Diagnosis Of AP Research Articles

Study on the potential diagnostic value of metabolomics changes in different biological fluids for aspiration pneumonia

BackgroundAspiration pneumonia (AP) is a type of lung inflammation caused by the aspiration of food, oropharyngeal secretions, or gastric contents. This condition is particularly common in older adults and individuals with impaired swallowing or consciousness. While the diagnosis of AP relies on clinical history, swallowing assessments, and imaging, these methods have significant limitations, often leading to underdiagnosis or misdiagnosis. Reliable biomarkers for AP diagnosis are lacking, making early detection and treatment challenging.MethodsNineteen patients diagnosed with pneumonia were included in this study, divided into two groups: AP (n = 10) and non-AP (n = 9). Biological fluid samples, including bronchoalveolar lavage fluid (BALF), saliva, serum, sputum, and urine, were analyzed using non-targeted liquid chromatography with tandem mass spectrometry (LC-MS/MS). Differential metabolites were identified using fold change analysis, statistical significance, and receiver operating characteristic (ROC) curve analysis to evaluate their diagnostic potential. Spearman correlation was used to examine the relationship between selected metabolites and clinical parameters.ResultsSignificant metabolic differences were found between AP and non-AP patients, with many different metabolites identified across biological fluids. Dehydroepiandrosterone sulfate (DHEAS), Androstenediol-3-sulfate (ADIOLS), and beta-muricholic acid were identified as key biomarkers through fold change analysis and ROC curve analysis, showing consistent increasing or decreasing trends in BALF, sputum, and serum samples. DHEAS was found to be negatively correlated with the Acute Physiology and Chronic Health Evaluation II (APACHE II) (r = − 0.619, p = 0.005) in BALF sample. The area under curve (AUC) values showed that these molecules could serve as effective biomarkers for AP.ConclusionsThis study identifies DHEAS, ADIOLS and beta-muricholic acid as promising biomarkers for AP, with the potential to improve early diagnosis and treatment. These findings underscore the clinical value of metabolomics in developing diagnostic tools for AP, facilitating better clinical management and patient outcomes. Further research is required to validate these biomarkers in larger cohorts and explore their mechanistic roles in AP pathophysiology.

Drug-induced pancreatitis: Study of 38 patients

IntroductionAcute pancreatitis (AP) is an inflammatory disease with multiple etiologies, and the emergence of complications. Between 0.1%–5% of cases are attributed to drugs. The absence of specific characteristics complicates the diagnosis and treatment of drug-induced AP. Reviewing patients admitted with the diagnosis of drug-induced AP can provide information and improve its management. Patients and methodsThis is a descriptive, observational, and retrospective study. All patients admitted to the Hospital Universitari de Bellvitge (HUB) between June 2007 and March 2023 with suspected drug-induced AP were included. The data were obtained from the HUB pharmacovigilance program database. ResultsThirty-eight patients with suspected drug-induced AP were identified, representing 0.62% of all adverse drug reactions (ADRs) (n = 6085). Of these, 65.8% (n = 25) had a single suspected drug. The median latency period for the onset of ADRs was 160.5 days (IQR 18–582 days), and the median hospital stay was 5 days (IQR 3–7 days). Fifty-nine suspected drugs were identified, involving 26 active principles. Azathioprine and atorvastatin were the most frequent, with 9 cases each (15.2%), followed by enalapril with 8 cases (13.6%). Drug etiology was assessed in 23 cases (60.5%), and the suspected drug was discontinued in all cases. There was 1 fatal case documented (2.63%). ConclusionThis study can contribute to better understanding of drug-induced pancreatitis episodes. We propose the creation of a diagnostic algorithm that includes the assessment of the drug as a possible cause.

Severe fetal distress and acute maternal pancreatitis secondary to severe hypertriglyceridemia: a case report

BackgroundAcute pancreatitis (AP) during pregnancy is a rare condition and a potential cause of maternal–fetal mortality. Its diagnosis can be challenging. Hypertriglyceridemia (HTG) is one of the causes. We describe a case of severe fetal distress in the third trimester of pregnancy, associated with severe HTG complicated by AP.Case presentationA 35-year-old pregnant patient at 36-week gestation presented to the emergency department with acute epigastric pain. After excluding preeclampsia and initially challenging laboratory analyses, a diagnosis of AP was made based on a lipase level 12 times the normal range. The etiology was HTG at 40 times the normal level. Despite initial conservative management, the patient deteriorated rapidly clinically, and severe fetal distress (SFD) necessitated an emergency cesarean section. Lactescent blood appearance was observed intraoperatively. We suspect that the severe and rapid HTG may have caused acute fetal hypoxia.ConclusionsAP during pregnancy is a rare condition, with significant maternal–fetal mortality. Early diagnosis remains challenging. A multidisciplinary approach is necessary for optimal management, with special consideration for rapid fetal delivery in cases of AP secondary to HTG due to the increased risk of fetal mortality.

Artificial intelligence-based tools with automated segmentation and measurement on CT images to assist accurate and fast diagnosis in acute pancreatitis.

To develop an artificial intelligence (AI) tool with automated pancreas segmentation and measurement of pancreatic morphological information on CT images to assist improved and faster diagnosis in acute pancreatitis. This study retrospectively contained 1124 patients suspected for AP and received non-contrast and enhanced abdominal CT examination between September 2013 and September 2022. Patients were divided into training (N = 688), validation (N = 145), testing dataset [N = 291; N = 104 for normal pancreas, N = 98 for AP, N = 89 for AP complicated with PDAC (AP&PDAC)]. A model based on convolutional neural network (MSAnet) was developed. The pancreas segmentation and measurement were performed via eight open-source models and MSAnet based tools, and the efficacy was evaluated using dice similarity coefficient (DSC) and intersection over union (IoU). The DSC and IoU for patients with different ages were also compared. The outline of tumour and oedema in the AP and were segmented by clustering. The diagnostic efficacy for radiologists with or without the assistance of MSAnet tool in AP and AP&PDAC was evaluated using receiver operation curve and confusion matrix. Among all models, MSAnet based tool showed best performance on the training and validation dataset, and had high efficacy on testing dataset. The performance was age-affected. With assistance of the AI tool, the diagnosis time was significantly shortened by 26.8% and 32.7% for junior and senior radiologists, respectively. The area under curve (AUC) in diagnosis of AP was improved from 0.91 to 0.96 for junior radiologist and 0.98 to 0.99 for senior radiologist. In AP&PDAC diagnosis, AUC was increased from 0.85 to 0.92 for junior and 0.97 to 0.99 for senior. MSAnet based tools showed good pancreas segmentation and measurement performance, which help radiologists improve diagnosis efficacy and workflow in both AP and AP with PDAC conditions. This study developed an AI tool with automated pancreas segmentation and measurement and provided evidence for AI tool assistance in improving the workflow and accuracy of AP diagnosis.

Investigation of Cytokines, Biochemical Parameters and Oxidative Stress Levels in Serum of Patients with Acute Pancreatitis

Objective: This study aimed to find new serum biochemistry parameters, especially for the early identification of severe AP. In the study serum cytokine levels (TNF-A, IL-1, IL-6, IL-10, IL-21), biochemical parameters (Aquaporin-1, Hepcidine, Iron, Zinc, Copper, Nitric Oxide, C-Reactive protein), and oxidative stress parameters analysis were performed. Method: A total of 46 patients with AP and 46 healthy controls were included in this study. Serum cytokine levels, biochemical, and oxidative stress parameters by the ELISA method, and CRP by the immunoturbidimetric method were measured. Results: When patients with AP and control groups were compared, all studied parameters were found to be statistically significant (p<0.05). However, IL-1 was found to be insignificant (p>0.05). Therefore, the Mann-Whitney U test, which is a non-parametric test, was found suitable to determine whether there was a significant difference between the patient and control groups. Conclusions: Investigating the role of cytokines, oxidative stress and other biochemical parameters in the pathogenesis and course of the disease may contribute to a better understanding of the disease process and its therapeutic value. It showed a significant increase in oxidative stress parameters and biochemical parameters such as aquaporin-1, hepcidin, lipase, and amylase, which may help in the diagnosis of AP.

Measuring the prevalence of aspiration pneumonia in view of improving the relevance of antibiotic prescription of antibiotics: A retrospective, observational study

PurposeAspiration pneumonia (AP) has significant incidence and impact on mortality. However, data about clinical diagnosis criteria are scarce. We aimed to evaluate according to predefined criteria the prevalence of true AP and its impact on antibiotic stewardship. MethodsRetrospective study of patients whose main diagnosis was AP hospitalized at Amiens University Hospital in 2018. We first defined diagnostic criteria of certainty for pneumonia and aspiration. AP was then classified according to degree of certainty. ResultsAmong 862 cases of AP, its diagnosis was certain, likely, probably in excess, certainly in excess or absent in 2 % (n = 17), 3 % (n = 26), 50.5 % (n = 433), 23.1 % (n = 198) and 21.4 % (n = 183) respectively. Irrelevant use of amoxicillin-clavulanic acid and metronidazole was found in 27 % and 13 % of cases, respectively. ConclusionsThe diagnosis of AP is frequently excessive, and diagnostic tools are urgently needed to improve antibiotic stewardship.

An Observational Study to To Find Impact of Covid 19 Infection on Causation and Prognosis of Pancreatitis in a Tertiary Care Center

Objective :To find impact of covid 19 infection on causation and prognosis of pancreatitis Design :Prospective observational study Setting :A large, academic, tertiary medical center Methodology:Clinical and laboratory data of all consecutive patients with a primary diagnosis of AP during past 6months with history of covid 19 infection was collected .Clinical and radiological grading was taken into consideration for finding severity. Results:out of 30 patient 4 patients had severe covid 19 infection requiring more than 10days of hostilization but though 1 of those 4patient developed recurrent pancreatitis but severity score was less(clinical and radiological).14 had mild covid 19 infection with minimal respiratory and more of GI symptoms .Out of these 14 ,10 developed severe acute necrotizing pancreatitis requiring ICU stay and prolonged hospital stay .12 patients had mild covid 19 infection with respiratory symptoms .10 of them had pancreatitis of mild severity ,2 developed severe necrotizing pancreatitis. Interpretation and conclusion:Based on our study we conclude that more than severe covid 19infection mild covid 19infection with GI symptoms has a greater impact on the prognosis of patient with pancreatitis.However there is still insufficient evidence showing that covid 19 can cause AP or negatively impact prognosis.Additional major studies are needed to clarify relationship between these two entities

Diagnostic accuracy of cerebral [18F]FDG PET in atypical parkinsonism

BackgroundAtypical parkinsonism (AP) often presents with Parkinson’s symptoms but has a much worse long-term prognosis. The diagnosis is presently based on clinical criteria, but a cerebral positron emission tomography (PET) scan with [18F]fluoro-2-deoxy-2-d-glucose ([18F]FDG) may assist in the diagnosis of AP such as multiple system atrophy (MSA), progressive supranuclear palsy (PSP), corticobasal degeneration (CBD), and Lewy body dementia (DLB). Only few studies have evaluated the sensitivity and specificity of [18F]FDG PET for separating the diseases in a mixed patient population, which we aim to assess in a retrospective material.ResultsWe identified 156 patients referred for a cerebral [18F]FDG PET for suspicion of AP during 2017–2019. The [18F]FDG PET was analysed by a nuclear medicine specialist blinded to clinical information but with access to dopamine transporter imaging. The reference standard was the follow-up clinical diagnosis (follow-up: 6–72 months). The overall accuracy for correct classification was 74%. Classification sensitivity (95% confidence interval, CI) and specificity (95% CI) for MSA (n = 20) were 1.00 (0.83–1.00) and 0.91 (0.85–0.95), for DLB/Parkinson with dementia (PDD) (n = 26) were 0.81 (0.61–0.93) and 0.97 (0.92–0.99) and for CBD/PSP (n = 68) were 0.62 (0.49–0.73) and 0.97 (0.90–0.99).ConclusionsOur results support the additional use of [18F]FDG PET for the clinical diagnosis of AP with moderate to high sensitivity and specificity. Use of [18F]FDG PET may be beneficial for prognosis and supportive treatment of the patients and useful for future clinical treatment trials.

Nano-curcumin supplementation in patients with mild and moderate acute pancreatitis: A randomized, placebo-controlled trial.

We aimed to investigate whether nano-curcumin as an anti-inflammatory agent is effective in patients with mild and moderate AP. This study was a double-blind, parallel-arm randomized controlled trial conducted at Taleghani hospital, Tehran, Iran. Eligible subjects with a diagnosis of mild and moderate AP were randomly assigned to receive either two doses of nano-curcumin (40 mg) or placebo (control) daily for 2 weeks. The primary endpoint was gastrointestinal (GI) ward length of stay (LOS). A total of 42 patients were randomly assigned to receive either nano-curcumin (n = 21) or placebo (n = 21). Compared with placebo, nano-curcumin supplementation decreased hospital LOS (RR = 0.67, 95% CI: 0.502-0.894; p = 0.006), reduced the need for analgesics over time (OR = 0.576, 95% CI: 0.421-0.790; p = 0.001), and increased overall appetite score over the study period (β = 0.104, SE: 0.053; p = 0.049). No adverse effects or mortality were reported and there was no withdrawal during the study period. The results indicate that nano-curcumin as an adjuvant therapy is safe and may reduce GI ward LOS, analgesics requirement, and improve the overall appetite in patients with mild and moderate AP. Future multi-center trials with larger sample sizes are required to verify these findings. Clinical trial registration: www.ClinicalTrials.gov NCT04989166.

Detect Acute Porphyrias in Emergency Departments (DePorED) – a pilot study

BackgroundAcute porphyrias (APs) are a group of rare metabolic diseases related to a disturbed heme biosynthesis. Symptoms may first occur as life threatening attacks, comprising abdominal pain and/or variable neuro-psychiatric symptoms, thus leading to presentation in emergency departments (ED) first. Due to the low prevalence, diagnosis of AP is often missed, even after readmission to the ED. Therefore, strategies are needed to consider APs in ED patients with unexplained abdominal pain, especially since early and adequate treatment will avoid an unfavorable clinical course. Aim of this prospective study was to investigate the prevalence of APs in ED patients and thus, addressing feasibility of screening for rare diseases, such as APs in the real life setting.MethodsFrom September 2019 to March 2021, patients presenting to the ED of three German tertiary care hospitals with moderate to severe prolonged abdominal pain (Visual Analog Scale, VAS > 4 out of 10 points) not otherwise explained were screened and prospectively enrolled. In addition to standard of care (SOC) diagnostics a blood and urine sample for plasma fluorescence scan and biochemical porphyrin analysis were sent to a certified German porphyria laboratory.ResultsOverall, of 653 screened patients, 68 patients (36 females; mean age 36 years) were included for biochemical porphyrin analysis. No patient with AP was detected. The most frequent discharge diagnoses included “abdominal and digestive symptoms” (n = 22, 32%), “gastrooesophageal diseases” (n = 18, 27%), “infectious bowel disease” (n = 6, 9%) and “biliopancreatic diseases” (n = 6, 9%). Although not primarily addressed, we observed an increase in knowledge of the ED staffs at all study sites regarding our screening algorithm and thus, awareness for APs.ConclusionsTo the best of our knowledge, we performed the first prospective screening project for APs in the ED. Although we detected no patient with AP in this study, we demonstrated the feasibility of a multicenter screening process for APs by building up a well-working infrastructure comprising laboratory testing as well as data management. This enables the set-up of a larger scale revised follow-up study with a central focus on structured education, thus, possibly acting as blueprint for other rare diseases.

Effectiveness of an Intravenous Insulin-Based Treatment Protocol for the Management of Hypertriglyceridemia-Associated Acute Pancreatitis.

There is burgeoning interest in intravenous insulin for hypertriglyceridemia-induced acute pancreatitis (HTG-AP) as a less invasive alternative to plasmapheresis; however, there are few published descriptions of disease-specific insulin protocols. To compare the efficacy and safety of an insulin infusion-based protocol with nonstandardized medical therapy for HTG-AP. This is a retrospective analysis before and after creation of an HTG-AP-specific insulin infusion treatment protocol. Inclusion criteria were age ≥18 years, an initial triglyceride level >1000 mg/dL, and a diagnosis of AP. The primary outcome of the study was time to a triglyceride level ≤1000 mg/dL. Sixty-seven patients were included in this study (26 pre-protocol and 41 in the HTG-AP insulin protocol group). Baseline characteristics between the groups were similar, with median initial triglyceride levels >3500 mg/dL. There was a trend toward patients treated with the HTG-AP-specific infusion reaching a triglyceride level ≤1000 mg/dL faster (43.3 [24.9-72.1] vs 26.9 [17.7-51.1] hours; P = 0.07). Those treated to ≤500 mg/dL achieved this faster with the disease-specific infusion (49.2 [29.4-67.8] vs 70.9 [36.3-107.2] hours, P = 0.04). Hypoglycemia was numerically lower in the HTG-AP-specific insulin infusion group despite higher insulin infusion rates (7.3% vs 19.2%). No patient in the HTG-AP-specific protocol group required plasmapheresis. The use of an HTG-AP-specific insulin infusion protocol, compared with antecedent nonstandardized care, resulted in prompter achievement of a triglyceride level ≤500 mg/dL and a strong trend toward faster achievement of ≤1000 mg/dL without an increased risk of hypoglycemia. While intravenous insulin may be considered the initial medical therapy for HTG-AP, further studies are needed to determine the optimal dosing.

Disrupted redox balance in utero-placenteal junction may be the main culprit in the occurrence of abruptio placenta.

To determine the oxidant/antioxidant balance and proinflammatory status in amniotic fluids collected during cesarean section of patients diagnosed with abruptio placenta. Twenty-five patients diagnosed with ablatio placenta with intact membranes who went to emergency cesarean section were included in the study. A diagnosis of AP was made in those who had at least one of the following criteria or, in suspicious cases, two findings. (i) Antepartum hemorrhage starting after 20 weeks of gestation, (ii) presence of retroplacental hematoma on ultrasonography, (iii) severe fetal distress or death, (iv) localized or diffuse uterine tenderness or pain. The control group consisted of 25 patients who presented for delivery, who were not diagnosed with AP, and whose membranes were intact. NF-κB, total oxidant capacity (TOC), total antioxidant capacity (TAC), and oxidative stress index (TOC/TAC=OSI) levels were measured in amniotic fluids collected during cesarean section from both groups. Amniotic fluid TAS values of the AP group were significantly lower than the healthy controls (1.14±0.33 vs. 9.05.±3.40, p<0.01). Amniotic fluid TOS values were significantly increased in the AP group (36.1±8.10 vs. 11.4±2.77, p<0.02). OSI values were significantly higher in the AP group (31.6±9.03 vs. 1.26±0.02, p<0.01). Amniotic fluid NF-κB expression of the AP group was approximately 5 times higher than the control group (10.4±2.56 ng/mL vs. 1.86±0.30 ng/mL, p<0.01). High blood pressure and smoking history were significantly higher in the AP group. Gestational age and fetal birth weight of the AP group were lower than the control group. Since the increase in amniotic fluid oxidant capacity and proinflammatory cytokine synthesis cannot be neutralized by the antioxidant system, hypoxic cell damage may lead to premature separation of the placenta.

PLEOMORPHIC ADENOMA IN PALATE: CASE REPORT

The objective of this work is to report the case of a 45-year-old dark-skinned female patient with the presence of an injury for 10 years and without treatment who attended the stomatology service with the main complaint of a "lump in the mouth." On intraoral examination, a nodular lesion on the hard palate was noted, with a normal color and with reddish spots in the center, a smooth, oval surface with a sessile base, sharp edges, and firm consistency, measuring 0.8 × 0.8 × 0.5 cm. The clinical hypothesis was pleomorphic adenoma (AP). An incisional biopsy was performed, and histopathologic sections revealed a benign neoplasm derived from the salivary gland. The patient was submitted to complete removal of the lesion after confirmation of the anatomopathologic diagnosis of AP. This case reinforces the importance of the stomatologist in elucidating the diagnosis of neoplasms in salivary glands as well as directing the conservative treatment.

Endoscopic ultrasound diagnostic gain over computed tomography and magnetic resonance cholangiopancreatography in defining etiology of idiopathic acute pancreatitis.

BACKGROUNDAbout 10%-30% of acute pancreatitis remain idiopathic (IAP) even after clinical and imaging tests, including abdominal ultrasound (US), contrast-enhanced computed tomography (CECT) and magnetic resonance cholangiopancreatography (MRCP). This is a relevant issue, as up to 20% of patients with IAP have recurrent episodes and 26% of them develop chronic pancreatitis. Few data are available on the role of EUS in clarifying the etiology of IAP after failure of one or more cross-sectional techniques.AIMTo evaluate the diagnostic gain after failure of one or more previous cross-sectional exams.METHODSWe retrospectively collected data about consecutive patients with AP and at least one negative test between US, CECT and MRCP, who underwent linear EUS between January 2017 and December 2020. We investigated the EUS diagnostic yield and the EUS diagnostic gain over different combinations of these cross-sectional imaging techniques for the etiologic diagnosis of AP. Types and frequency of EUS diagnosis were also analyzed, and EUS diagnosis was compared with the clinical parameters. After EUS, patients were followed-up for a median of 31.5 mo to detect cases of pancreatitis recurrence.RESULTSWe enrolled 81 patients (63% males, mean age 61 ± 18, 23% with previous cholecystectomy, 17% with recurrent pancreatitis). Overall EUS diagnostic yield for AP etiological diagnosis was 79% (20% lithiasis, 31% acute on chronic pancreatitis, 14% pancreatic solid or cystic lesions, 5% pancreas divisum, 5% autoimmune pancreatitis, 5% ductal abnormalities), while 21% remained idiopathic. US, CECT and MRCP, taken alone or in combination, led to AP etiological diagnosis in 16 (20%) patients; among the remaining 65 patients, 49 (75%) obtained a diagnosis at EUS, with an overall EUS diagnostic gain of 61%. Sixty-eight patients had negative US; among them, EUS allowed etiological diagnosis in 59 (87%). Sixty-three patients had a negative CECT; among them, 47 (74%) obtained diagnosis with EUS. Twenty-four had a negative MRCP; among them, 20 (83%) had EUS diagnosis. Twenty-one had negative CT + MRCP, of which 17 (81%) had EUS diagnosis, with a EUS diagnostic gain of 63%. Patients with biliary etiology and without previous cholecystectomy had higher median values of alanine aminotransferase (154 vs 25, P = 0.010), aspartate aminotransferase (95 vs 29, P = 0.018), direct bilirubin (1.2 vs 0.6, P = 0.015), gamma-glutamyl transpeptidase (180 vs 48, P = 0.006) and alkaline phosphatase (150 vs 72, P = 0.015) Chronic pancreatitis diagnosis was more frequent in patients with recurrent pancreatitis at baseline (82% vs 21%, P < 0.001). During the follow-up, AP recurred in 3 patients, one of which remained idiopathic.CONCLUSIONEUS is a good test to define AP etiology. It showed a 63% diagnostic gain over CECT + MRCP. In suitable patients, EUS should always be performed in cases of IAP. Further prospective studies are needed.

Comparative Evaluation of Bedside Index of Severity in Acute Pancreatitis Bisap) &amp; Modified Computed Tomography Severity Index (MCTSI) in Assessing Severity of Acute Pancreatitis

Objective: To compare diagnostic accuracy of BISAP and MCTSI in predicting the severity of Acute pancreatitis. Study design: cross sectional study. Setting: Surgical department Khyber Teaching Hospital, Peshawar and Bacha Khan Medical Complex, Swabi. Duration: 6 months Jan, 2021 to June, 2021 Material and Methods: In this study a total of 246 patients were observed. The demographic, clinical and laboratory data of all consecutive patients with a primary diagnosis of AP admitted/transferred to our ward were prospectively collected and then this data were retrospectively analyzed. The day of admission is defined as the first 24hr of hospitalization in our ward or in the referring hospital/ward. Contrast enhanced CT(CECT) and BISAP score were calculated after 72hrs in all patients and they were categorized into three severity grades of Acute pancreatitis based on Atlanta classification 2012 as discussed in operational definition. BISAP score greater than 4 and MCTSI score greater than 8 were considered severe acute pancreatitis. Results: In this study mean age was 45 years with SD ± 16.21. Forty three percent patients were male while 57% patients were female. MCTSI had sensitivity 89.83%, specificity 60%, Positive predictive value was 98.14%, Negative predictive value was 20% and the overall diagnostic accuracy was 88.61%. While BISAP had sensitivity 82.05%, specificity 70%, Positive predictive value was 98.49%, Negative predictive value was 14.89% and the overall diagnostic accuracy was 82.52%. Conclusion: Our study concludes that the diagnostic accuracy of MCTSI is better than BISAP score in predicting the severity of acute pancreatitis. Keywords: MCTSI, BISAP score, severe acute pancreatitis.

The Prognostic Value of Different Levels of Cortisol and High-Sensitivity C-Reactive Protein in Early Acute Pancreatitis

BackgroundAcute pancreatitis (AP) ranges in severity from mild to severe with high mortality. Severe AP, similar to other critical illnesses, is associated with changes in cortisol level. Early increase of high-sensitivity C-reactive protein (hs-CRP) as an inflammatory marker could be an indicator of AP progression. We aimed to assess the level of cortisol and hs-CRP on initial diagnosis of AP and identify their prognostic value. MethodsThis case-control study included patients with AP and a control group of healthy subjects. Laboratory tests such as liver profile, kidney functions, blood picture, lactate dehydrogenase, blood glucose, and lipogram were evaluated, the severity of AP was determined, the duration of hospitalization, complications, and outcomes were identified, and the serum levels of cortisol and hs-CRP were assessed. ResultsThere were 90 patients with AP and 60 controls with a higher percent of females in both groups. Serum cortisol and hs-CRP were significantly higher in AP relative to controls and were higher in severe AP relative to mild AP. Significant positive correlation was present between high cortisol and severity of AP (r = 0.520 and p<0.001) and negatively with pancreatic necrosis (r= - 0.303 and p = 0.007) and morality (r= - 0.432, p = 0.005) while hs-CRP did not show significant correlation. ConclusionsDifferent levels of serum cortisol in early AP should be considered on initial diagnosis. High cortisol level was a good prognostic indicator for AP with low mortality. This could have further implications on the appropriate initiation of steroid therapy to prevent necrotizing pancreatitis and lower the mortality. Meanwhile, hs-CRP has a low prognostic value in early AP.

Systemic anticoagulation is associated with decreased mortality and morbidity in acute pancreatitis

Background/objectivesAcute pancreatitis (AP) is a procoagulant state, and markers of coagulopathy are associated with AP severity. We aimed to explore the association of systemic anticoagulation therapy before AP onset with the inpatient outcomes of patients with acute pancreatitis. MethodsThis case-control, retrospective study used data from the Nationwide Inpatient Sample (Jan 2014–Dec 2016). We used medical coding data to identify patients with a principal diagnosis of AP who were receiving systemic anticoagulation therapy. Patients with anticoagulation were matched to those without it on the propensity for having anticoagulation. The propensity for having anticoagulation was estimated using a logistic regression model, matching for age, gender, race, median household income for patients' zip code, Charlson comorbidity score, region of hospital, location of hospital (urban/rural), teaching status of hospital, if admission day was on a weekend, pancreatic cancer class, obesity, tobacco usage. Secondary outcomes were inpatient outcomes and hospital expenditures. ResultsA total of 190,474 patients admitted for acute pancreatitis were identified, out of which 7827 patients were on anticoagulation. After propensity matching, 5776 matched pairs were successfully identified. Patients with AP on anticoagulation tended to have lower risk for ICU admission, acute kidney injury, organ failure or inpatient mortality. However, the group with anticoagulation had longer hospital length of stay and higher hospital costs. ConclusionsAnticoagulation therapy may have a pivotal role in the pathogenesis and progression of AP. These data suggest a potential therapeutic role for anticoagulants in AP. Further studies are needed to better understand these observations.

Identification of a Risk Profile for New-Onset Diabetes After Acute Pancreatitis.

There is a paucity of studies evaluating predictors of new-onset diabetes mellitus (DM) after acute pancreatitis (AP-related DM). We used a population-based database to evaluate predictors of AP-related DM. The Nationwide Readmissions Database (2010-2014) was used to identify all nondiabetic adults with an index primary diagnosis of AP. Multiple exclusions were applied to identify cohorts with and without AP-related DM. A case-control study was conducted to identify risk factors for developing AP-related DM within the calendar year. We identified 2510 subjects with AP-related DM and 40,308 controls with AP who did not develop DM. Multivariable analysis revealed that increasing age (50-64 years; adjusted odds ratio [aOR], 1.35; 95% confidence interval [CI], 1.14-1.60), male sex (aOR, 1.2; 95% CI, 1.03-1.40), lowest income quartile (aOR, 1.48; 95% CI, 1.18-1.84), Elixhauser comorbidity index of 3 or higher (aOR, 1.47; 95% CI, 1.23-1.75), components of metabolic syndrome (aOR, 2.12; 95% CI, 1.21-3.70), severe AP (aOR, 1.60; 95% CI, 1.34-1.90), and recurrent AP (aOR, 1.46; 95% CI, 1.24-1.72) were independently associated with increased risk of AP-related DM. These population-level variables predictive of developing AP-related DM can potentially identify patients who may benefit from closer follow-up, intensive education, and implementation of preventative strategies.

Management of Apical Periodontitis in Dental Clinic

Apical periodontitis is an inflammation and destruction of peri-radicular tissues, with a clinical feature of mild pain or no pain to moderate to severe pain that couldn’t be tolerated by the patient depending upon the type to AP from which patient is suffering from. Here in this article, we are going to describe briefly about the AP with its dental management in dental clinic. Although, it could not be possible to give confirmatory diagnosis for AP in every dental clinic because of lack of histopathological labs, but on the basis of clinical &amp; radiographical findings we can go for the provisional diagnosis of AP and thus manage it accordingly depending upon the prognosis of the disease.

Evaluation of patients who are clinically suspected for the case of acute pancreatitis by MCTSI

AP can be diagnosed either by clinical, laboratory, or image findings. For an appropriate diagnosis of AP, at least two of the following criteria to be fulfilled. In majority of cases, the disease is self-limiting and presents with response to supportive treatment alone. The assessment of the severity of AP has a significant role in management. All male and female patients with complaints of abdominal pain (epigastric pain), vomiting with raised serum amylase & lipase levels and who underwent contrast enhanced MDCT during study period were study subjects. MDCT being a useful, non-invasive, accurate investigative tool in confirming the clinical diagnosis of acute pancreatitis and grading of AP as mild (grade 2 and grade 4), moderate (grade 6) and severe (grade 8 and 10) contrary to other previous studies which classified it into mild (grade 2), moderate (grade 4 and grade 6) and severe (grade 8 and 10) on the basis of MCTSI scoring index.