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Abstract Background Neonatal physiological jaundice is a common benign condition that rarely extends behind the second week of life; however, it may interfere with the diagnosis of a pathological condition termed neonatal cholestasis (NC). The latter is a critical, uncommon problem characterized by conjugated hyperbilirubinaemia. This review aims to highlight the differences between physiological and pathological jaundice, identify different causes of NC, and provide a recent approach to diagnosis and management of this serious condition. Main text NC affects 1/2500 live births, resulting in life-threatening complications due to associated hepatobiliary or metabolic abnormalities. NC is rarely benign and indicates the presence of severe underlying disease. If jaundice extends more than 14 days in full-term infants or 21 days in preterm infants, the serum bilirubin level fractionated into conjugated (direct) and unconjugated (indirect) bilirubin should be measured. A stepwise diagnostic approach starts with obtaining a complete history, and a physical examination which are valuable for the rapid diagnosis of the underlying disease. The most frequently diagnosed causes of NC are biliary atresia (BA) and idiopathic neonatal hepatitis (INH). The early diagnosis of NC ensures more accurate management and better prognosis. Despite the unavailability of any specific treatments for some causes of NC, the patient can benefit from nutritional management and early medical intervention. Future research should attempt to shed light on methods of screening for NC, especially for causes that can be effectively treated either through proper nutritional support, appropriate chemotherapeutic management, or timely surgical intervention. Conclusion Further attention should be paid for diagnosis and treatment of NC as it may be misdiagnosed as physiological jaundice; this may delay the proper management of the underlying diseases and aggravates its complications.

Biliary atresia (BA) is a rare disease characterized by ascending obstruction of bile ducts that exclusively affects newborn infants. The etiology of the disease is not known. BA is considered to be a phenotype resulting from several pathogenic processes leading to obstruction of the biliary tree. It usually presents shortly after birth, characterized by persistent jaundice, hepatosplenomegaly, clay-colored stool, and dark urine. It affects both the extra-hepatic biliary ducts (EHBDs) and the intra-hepatic biliary system (IHBDs), but the former is more severely affected. Diagnosis of BA is a great challenge and must be achieved as early as possible to delay progression to cirrhosis. Laboratory tests reveal direct hyperbilirubinemia and, variable levels of transaminases, gamma-glutamyl transpeptidase (GGT), and alkaline phosphatase (ALP), which overlap significantly with other causes of neonatal cholestasis. The intraoperative cholangiogram is considered the gold standard for the diagnosis of BA and is performed routinely in many institutions. BA can be divided into correctable and non-correctable types; the former accounts for (10–15%) of cases, in which the proximal common hepatic duct is patent, allowing primary anastomosis of the EHBDs to the bowel. All patients are subjected to identical surgical and medical treatments; consisting of Kasai portoenterostomy (KPE), which entails removal of the atretic extra-hepatic tissue and a Roux-en-Y jejunal loop anastomosed to the hepatic hilum. Kasai portoenterstomy is considered a transition to liver transplantation, as the pathology may be still ongoing. BA is the most frequent indication for liver transplantation in infants, which is the only treatment that can definitively arrest the natural disease course. In conclusion: BA is a serious liver disease that needs to be further studied, and awareness of BA should be increased among the public and health care workers to prevent the complications of this disease.

The standard-of-care treatment for biliary atresia (BA) is surgical restoration of bile flow by Kasai portoenterostomy. We aimed to study serum interleukin- (IL-) 12p40, a natural antagonist for the proinflammatory IL-12p70, and its relation to surgical outcomes of BA. The study included 75 infants with neonatal cholestasis: BA group (n=25), non-BA cholestasis group (n=30), and neglected BA group (n=20), in addition to thirty healthy neonates serving as controls. IL-12p40 was measured by ELISA in all individuals and a second assessment was performed 3 months postoperatively in the BA group. The surgical outcomes were classified as successful (bilirubin ≤ 2 mg/dl) or failed (bilirubin > 2 mg/dl). IL-12p40 was higher in BA compared to that in the non-BA and control groups (P values were 0.036 and

Background & Aims. The currently available treatment for chronic hepatitis C (CHC) in children is costly and with much toxicity. So, predicting the likelihood of response before starting therapy is important. Methods. Serum adiponectin, vitamin D, and alpha-fetoprotein (AFP) were measured before starting pegylated-interferon/ribavirin therapy for 50 children with CHC. Another 21 healthy children were recruited as controls. Results. Serum adiponectin, vitamin D, and AFP were higher in the CHC group than healthy controls (p

Abstract Background COVID-19, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has evolved into a pandemic. Oyo state, Nigeria with a population of 9,233,010, recorded the first case of COVID-19 on the 12th of March 2020 and it is among the highest contributing States to the nation’s burden of the disease with 3267 confirmed cases, including 40 deaths as of date, with an overall test positivity rate of 18.1%, far higher compared to the National average within a limited period from recorded index case. A ‘Hotspot strategy’ was designed by the Presidential Task Force on COVID-19 and Oyo State was selected to implement the strategy through upscaling case detection, isolation and treatment, quarantine of contacts and strengthening public health and social measures. Methods We used a descriptive cross-sectional survey of 3 identified hotspot Local Government Areas (LGAs) in Oyo State using mobile phones under Surveillance, Outbreak Response Management and Analysis System (SORMAS) platform to collect data from October to December 2020. Interventions comprised of enhanced active case search, contact line listing, contact investigation, and contact follow-up as well as to facilitate data collection and entry, community sensitization and management of alert/rumors. Baseline information and that after the 3-month period was then analyzed with the descriptive statistics presented. Results The implementation of the hotspot strategy was shown to have had a major impact in Irepo LGA, where more than a 100% increase in samples tested, confirmed cases, contacts listed and contacts followed were recorded, while there were no significance changes noticed in Ibadan North and Lagelu LGAs. However, test positivity rates among contacts were found to be quite high in Ibadan North LGA (48%), compared to the other two, even though Lagelu LGA (5.7%) tested more contacts than Ibadan North. Conclusion The observed increase in number of samples tested, cases confirmed, contact listed and investigated as well as test positivity rate in the 3 LGAs after the intervention implies that the hotspot strategy can be said to have contributed positively to the sensitivity of COVID-19 surveillance in Oyo State, Nigeria. This implies that strengthening this ‘hotspot strategy’ may be a key area of focus to improve COVID-19 surveillance sensitivity and response and in turn may help in breaking the transmission and bringing the pandemic to a halt.