《新英格蘭醫學期刊》(New England Journal of Medicine)最近刊登了一個案例報告。
一位12歲的男孩因喉嚨痛、小便變黑及腹痛入院。他出現黃疸,舌頭變黃(如圖)血液檢查發現血紅蛋白濃度只有6.1g/dL。他的LDH及未接合型膽紅素(unconjugated bilirubin)量上升,顯示病人出現溶血性貧血。直接抗球蛋白試驗(Direct Antiglobulin Test,簡稱DAT)呈陽性,並檢驗到有冷凝集素(cold agglutinin)。最後的診斷是病人患有愛潑斯坦-巴爾病毒(Epstein-Barr virus)引起的冷凝集素病(cold agglutinin disease)。
冷凝集素是一種攻擊紅血球的抗體,它在低溫的情況下最為活躍。紅血球被破壞後會釋出血紅蛋白。血紅蛋白經腎臟排出,令尿液變深色。另一方面,紅血蛋白經過降解後會轉化成膽紅素(bilirubin)。膽紅素雖然被稱為膽紅素,但在皮膚下主要是呈黃色的,於是病人的皮膚以至舌頭都變成黃色。
有興趣的朋友可以參考以下的案例:
https://www.nejm.org/doi/full/10.1056/NEJMicm2034755?fbclid=IwAR3nDghImPXIV1b1qCl7kqMwneU3BbL533BAAMXUpJOrDS_pWTd6AW7nOfE.
圖片都是取自以上的案例
direct bilirubin 在 陳三奇醫師-血液腫瘤科 Facebook 的最佳貼文
使用營養食品導致急性肝衰竭而致命的案例。癌友在選用營養食品時,仍須謹慎小心,一般建議盡量攝取天然的食物即可。
<印度Herbalife(賀X芙)產品-和致命性急性肝衰竭有關-重金屬、毒性化合物、細菌污染和精神用藥>
這是一篇發表於2019年的case report。
一名24歲女性患有甲狀腺機能低下症,沒有其他慢性疾病,過去五年補充甲狀腺素(每天75mcg),在BMI為32.1時開始補充在當地營養俱樂部所販售的 Herbalife 產品。
在此期間,這名女性沒有服用任何其他藥物或補充和替代的藥物。兩個月後,他開始食慾下降長達一個禮拜,接著有黃疸和短暫的搔癢症出現。
初步的血液檢查顯示:
Total serum bilirubin level was 12.4 (upper limit of normal [ULN] 1.1 mg/dL); direct bilirubin, 9.9 (ULN 0.2 mg/dL); aspartate aminotransferase, 582 (ULN 36 U/L); alanine aminotransferase, 648 (ULN 45 U/L); alkaline phosphatase, 248 (ULN 120 U/L); gamma-glutamyl transferase level, 398 (ULN 35 U/L); albumin, 3 (ULN 5.5 g/dL) and international normalised ratio, 4.7 (normal < 1.2).
12天後,黃疸惡化(total bilirubin 28.6 mg/dL),接著進展到第三級肝性腦病變。
▪️急性和慢性病毒性肝炎的血液檢查包括 herpes simplex and zoster virus, cytomegalovirus, parvovirus, human immunodeficiency virus and human T-cell lymphotropic virus and autoimmune hepatitis (antinuclear antibody, anti-liver kidney muscle antibody type 1,anti-smooth muscle antibody) 為陰性。
▪️Serum gamma globulins 升高 (2682 mg/dL, 正常 620–1400)。
▪️自身免疫性肝炎的評分(The simplified autoimmune hepatitis (AIH) score)為4分( score <6 不太可能是AIH)。
▪️Serum ceruloplasmin & iron studies 是正常的。
▪️腹部超音波顯示脂肪肝腫大、正常膽道和血管解剖,沒有門靜脈高壓。
👉評估 Herbalife 產品所造成肝臟之不良反應, Roussel Uclaf causality assessment method (RUCAM)評分為6分,表示可能有不良反應。
頸靜脈肝臟切片(transjugular liver biopsy)顯示 extensive periportal and perivenular bridging necrosis,伴隨中度到重度的發炎浸潤、介面性肝炎、膽管炎、膽汁淤積等......(圖1)。
這名女性被轉介到移植中心後,在等待候補名單時去世了。研究人員很難從失去親人的家庭中去取得相同的 Herbalife 產品,但可以從當初這位女性購買產品的店家去取得。這間營養俱樂部在沒有許可證的情況下,以健康和保健的名義來銷售 Herbalife 產品,最後已被政府下令關閉。
研究人員還從網路上去取得類似的 Herbalife 產品,並對其進行了重金屬分析、毒理學和細菌污染研究。分析結果如表1顯示。
研究人員在 Herbalife 的產品中發現了高濃度的重金屬和未公開的有毒化合物(75%的樣本中含有精神用藥)。在微生物分析中,從63%的樣品中分離出了細菌脫氧核糖核酸。16s RNA 分析顯示了Herbalife產品中的多種細菌群落,包括高致病性物種(圖2)。
⭐️原文:
Philips CA, Augustine P, Rajesh S, et al. Slimming to the Death: Herbalife®-Associated Fatal Acute Liver Failure-Heavy Metals, Toxic Compounds, Bacterial Contaminants and Psychotropic Agents in Products Sold in India. J Clin Exp Hepatol. 2019 Mar-Apr;9(2):268-272.
https://www.ncbi.nlm.nih.gov/pubmed/31024209
⬇️下載檔案:
https://drive.google.com/…/18utyfvQFkWlJcW3H3kQNmZPJU…/view…
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PS:關於這篇文獻是否有虛假陳述和不精確的資訊,期待該公司趕緊整理科學反駁資料並發表在同一期刊上作澄清。
direct bilirubin 在 9bulan10hari Facebook 的最佳解答
🔴 KALAU ANAK KENA JAUNDICE... BAGI JE MINUM SUSU KAMBING THEN JEMUR TENGAH PANAS PAGI.
#Eh... boleh ka?
Kalau tak sanggup tengok anak ditahan & bermalam dalam incubator dengan cahaya fototerapi.. ibu boleh try tips dibawah ni =)
Rata rata bayi yang baru lahir berdepan kemungkinan untuk dapat demam kuning..
& menyebabkan mak ayahnya terpaksa turun naik klinik untuk checkup tahap bilirubin dalam badan.
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Part paling sedih bila ibu yang tak habis penat & sakit meneran bersalin & berpantang ni tengok anaknya kena cucuk tiap hari untuk ambil sample darah....
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Ramai mommies yang ikut saja petua bagi bayi yang baru lahir ni minum susu kambing... dengan harapan kuning anaknya akan turun...
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🔴 Fakta : Hanya susu ibu saja yang boleh diberikan kepada bayi yang baru dilahirkan sehingga usianya 6 bulan. Bagi bayi yang minum susu formula, dia hanya boleh minum susu formula & air suam saja.
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So susu kambing tu semua tak boleh bagi direct kepada bayi. Yang terbaik ialah, ibu yang menyusukan anak ni minum susu kambing, makan kurma & madu & bagilah sebanyak mungkin susu ibu kepada anak.
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Ada juga yang suruh jemur jemur anak masa panas pagi. Mungkin zaman dulu boleh, tapi sekarang ni 'kelembutan' sinar uv tak sama macam dulu..
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🔴 Tips :
- Selitkan ulam pegaga dalam set menu berpantang.
Cth : Ikan goreng masak pegaga & bawang putih + halia...
& minum jus pegaga. Jus pegaga yang diminum ibu menyusu, akan sangat bantu kurangkan kuning pada anaknya ketika menyusu.
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🔴 Penting : Kalau mommy betul betul tak nak anak kena tahan & bermalam dalam incubator, make sure bagi susu ibu sebanyak yang boleh & make sure anak mommy membuang sekurang kurangnya 6 kali sehari.
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Rujuk page 145, 146 & 147 buku 9bulan10hari untuk tahu punca & kesan jaundice terhadap bayi & cara elakkannya.
InsyaALLAH, bila kita follow sunnah... ikhtiar benda benda baik...fikir benda benda baik... Allah akan mudahkan.... =)
💊 Like, tag & share info ini dengan wanita lain agar mereka juga boleh mengelak jaundice dari anak.
💊 COPYRIGHT@Nazira Nazir buat 9bulan10hari. Tak dibenarkan copy paste.
Picture credit : stbotanica.com
🔴 if the child gets sick... just give him a drink of goat milk then dry it in the middle of the morning.
#Eh... is it possible?
If you can't bear to see the child being held & overnight in the incubator with the light of phototherapy.. Mom can try the tips below =)
The average newborn baby is facing the possibility of getting a yellow fever..
& cause his parents had to go down to the clinic for a check level checkup in the body.
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The most sad part when the mother who doesn't finish tired & sick of giving birth & confinement is seeing her child being stabbed every day to take blood samples....
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A lot of mommies who just follow the tips for this newborn baby drink goat milk... with the yellow hope the child will come down...
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🔴 fact: only mother's milk can be given to a newborn baby until she is 6 months old. For babies who drink formula milk, they can only drink formula milk & warm water.
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So the goat's milk can't be given directly to the baby. The best is, the mother who breastfeeding this child drink goat milk, eat dates & Honey & share as much as mother's milk to the child.
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There are also people who asked to dry dry children during the hot morning. Maybe the old days can, but now the 'tenderness' of UV Rays is not the same as before..
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🔴 Tips:
- insert asiatica ulam in the confinement menu set.
Example: fried fish with Asiatica & Garlic + Ginger...
& drink asiatica juice. Asiatica juice that mothers drink, will really help reduce yellow on their children while breastfeeding.
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🔴 important: if mommy really doesn't want children to be held & overnight in incubator, make sure to give mother's milk as much as you can & make sure mommy's child is throwing away at least 6 times a day.
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Refer to the page 145, 146 & 147 book of @[151329642013884:274:9bulan10hari] to know the causes & effects of it against babies & the way way.
Insyaallah, when we follow Sunnah... try good things... think good things... Allah will make it easy.... =)
💊 like, tag & share this info with other women so that they can also avoid children from children.
💊 Copyright @ @[1416700617:2048:Nazira Nazir] for @[151329642013884:274:9bulan10hari]. Not allowed to copy paste.
Picture credit : stbotanica.comTranslated
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