Unusual presentation of Gilbert disease with high levels of unconjugated bilirubin: report of two cases

Gilbert's syndrome is a benign condition characterized by asymptomatic sporadic episodes of jaundice, due to a mild unconjugated hyperbilirubinemia caused by a deficiency in bilirubin glucoronidation. Under certain physiologic or pathologic events, bilirubin level rises but according to literature it does not reach out more than 3 mg/dl. We report 2 cases of Gilbert's syndrome, genetically tested, which presented with bilirubin levels above 6 mg/dl without any trigger or coexisting condition. In conclusion, bilirubin levels higher than 6 mg/dl in Gilbert syndrome are rare, hemolytic and other metabolism diseases must be ruled out, and genetic testing may be necessary in some cases.

Metacognition and executive functioning in Elementary School

This study analyzes differences in metacognitive skills and executive functioning between two groups of students (10-12 years) with different levels of metacognitive knowledge (high n = 50, low n = 64). Groups were established based on students' score on a test of knowledge of strategy use. Metacognitive skills were assessed by means of self-report. Students reported the frequency with which they applied these strategies during the phases of planning, execution, and evaluation of learning. Information about student executive functioning was provided by families and teachers, who completed two parallel forms of a behavior rating scale. The results indicated that: a) the group with high levels of metacognitive knowledge reported using their metacognitive skills more frequently than their peers in the other group. These differences were statistically significant in the phases of planning and execution; b) both family and teachers informed of better levels of executive functioning in the students with high metacognitive knowledge. Statistically significant differences were found in planning, functional memory, focus, and sustained attention. These results show the existence of an association between different levels of metacognitive knowledge, and differences in metacognitive skills and executive functions, and suggest the need to emphasize this set of variables in order to encourage students to acquire increasing levels of control over their learning process.