Acute Pancreatitis Research Articles

Objective: To investigate the clinicopathological characteristics of type 2 autoimmune pancreatitis (AIP) and to explore its relationship with inflammatory bowel disease (IBD). Methods: AIP cases confirmed by pathology in the First Affiliated Hospital of Zhejiang University School of Medicine from 2009 to 2024 were collected. According to the International Consensus Diagnostic Criteria (ICDC) for AIP, 11 patients were identified as histological level 1 (definite) or level 2 (probable) type 2 AIP. Their clinical manifestations, laboratory test results, imaging features, and histopathological characteristics were analyzed, and a follow-up was conducted. Meanwhile, 130 patients with type 1 AIP diagnosed in our hospital during the same period were selected as control group. Results: Among 141 AIP patients, 11 cases (7.8%, 11/141) were diagnosed with type 2 AIP, including 7 cases of histologically level 1 and 4 cases of level 2. There were 10 male patients and 1 female patient, with a median age of 37(31,46) years (range: 25-47 years). Three patients were complicated with ulcerative colitis (UC). Compared with type 1 AIP patients, type 2 AIP patients were younger, often presented with acute pancreatitis or abdominal pain as the initial symptom, and had a close association with IBD (P<0.05). Laboratory tests showed that only 1 patient had slightly elevated serum IgG4, while the other 10 patients had normal serum IgG4 levels. Serum CA19-9 was elevated in 8 patients, and the percentage of peripheral blood neutrophils was increased in 9 patients. Imaging findings revealed diffuse pancreatic enlargement in 8 patients and localized enlargement in 3 patients (2 cases in the pancreatic head and 1 case in the pancreatic body-tail). Magnetic resonance cholangiopancreatography (MRCP) showed main pancreatic duct stenosis in 5 cases (5/7). Histopathological features included 7 cases of level 1 type 2 AIP that showed neutrophilic infiltration in the pancreatic duct epithelium and massive neutrophilic infiltration between the acini. Immunohistochemistry showed that only 1 case had <5 IgG4-positive plasma cells per high-power field (HPF), while the other 10 cases were negative. All 11 patients with type 2 AIP received steroid therapy, and no recurrence was observed during the follow-up period of 5 to 174 months. Conclusions: Type 2 AIP has unique clinicopathological characteristics. It is more commonly found in young patients and often presents with manifestations similar to acute pancreatitis. Histologically, neutrophilic infiltration in the ductal epithelium is the common feature. Type 2 AIP is closely associated with IBD, especially UC.

Paralytic ileus is a frequent complication of acute pancreatitis (AP), contributing to increased morbidity, nutritional compromise, and risk of infection. Despite its clinical relevance, data on its incidence, predictors, management, and outcomes in AP remain limited. We conducted a retrospective study of 426 adult patients admitted with AP over a 3-year period at a tertiary-care center. The primary outcome was paralytic ileus; secondary outcomes included infected necrosis, intervention, and mortality. Multivariate logistic regression identified independent predictors expressed as adjusted odds ratio (aOR). Paralytic ileus occurred in 167/426 (39.2%) patients. Patients with ileus were more frequently male, obese, and had higher rates of SIRS compared to those without ileus. They also exhibited significantly higher leukocyte counts, neutrophil-lymphocyte ratio (NLR), serum creatinine, and lower serum albumin and sodium levels. In multivariate analysis, obesity (aOR: 2.329), NLR (aOR: 1.131), serum albumin (aOR: 0.342), and serum sodium (aOR: 0.802) were identified as independent predictors. An NLR of 9.5 had a sensitivity of 82.6% and a specificity of 76.1% for predicting paralytic ileus. Conservative management resolved ileus in 85% of cases, 6% responded to neostigmine, while 9% with unresolved ileus succumbed to multiorgan failure. Paralytic ileus was independently associated with increased risk of infected necrosis (aOR: 3.62), intervention (aOR: 4.43), and mortality (aOR: 4.71). Paralytic ileus affects a significant proportion of patients with moderate to severe AP and is a marker of local and systemic complications. Paralytic ileus was an independent predictor of infected necrosis, intervention, and mortality, underscoring its prognostic relevance.

Introduction The obesity epidemic has led to a rise in related health conditions, with metabolic syndrome (MS) affecting 25% of Western populations. In severe acute pancreatitis (AP), mortality can reach 50%. Previous studies have linked MS elements to increased complications and mortality in AP. This meta-analysis aims to identify potential risk factors and their synergistic effects on AP outcomes. Methods We systematically searched PubMed, Embase, and the Cochrane Library up to November 1, 2023, and included studies based on predefined criteria. We examined the impact of MS and its factors (obesity, hypertension, diabetes mellitus, and hypertriglyceridemia) on AP outcomes, calculating pooled odds ratios (OR) with 95% confidence intervals (CIs). The protocol was registered in PROSPERO under number CRD42023471092. Results Out of 15,904 records, 89 studies were analyzed. Overweight and obesity were significant risk factors for complications (local OR: 2.677, 95%CI: 1.421-5.044; systemic OR: 2.404, 95%CI: 1.481-3.901) and severe AP (BMI≥30 kg/m 2 , OR: 3.058, 95%CI: 1.369-6.829). High triglyceride levels were associated with ICU admission (OR: 2.546, 95%CI: 1.529-4.237) and severe AP (OR: 2.686, 95%CI: 1.205-5.989); hypertension increased mortality (OR: 2.135, 95%CI: 1.870-2.437), while diabetes increased the odds of ICU admission (OR: 1.645, 95%CI: 1.358-1.992) and severe AP (OR: 1.49, 95%CI: 1.09-2.03). We found a non-significant trend toward increased odds of severe AP among patients with MS (OR = 1.398, 95% CI: 0.918–2.129). Conclusion Individual components of MS are risk factors for complications, severity, and mortality in AP. Lifestyle counseling, education, and treatment of patients with obesity is crucial. Systematic Review Registration https://www.crd.york.ac.uk/prospero/ , identifier CD42023471092.

Introduction: Takotsubo cardiomyopathy is an uncommon condition characterized by transient regional systolic dysfunction, which can mimic an acute myocardial infarction in the absence of coronary artery obstruction, typically in response to stress-induced states. An even rarer variant is reverse Takotsubo, which presents with basal akinesis and apical hyperkinesis. We present a rare case of reverse Takotsubo in a young female that is believed to be triggered by acute pancreatitis. Case Presentation: A 48-year-old female with a past medical history of hypertension presented with acute abdominal pain and an elevated lipase of 512, leading to a diagnosis of acute pancreatitis. On the second day of hospitalization, laboratory studies showed marked elevation of troponin levels from 47.8 to 10,601 ng/l, although the patient remained asymptomatic from a cardiac standpoint. Electrocardiogram demonstrated no ischemic changes, and coronary angiography ruled out obstructive coronary artery disease. A transthoracic echocardiogram revealed left ventricular ejection fraction (EF) of 45–50% and global hypokinesis with sparing of the left ventricle (LV) apex, consistent with reverse Takotsubo cardiomyopathy. The etiology was suspected to be physiologic stress induced by acute pancreatitis. Common causes of pancreatitis were excluded, however the patient was recently started semaglutide, making this the most likely precipitating factor at the time. She was treated conservatively with guideline-directed medical therapy for stage B heart failure, including beta-blockers and angiotensin receptor blockers. A follow-up echocardiogram performed two months later revealed normalization of LVEF and resolution of wall motion abnormalities. Discussion: Reverse Takotsubo cardiomyopathy is a rare variant of stress cardiomyopathy that predominantly affects younger females and is often triggered by physical stressors like acute illness. While the exact pathophysiology remains unclear, proposed mechanisms include catecholamine-induced myocardial stunning or inflammation-mediated injury. Recognizing the association between stress-inducing conditions like acute pancreatitis and this uncommon cardiac presentation is essential for facilitating timely diagnosis and appropriate management.

Acute pancreatitis (AP) requires early risk stratification, particularly in resource-limited settings. This study evaluates the Neutrophil× C-Reactive Protein Index (NCI) as a biomarker for predicting severe acute pancreatitis (SAP) and in-hospital mortality. In this prospective cohort study, adult AP patients were enrolled consecutively at a tertiary hospital in Vietnam. Complete blood count and C-reactive protein (CRP) levels were measured within 24hours of admission. NCI was compared against other neutrophil-lymphocyte-CRP combinations and the Bedside Index for Severity in Acute Pancreatitis (BISAP). Prognostic performance was assessed using the area under the receiver operating characteristic curves (AUCs), and a Restricted Cubic Splines analysis explored the linear relationship between NCI and SAP risk. Internal and external validations were performed. The study included 257, 83, and 121 patients in the training, internal, and external cohorts, respectively. Optimal NCI cut-off values were ≥1877 for SAP and ≥3180 for mortality. NCI showed a linear relationship with SAP risk (p-values for non-linearity: 0.420-0.773). NCI predicted SAP with AUCs of 0.853, 0.897, and 0.844 across cohorts. It outperformed CLR (AUCs 0.653-0.856) and NLR (AUCs 0.719-0.844), with performance similar to NCLR (AUCs 0.832-0.898). For in-hospital mortality, NCI achieved AUCs of 0.824-0.902, comparable to BISAP (0.735-0.943), and outperformed other combinations. Good calibration and clinically relevant post-test probabilities were observed. NCI is a simple, accessible, and effective biomarker for early risk stratification in SAP and in-hospital mortality, particularly in resource-limited settings. Its reliance on routine blood tests supports its practical use for timely triage and management of AP.

Background: Type 2 diabetes mellitus (T2DM) significantly increases the risk of cardiovascular events, particularly in high-risk patients—those with coexisting cardiovascular disease (CVD) or chronic kidney disease (CKD). Oral semaglutide, a novel glucagon-like peptide-1 (GLP-1) receptor agonist, has demonstrated strong efficacy in glycemic control and potential cardiovascular benefits in T2DM. However, its impact on cardiovascular outcomes in T2DM patients with coexisting CVD or CKD remains to be fully elucidated. Methods: A comprehensive literature search of PubMed, Cochrane Library, and ClinicalTrials.gov was conducted to identify randomized, placebo-controlled trials (RCTs) evaluating oral semaglutide in T2DM patients aged over 50 years with either CVD or CKD. Primary outcomes included all-cause mortality, major cardiovascular events, non-fatal myocardial infarction (MI), cardiovascular death, and non-fatal stroke. The secondary outcomes assessed were adverse events of special interest, such as malignant neoplasms and acute pancreatitis. A random-effects model using the Mantel-Haenszel method was used to calculate pooled hazard ratios (HRs) with 95% confidence intervals (CIs). Results: Four RCTs comprising 19,663 patients (9,831 in the semaglutide group; 9,832 in the placebo group) were included. Oral semaglutide significantly reduced all-cause mortality (HR: 0.87; 95% CI: 0.78–0.95; p = 0.004), major cardiovascular events (HR: 0.81; 95% CI: 0.75–0.88; p &lt; 0.00001), and non-fatal MI (HR: 0.79; 95% CI: 0.67–0.93; p = 0.005) compared to placebo. No significant differences were observed for cardiovascular death (HR: 0.80; 95% CI: 0.64–1.01), non-fatal stroke (HR: 0.88; 95% CI: 0.67–1.15), or heart failure hospitalization (HR: 0.91; 95% CI: 0.76–1.09). All adverse events of special interest, including malignant neoplasms (RR: 1.08; p = 0.17) and acute pancreatitis (RR: 0.89; p = 0.60), did not differ significantly between groups. Conclusion: Oral semaglutide is associated with significant reductions in all-cause mortality, major cardiovascular events, and non-fatal myocardial infarction in high-risk T2DM patients with CVD or CKD, supporting its role as a cardioprotective agent in this population. Importantly, semaglutide did not increase the risk of serious adverse events, underscoring its safety. These findings support broader consideration of oral semaglutide in cardiovascular risk management for high-risk T2DM patients.

Background: GLP-1 receptor agonists have demonstrated cardiovascular and metabolic benefits in patients with obesity and type 2 diabetes. However, their impact on clinical outcomes following bariatric surgery remains unclear. Objective: To evaluate the association between post-operative GLP-1 analog use and key clinical outcomes among patients who underwent bariatric surgery. Methods: We conducted a retrospective cohort study using the TriNetX US Collaborative Network. Adults (BMI ≥30) who underwent bariatric surgery were divided into two cohorts: those who initiated GLP-1 analogs post-operatively and those who did not. After 1:1 propensity score matching, 18,017 patients were included in each group. The primary outcome was all-cause mortality; secondary outcomes included major adverse cardiovascular events (MACE), atrial fibrillation/flutter, hospital readmission, HbA1c &lt;7% achievement, acute pancreatitis, and gastroparesis. Outcomes were assessed over a 12-month follow-up. Results: All-cause mortality was comparable between groups (0.3% vs. 0.3%; HR 0.777, p=0.084). GLP-1 users experienced a slightly higher incidence of MACE (1.7% vs. 1.3%; HR 1.27, p=0.006) and atrial fibrillation/flutter (3.2% vs. 3.1%; HR 1.02, p=0.179), though only the MACE difference reached statistical significance. Notably, GLP-1 use was associated with reduced readmissions (20.1% vs. 25.5%; HR 0.74, p&lt;0.001) and higher rates of glycemic control (HbA1c &lt;7%: 35.1% vs. 32.3%; HR 1.07, p=0.001). There was no significant difference in acute pancreatitis. Gastroparesis was less frequent in GLP-1 users (0.6% vs. 0.8%; HR 0.76, p=0.028). Conclusion: In this large real-world cohort, post-operative GLP-1 analog use was associated with improved glycemic control and reduced readmissions, without an increase in all-cause mortality or pancreatitis. Slightly higher rates of MACE warrant further investigation. These findings support the selective use of GLP-1 analogs as adjuncts following bariatric surgery.

Background: Glucagon-like peptide-1 (GLP-1) receptor agonists are increasingly prescribed for type-2 diabetes and obesity, with emerging evidence of cardiovascular benefits. However, their impact on postoperative outcomes in adult congenital heart disease (CHD) patients undergoing coronary artery bypass grafting (CABG) remains underexplored. Methods: We conducted a retrospective cohort study using de-identified patient data from the TriNetX Research Network from 2005-2025. Adult CHD patients (ICD-10: Q20-Q28) who underwent CABG (CPT: 1006208, 1006217, 1006200) were divided into two cohorts: those with documented GLP-1 agonist use (ATC: A10BJ) prior to or within 6 months after surgery and those without (control). Propensity score matching (1:1) was used to balance cohorts based on race, ethnicity, sex, age at surgery, comorbidities including diabetes, obesity, and heart failure, and CHD diagnoses. Primary outcomes included 6-month all-cause mortality and hospital readmission rate. Secondary outcomes included GLP-1-related complications (acute pancreatitis, gastroparesis, weight loss) and postoperative events (acute kidney injury [AKI], myocardial infarction [MI], transient ischemic attack [TIA], cerebral infarction, and hypoglycemic event). Results: The total number of patients included in the study was 1468, of which 734 patients were in GLP-1 group and control group, respectively. After matching, no differences were observed between the cohorts in the prevalence of key comorbidities prior to CABG: chronic ischemic heart disease, nonrheumatic aortic valve disorders, cerebrovascular diseases, acute MI, and angina pectoris (Table 1) GLP-1 agonist use was associated with a significant reduction in 6-month hospital readmission rate (Odds Ratio [OR]=0.76, p=0.008) but no difference in 6-month mortality (OR=0.84, p=0.43) compared to controls. No differences were noted among known complications of GLP-1 agonists: acute pancreatitis (OR=1, p=1), gastroparesis (OR=1.146, p=0.71) and abnormal weight loss (OR=1, p=1). Other post-operative outcomes such as AKI, MI, TIA, cerebral infarction and hypoglycemic event, were not significant either (Table 2). Conclusion: In adult CHD patients undergoing CABG, preoperative use of GLP-1 receptor agonists was associated with a significant reduction in 6-month hospital readmission rate. However, their use was not associated with differences in other postoperative outcomes or known complications.

Background: SGLT2i and GLP-1RA Independently Improve CV outcomes in pts with T2DM.Their combined effect in real-world pts with coexisting HF and T2DM remains underexplored. Methods: We conducted a propensity-matched cohort study using the TriNetX global federated health research network.We identified adults (≥18 years) with HF and T2DM who initiated either SGLT2i with GLP1-RA (Cohort A) or SGLT2i alone (Cohort B) across 102 healthcare organizations.Among 58,525 adults, 22,322 pts received SGLT2i with GLP-1RA, and 36,203 pts were on SGLT2i alone between Jan 2015 and May 2022.After propensity score matching 18,141 pts were included in each cohort.The primary outcome was a composite of all-cause mortality,acute myocardial infarction(AMI),or stroke at 1 year and 3 years.Secondary outcomes included individual event rates,hospitalizations,HFexacerbations,and safety events. Results: At 1 year,combination therapy with SGLT2i and GLP-1RA was associated with a significantly lower risk of the primary composite outcome than SGLT2i alone.Specifically, the combination group showed reduced all-cause mortality(RR: 0.647; 95% CI: 0.595–0.703; p&lt;0.001),AMI (RR: 0.796; 95% CI: 0.708–0.894; p&lt;0.001).Among secondary outcomes,HF exacerbations(RR: 0.755; 95% CI: 0.665–0.857; p&lt;0.001)and AKI(RR: 0.881; 95% CI: 0.845–0.919; p&lt;0.001)were also significantly lower in the combination group.These clinical benefits remained consistent over a 3-year follow-up,with ongoing reductions in all-cause mortality and AMI observed in the combination group.No significant increase in stroke risk was observed.The 1-year RR was 0.882(95% CI: 0.767–1.013; p=0.075),and the 3-year RR was 0.943(95% CI: 0.862–1.031; p=0.198).Similarly, adverse events—including atrial fibrillation/atrial flutter, need for renal replacement therapy or dialysis, pulmonary HTN, acute pancreatitis, UTI, and euglycemic DKA—did not show significant differences.All-cause hospitalization or emergency room visits were significantly reduced at 1 year in the combination therapy(RR: 0.958; 95% CI: 0.936–0.979; p&lt;0.001),though this difference was no longer significant at 3 years(RR: 0.989; 95% CI: 0.973–1.004; p=0.157). Conclusion: In a large real-world cohort of patients with HF and T2DM, combined SGLT2i and GLP1-RA therapy was associated with significantly improved CV outcomes and survival over 1 and 3 years,with no increase in major adverse safety events.These findings support the consideration of dual therapy in this high-risk population.

Background: Familial partial lipodystrophy (FPLD) is a rare genetic disorder often underrecognized in clinical practice. Given its phenotypic overlap with common metabolic disorders, its identification as an underlying clinical syndrome is often delayed. Case: A 41-year-old woman with type 1 diabetes mellitus (diagnosed following acute pancreatitis at age 19), necrobiosis lipoidica, combined hyperlipidemia, and prior triglyceride levels &gt;1,000 mg/dL presented to the care with progressive exertional dyspnea. Physical examination revealed increased facial and nuchal adiposity with thin extremities featuring prominent veins, suggesting abnormal fat distribution. She had a recent marked improvement in her metabolic control (A1c down to 7.0% from 14.5%; triglycerides down to 112 mg/dL from 1160mg/dL) found to have NT-proBNP of 6,489 pg/mL and mildly elevated high-sensitivity troponin. Echocardiography revealed an LVEF of 38% with new regional wall motion abnormalities as well as grade 2 diastolic dysfunction. Invasive hemodynamics testing was notable for elevated bi-atrial filling pressures and subsequent coronary angiography revealed multivessel coronary artery disease. Given the patient's selective fat loss, early-onset insulin-resistant diabetes, prior hypertriglyceridemia, and now premature cardiovascular disease leading to an ischemic cardiomyopathy, a unifying diagnosis of lipodystrophy was suspected. Genetic testing confirmed a pathogenic LMNA variant, consistent with type 2 familial partial lipodystrophy, also known as Dunnigan type. Discussion: This case underscores the importance of pattern recognition in patients with atypical cardiometabolic profiles. The diagnosis of FPLD helped clarify the etiology of this patient’s cardiomyopathy and provided insight into her prior metabolic derangements. Early identification of LMNA mutations is crucial due to associated risks of arrhythmias, worsening cardiomyopathies, and sudden cardiac death. It also provided the patient with an explanation for her body morphology and the severity of her metabolic conditions, which she reported has reduced her body shame and enabled her to cope with her condition better. Conclusion: Familial partial lipodystrophy should be considered in individuals with abnormal fat distribution, severe dyslipidemia, insulin resistance, and premature cardiovascular disease. Timely genetic testing can guide management and provide answers for patients who have delays in diagnosis.

The comparative gastrointestinal safety across glucagon-like peptide-1 receptor agonists and tirzepatide is still unclear. To compare the risk for severe gastrointestinal adverse events across dulaglutide, subcutaneous semaglutide, and tirzepatide in patients with type 2 diabetes (T2D) in routine clinical practice. New-user, active-comparator cohort study. Population-based study. Adults with T2D initiating dulaglutide, subcutaneous semaglutide, and tirzepatide between 1 January 2019 and 30 August 2024 in 3 cohorts corresponding to 3 pairwise comparisons. The primary outcome was a composite of acute pancreatitis, biliary disease, bowel obstruction, gastroparesis, and severe constipation. Secondary outcomes of interest were the individual components of the primary outcome. Patients were 1:1 propensity score matched within each comparison. We calculated hazard ratios (HRs) with 95% CIs. There were 65 238 matched pairs in the semaglutide versus dulaglutide cohort, 20 893 in the tirzepatide versus dulaglutide cohort, and 46 620 in the tirzepatide versus semaglutide cohort. The HR of gastrointestinal events was 0.96 (95% CI, 0.87 to 1.06) in the semaglutide versus dulaglutide cohort, 0.96 (CI, 0.77 to 1.20) in the tirzepatide versus dulaglutide cohort, and 1.07 (CI, 0.90 to 1.26) in the tirzepatide versus semaglutide cohort. Possible residual confounding by glycemic control and body mass index. These findings suggest that dulaglutide, semaglutide, and tirzepatide have similar gastrointestinal safety profiles in adults with T2D. This study provides clinicians with evidence to weigh the benefits and risks of these medications. National Institute of Diabetes and Digestive and Kidney Diseases.

Background: Severe hypertriglyceridemia (SHTG) and familial chylomicronemia syndrome (FCS) are marked by extreme triglyceride (TG) elevations, raising the risk for acute pancreatitis and cardiovascular complications. Apolipoprotein C-III (APOC3) impairs TG catabolism and clearance. Loss-of-function APOC3 mutations are linked to lower TGs and reduced atherosclerotic risk, highlighting APOC3 as a promising therapeutic target. CRISPR-CasXE (XE) is an engineered gene editing platform with improved potency and specificity over natural systems. Here, we report the development of STX-1400, the first liver-targeted XE gene editing therapy designed to disrupt APOC3 expression and reduce circulating TGs. Approach: STX-1400 consists of an mRNA encoding an engineered XE editor and a single APOC3-targeting gRNA delivered via lipid nanoparticles. We evaluated the efficacy of a STX-1400 prototype in multiple in vitro and in vivo models. Specificity was assessed using a comprehensive off-target strategy to nominate potential off-target sites, followed by deep sequencing evaluation in primary human hepatocytes (PHHs) treated at 10xEC90. A non-human primate (NHP) surrogate was also tested in cynomolgus monkeys at escalating doses, with APOC3 editing measured in liver biopsies 18 days post-dose. Results: In PHHs, a STX-1400 prototype showed dose-dependent APOC3 editing (up to 90%) with &gt;70% decrease in secreted APOC3 protein. In human APOC3 transgenic mice, hepatic editing at the APOC3 locus exceeded &gt;70%, reducing circulating APOC3 by 80%. In hypertriglyceridemic mice, the STX-1400 prototype reduced APOC3 mRNA by &gt;90% and protein by &gt;95%, which corresponded with decreasing plasma TGs by &gt;95% and total cholesterol by &gt;80%. No off-target editing was observed in PHHs treated at 10xEC90. Notably, a single administration of the NHP analog of the STX-1400 prototype in cynomolgus monkeys achieved saturated editing levels (&gt;70%) in the liver at 1mg/kg, with liver enzyme profiles comparable to controls. Conclusions: Our findings demonstrate that the STX-1400 prototype potently and specifically edits APOC3 across human cells, mouse models, and non-human primates. This study is the first demonstration that a CRISPR-based therapy has achieved saturated in vivo editing of the APOC3 locus in NHP liver. These results provide strong preclinical evidence supporting the potential of STX-1400 as a first-in class genome editing therapy for hypertriglyceridemia in patients with SHTG and FCS.

Introduction: Severe hypertriglyceridemia (HTG) in pregnancy increases the risk of acute pancreatitis and preeclampsia, carrying a high maternal and fetal mortality rate. Management of severe HTG during pregnancy is challenging, as pharmacologic options are limited due to potential fetal risks. Description of Case: A 34-year-old G1P000 woman with type 2 diabetes mellitus and HTG was referred to cardio-obstetrics clinic at 16 weeks of gestation with a triglyceride (TG) level of 1,562 mg/dL. Prior to conception, she had been treated with a biguanide for diabetes and a combination of fish oil, fenofibrate, and a statin for HTG, which were discontinued for fetal safety. Given the markedly elevated TG level, a multidisciplinary decision was made to urgently reinitiate lipid-lowering therapy with omega-3 acid ethyl esters 4g daily (Lovaza) and subcutaneous insulin glargine. In addition, she received counseling on lifestyle modification, including a low-fat, low-carbohydrate diet and a goal of 150 minutes of moderate physical activity per week. At two-month follow-up, her TG level had significantly improved to 328 mg/dL, with a further decrease to 287 mg/dL by four months without maternal or fetal complications. Discussion: This case highlights the complexities involved in managing HTG during pregnancy. While total cholesterol and TG levels naturally increase throughout pregnancy, levels typically remain below 250 mg/dL. Traditional lipid-lowering agents, including statins, PCSK9 inhibitors, ezetimibe, bempedoic acid, and lomitapide, are generally avoided during pregnancy due to limited fetal safety data. In high-risk women with dyslipidemia, an individualized treatment approach can include insulin and omega 3 fatty ethyl esters or even LDL apheresis to prevent life-threatening complications. Lifestyle modification with a low-fat diet and omega-3 fatty acids must be balanced with both maternal and fetal nutritional needs to prevent abnormal fetal development. Thus, cardio-obstetric management of high-risk women with metabolic disorders should center around preconception risk assessment, multidisciplinary care, intensive lifestyle modification, selective use of non-statin agents or apheresis, and vigilant monitoring throughout pregnancy. There remains a significant gap in evidence regarding the safety and efficacy of lipid-lowering therapies during pregnancy, underscoring the urgent need for further research to guide management of severe HTG in pregnancy.

Objective: To examine the relationship between acute pancreatitis (AP) severity and both coagulation function and serum calcium levels. Methodology: This is a retrospective study. A total of one hundred patients with AP admitted to our hospital from July 2022 to January 2024. Fifty patients with severe AP(SAP) were assigned to the experimental group, fifty patients with mild-to-moderate AP were assigned to the control group. The pancreatitis activity score system(PASS) score, platelet(PLT) count, von Willebrand factor antigen(vWF:Ag), prothrombin time(PT), activated partial prothrombin time, fibrinogen, thrombin time, antithrombin III(ATIII), plasminogen, serum calcium(Ca) and D-dimer(D-D) were compared. The independent risk factors for predicting AP severity were analysed. The prognostic predictive value and diagnostic efficacy of these independent risk factors were assessed. Results: The experimental group exhibited a statistically significant increase in the PASS score, vWF:Ag, PT and D-D levels and a significant decrease in PLT, ATIII and Ca levels compared with the control group(P&lt; 0.001). Logistic regression analysis showed that PASS, vWF:Ag, PT, ATIII, D-D and Ca were independent risk factors for predicting the severity of AP; Ca levels had the highest diagnostic efficacy, followed by ATIII and PT; vWF:Ag was the least effective. The levels of vWF:Ag, PT, and D-D are positively correlated with PASS scores, the levels of ATIII and Ca are negatively correlated. Conclusion: The levels of vWF:Ag, PT, D-D, ATIII, and Ca in AP patients are correlated with the severity of the condition, and Ca levels may more accurately and early assess the severity of AP patients.

Quality of life (QOL) after acute pancreatitis (AP) has been assessed months to years after the episode. Our aim was to define the QOL during hospitalization and at short-term follow-up in AP patients. We analyzed responses to PROMIS-29 questionnaire completed during hospitalization by 137 participants with alcohol-related AP or recurrent AP. A subset (n=63) also completed PROMIS-29 within 5-20 months after discharge (median 11wk). Summary physical and mental QOL T-scores were computed using validated algorithm. T-score change from baseline to follow-up of ≥3 points was considered a clinically meaningful change. Univariate and multivariable linear regressions evaluated factors associated with QOL. During hospitalization, physical (T-score 30.0±8.0) and mental QOL (38.4±3.6) were profoundly lower than population standards (50±10). On multivariable analyses, presence of diabetes was associated with lower physical QOL (-3.72 points) and current marijuana use was associated with lower mental QOL (-1.62 points). At follow-up, 84% participants had no change in physical QOL T-score (mean change -2.26 points), while mental QOL improved in 80% (mean change +7.6 points). Odds of maintaining or improving physical QOL were inversely associated with body mass index (OR 0.91/unit), and of improving mental QOL increased with Not-Hispanic or Latino ethnicity (OR 10.62) and presence of no other psychiatric history (OR 7.14). QOL is profoundly affected during hospitalization for alcohol-related AP, with persistent impairment in physical QOL at short-term follow-up. Efforts to address physical rehabilitation and mental health support during and in the post-hospitalization period may help optimize outcomes in alcohol-associated AP.

Pancreatic pseudocysts (PPs) and walled-off necrosis (WON) are two distinct sequelae of acute and chronic pancreatitis, requiring accurate differentiation to guide appropriate management. Computed tomography (CT) and magnetic resonance imaging (MRI) remain essential for distinguishing PPs from WON, assessing their content, and identifying potential complications. Endoscopic ultrasound (EUS) has emerged as a key modality for both diagnosis and drainage planning, offering high-resolution imaging and the possibility of real-time aspiration. Management strategies have evolved significantly, shifting from surgical to minimally invasive approaches. Endoscopic drainage, including EUS-guided transmural drainage with double-pigtail or lumen-apposing metal stents (LAMS), has become the preferred strategy for symptomatic or infected collections. Endoscopic necrosectomy is increasingly performed for WON, providing a less invasive alternative to surgical debridement. However, patient selection and procedural techniques remain topics of ongoing debate. The aim of this review is to provide a comprehensive synthesis of current evidence regarding the diagnosis and management of pancreatic pseudocyst and walled-off necrosis. We will synthesize current evidence on diagnostic criteria, imaging modalities, and therapeutic algorithms for PPs and WON. We will discuss technical aspects, success rates, and complications associated with drainage modalities, comparing endoscopic, percutaneous, and surgical approaches. Special attention will be given to recent advancements in interventional endoscopy and their impact on patient outcomes. By integrating clinical insights with the latest literature, this review aims to provide an up-to-date reference for clinicians managing pancreatic fluid collections. A literature search was performed using PubMed, Scopus, Web of Science, and MEDLINE databases to identify relevant studies on diagnostic criteria, imaging techniques, and management strategies.

Effects of low vs high fat diet in dogs with Cerulein-induced acute pancreatitis.

Ultrasound-guided TAP block: A promising strategy for managing acute pancreatitis pain in a prospective interventional study.

Psychotropic drugs and risk of pancreatitis: a systematic review and meta-analysis.

Although diuretic-induced Acute Pancreatitis (AP) cases are typically mild to moderate, severe and potentially fatal occurrences can arise. Case Series and Literature Review: We have, herein, presented a series of diuretic-induced AP cases from March 2018 to February 2024 of a 54-year-old woman treated with chlorthalidone, a 45-year-old male treated with hydrochlorothiazide, and a 48-year-old male treated with frusemide. The literature search has identified 26 cases published to date, 10 from frusemide and 16 from thiazide diuretics. The Naranjo adverse reaction probability scale has categorized all three drugs as "probable". All cases have responded to conservative treatment and cessation of the offending drug. Various mechanisms, such as hypersensitization, ischemia, direct cytotoxic effects, hypercalcemia, and dose-dependent idiosyncrasy, have been found to lead to intrapancreatic activation of pancreatic enzymes, resulting in drug-induced AP. Further research into the mechanisms and genetic factors contributing to diureticinduced AP is essential for enabling early diagnosis and management of diuretic-induced AP.