Gilbert’s syndrome coexisting with hereditary spherocytosis might not be rare: Six case reports

BACKGROUND Both Gilbert's syndrome(GS)and hereditary spherocytosis(HS)are common genetic disorders.However,comorbidity of GS with HS has always been considered a rare phenomenon,and it can impede accurate diagnoses in the presence of isolated unconjugated hyperbilirubinemia.CASE SUMMARY In a study on Levitt’s carbon monoxide(CO)breath test for the differential diagnosis of isolated hyperbilirubinemia,we found six GS patients with HS in 6 mo.The patients,including five males and one female,aged 25-58 years,were from four families and generally in good health.Their chronic fluctuating jaundice and/or hyperbilirubinemia had been diagnosed as simple constitutional jaundice for 6-30 years.Liver function tests showed isolated unconjugated hyperbilirubinemia with serum total bilirubin ranging from 20.7-75.4μmol/L.Blood hemoglobin was normal in five cases,and slightly decreased in one(11.5 g/dL).Overt hemolytic signs were absent,while erythrocyte lifespan determined by the newly developed Levitt’s CO breath test was significantly short(15-50 d),definitely demonstrating the presence of hemolysis.Given that their unconjugated hyperbilirubinemia compared inappropriately with hemolytic severity,as indicated by the hemoglobin level,further combined genetic tests for both UGT1A1 and hereditary erythrocyte deficiencies were conducted.These tests confirmed,at last,the coexistence of GS with HS.CONCLUSION Comorbidity of GS and HS might not be uncommon in isolated unconjugated hyperbilirubinemia.While CO breath test would sensitively detect the hemolysis,the discordance between the hyperbilirubinemia and hemoglobin level could strongly indicate the coexistence of GS and HS.

Contribution of G71R mutation to Gilbert's syndrome phenotype in a Greek patient: A case report

Gilbert's syndrome is characterized by a benign indirect hyperbilirubinemia.It has often been underestimated and undiagnosed because of its mild symptoms;al-though it is not as rare as was once believed when its frequency was estimated using data originating from biochemical tests.Based on molecular techniques,the occurrence of Gilbert's syndrome has changed,increas-ing to 10% in the Caucasian population.This molecular defect was described,by Bosma et al,in 1995,and af-fects the promoter region of the UGT 1A1 gene.In this case report,our aim is to present a new combination of two molecular defects in a Greek patient with Gilbert' s syndrome.A 13-year-old Greek girl was examined for Gilbert's syndrome using molecular techniques,and an uncommon genotype was revealed comprising the rare mutation G71R in trans with A(TA)7TAA motif.TheG71R mutation according to the literature,as well as our epidemiological data,is rare in Caucasians,while it is common in Asian populations.This is the first case study in the Greek population to report a new genotype for Gilbert's syndrome manifestation in the Caucasian population.

On Feminism in Eat,Pray,Love

This paper focuses on the contentious space between self-affirmation and self-preoccupation in Elizabeth Gilbert's popular travel memoir, Eat, Pray, Love. Use the theory of Feminism to analyze it. The results confirms to be walking a fine line between critical self- insight and obsessive self- importance and insists that a lot of Elizabeth's own experiences can make the readers especially women learn to be stronger and more independent. Besides that the novel Eat, Pray, Love can have a heavy touch on the readers. People becomes more materialistic and always pursuit the worldly happiness in modern time. Eat, Pray,Love is also can make readers learn to respect other cultures. While the strengths of this novel are the unique format, the simple language styles which can make the readers more acceptable, the flexible use of foreign languages, and the cultural diversity.This novel also has weaknesses such as the viewpoint in subjective way and the plot in complicated way.