national experts on the following issues: timing of diagnosis of obstructive jaundice, features of diagnostic measures, the need and possibility of conservative measures for obstructive jaundice, and strategy of biliary decompression depending on the cause and level of biliary block.

Hemophagocytic Lymphohistiocytosis in Autopsied Adults: Clinical, Laboratory and Immunohistochemical Evaluation for CD68 and CD57. Case Report and Literature Review

AbstractHemophagocytic lymphohistiocytosis (HLH) is a rare, usually fatal and underdiagnosed autoimmune-activated disease. The present study aimed to perform a macroscopic, histopathological and immunohistochemical evaluation for CD68 and CD57 in organs of autopsied adults with HLH. A total of 604 autopsy reports were analyzed, and all the patients that filled the diagnostic criteria for HLH (n = 2) were selected. These patients were 18 and 37 years old. Were evaluated both clinical and autopsy reports and performed histopathological and immunohistochemical analysis of the liver and spleen. Both patients filled the diagnostic criteria for HLH, as well as presented common signs and symptoms of this disease, such as chills, abdominal pain, diaphoresis, and jaundice. Hemophagocytosis was observed in the spleen, bone marrow, and lymph nodes of the two patients at autopsy. Immunostaining in the liver and spleen of both patients was mainly severe for CD68, and predominantly mild for CD57, indicating a decrease in NKC numbers and an increase in the number of macrophages, respectively. This was the first study to evaluate CD57 and CD68 in autopsies of adults with HLH. Thus, more studies are required, not only to better elucidate the pathogenetic mechanisms involved in the secondary HLH, but also to disseminate the results in the clinical environment, contributing to the early diagnosis and treatment with consequent reduction of mortality rate. Keywords: Autoimmune Diseases. Histiocytosis. Biomarkers. ResumoA Linfohistiocitose Hemofagocítica (HLH) é uma doença autoimune rara, geralmente fatal e subdiagnosticada. Este estudo tem como objetivo realizar avaliação macroscópica, histopatológica e imunohistoquímica para CD68 e CD57 em órgãos de pacientes adultos com HLH submetidos a autópsia. Um total de 604 laudos de autópsias foram analisados e todos os pacientes que preencheram os critérios diagnósticos para HLH (n = 2) foram selecionados. Esses pacientes tinham 18 e 37 anos de idade. Foram analisados tanto os prontuários quanto os laudos de autópsia, bem como foram realizadas análises histopatológicas e imunohistoquímicas do fígado e baço dos pacientes. Ambos preencheram os critérios diagnósticos para HLH e apresentarem sinais e sintomas comuns da doença, como calafrios, dor abdominal, sudorese e icterícia. A hemofagocitose foi observada no baço, medula óssea e linfonodos dos dois pacientes na autópsia. A imunohistoquímica do fígado e do baço de ambos os pacientes demonstrou imunomarcação acentuada para CD68 e predominantemente discreta para CD57, que indicam diminuição do número de NKC e aumento do número de macrófagos, respectivamente. Este foi o primeiro estudo a avaliar o CD57 e CD68 em autópsias de adultos com HLH. Assim, mais estudos são necessários, não apenas para melhor elucidar os mecanismos patogenéticos envolvidos na HLH secundária, mas também para disseminar os resultados no ambiente clínico, contribuindo para o diagnóstico e tratamento precoces com consequente redução da taxa de mortalidade. Palavras-chave: Doenças Autoimunes. Histiocitose. Biomarcadores.

Toward development of generic inhibitors against the 3C proteases of picornaviruses

Development of novel antivirals, which requires knowledge of the viral life cycle in molecular detail, is a daunting task, involving extensive investments, and frequently resulting in failure. As there exist significant commonalities among virus families in the manner of host interaction, identifying and targeting common rather than specific features may lead to the development of broadly useful antivirals. Here, we have targeted the 3C protease of Hepatitis A Virus (HAV), a feco-orally transmitted virus of the family Picornaviridae, for identification of potential antivirals. The 3C protease is a viable drug target as it is required by HAV, as well as by other picornaviruses, for post-translational proteolysis of viral polyproteins and for inhibiting host innate immune pathways. Computational screening, followed by chemical synthesis and experimental validation resulted in identification of a few compounds which, at low micromolar concentrations, could inhibit HAV 3C activity. These compounds were further tested experimentally against the 3C protease of Human Rhinovirus, another member of the Picornaviridae family, with comparable results. Computational studies on 3C proteases from other members of the picornavirus family have indicated that the compounds identified could potentially be generic inhibitors for picornavirus 3C proteases.