Elevated Serum Amylase Research Articles

Post-pancreatectomy Acute Pancreatitis in Distal Pancreatectomies — a Rare Bird According to the New Definition

BackgroundPost-pancreatectomy acute pancreatitis (PPAP) is a recently identified clinical condition characterized by sustained elevated serum amylase levels for at least 48 h post-operatively, consistent radiological findings, and relevant clinical features. The purpose of this study was to determine the frequency of PPAP after DP, to investigate the rate of major complications in patients with sustained or transiently elevated serum amylase activity, and to explore the usability of CT as a prerequisite for the diagnosis of PPAP. MethodsThis retrospective single-center observational study included consecutive patients 18 years or older who underwent DP at Karolinska University Hospital between 2008 and 2020. The two serum amylase levels on post-operative days (POD) 1 and 2 were correlated with post-operative major complications by logistic regression analyses. ResultsOf the 403 patients who underwent DP, 14% (n = 58) had sustained elevated serum amylase levels according to PPAP criteria, and 31% (n = 126) had transiently elevated serum amylase levels on either POD1 or POD2. Of the patients with sustained elevated levels, 45% (n = 26) developed major complications, but less than 2% (n = 1) showed imaging findings consistent with acute pancreatitis. Of the 126 patients who exhibited only transiently elevated serum amylase on either POD1 or POD2, 38% (n = 48) developed major complications. The frequency of PPAP was 0.25% (n = 1). ConclusionThese findings indicate that PPAP after DP is rare and that computed tomography has limited usability for diagnosing PPAP. The findings also suggest that transiently elevated serum amylase may be an early indicator of acute pancreatitis, especially when peaked.

Pancreatic adverse events of immune checkpoint inhibitors therapy for solid cancer patients: a systematic review and meta-analysis.

This review aims to determine the incidence and risk of pancreatic adverse events (AEs) associated with immune checkpoint inhibitors (ICIs) therapy for solid tumors. We conducted a comprehensive systematic literature search in PubMed, Embase, and Cochrane Library up to March 15, 2023, to identify all randomized controlled trials comparing ICIs with standard treatment in solid tumors. We included studies that reported immune-related pancreatitis or elevation of serum amylase or lipase levels. Following protocol registration in PROSPERO, we conducted a systematic review and meta-analysis. 59 unique randomized controlled trials with at least one ICI-containing arm (41 757 patients) were retrieved. The incidences for all-grade pancreatitis, amylase elevation and lipase elevation were 0.93% (95% CI 0.77-1.13), 2.57% (95% CI 1.83-3.60) and 2.78% (95% CI 1.83-4.19), respectively. The incidences for grade ≥3 pancreatitis, amylase elevation and lipase elevation were 0.68% (95% CI 0.54-0.85), 1.17% (95% CI 0.83-1.64) and 1.71% (95% CI 1.18-2.49), respectively. The use of ICIs was associated with an increased risk of all-grade pancreatic immune-related AEs (irAEs) including pancreatitis (OR=2.04, 95% CI 1.42-2.94, P =0.0001), amylase elevation (OR=1.91, 95% CI 1.47-2.49, P < 0.0001) and lipase elevation (OR=1.77, 95% CI 1.37-2.29, P < 0.0001). In addition to these, the post-hoc analysis found that PD-1 inhibitors had a significant higher risk of pancreatic AEs compared with PD-L1 inhibitors and the patients undergoing dual ICI therapy were at a significantly higher risk of pancreatic AEs than the patients receiving single ICI therapy. Our study provides an overview of the incidence and risk of ICI-associated pancreatitis and pancreatic enzyme elevations in the treatment of solid tumors. Our findings may help raise awareness among clinicians of the potential for ICI-associated pancreatic AEs in clinical practice. https://www.crd.york.ac.uk/PROSPERO, identifier 345350.

Acute pancreatitis: An unusual presentation of systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is a multi-system and chronic inflammatory autoimmune disease characterised by the presence of autoantibodies and the creation of immune complexes, coming up with protean manifestations. Its occurrence in children is rare and acute pancreatitis as the presenting manifestation of childhood SLE is exceptional. Diagnosis of lupus pancreatitis is clinical, biological and radiological. Here, we report an 8 year 8-month-old young girl who presented to our hospital with abdominal pain, nausea and vomiting. She also had a fever, alopecia, oral ulceration and glossitis. Her investigations showed elevated serum amylase and lipase levels, suggestive of acute pancreatitis. Other investigations revealed pancytopenia, low complement, microalbuminuria and high antinuclear antibodies level, indicative of SLE. As a result, the diagnosis of lupus pancreatitis was retained. Her clinical symptoms and signs markedly improved after a course of glucocorticoid and immunosuppressive therapy. The child is now being brought for regular follow-up and is doing well.

Abstract #1385190: Empagliflozin Induced Acute Pancreatitis

Acute pancreatitis is a rapid onset inflammatory process of the pancreas which may have local and systemic manifestations. The most common causes of acute pancreatitis are gallstones and alcohol use. Other causes include drug-induced. Sodium-glucose cotransporter-2 (SGLT2) inhibitors are a class of oral hypoglycemic agents which is approved by the FDA for treating diabetes and for heart failure. 56-year-old, female patient known to have uncontrolled type 2 diabetes. Presented with a complaint of acute epigastric pain radiating to the back and then become a generalized abdominal pain, moderate in severity, not relieved by analgesic, associated with nausea and vomiting. The patient denied any history of alcohol, smoking use. A review of her medication list included sitagliptin 100 mg, metformin 2g, gliclazide 60 mg and more recently, empagliflozin 10 mg which was started seven weeks prior to symptoms onset. Physical examination was significant for tenderness in epigastric area. Laboratory workup revealed an elevated serum lipase 3851 units/L, serum amylase 3755 units\L abdominal CT scan shows mild fatty atrophy and mild peri-pancreatic fat stranding and free fluid adjacent to the tale and body suggesting evidence of acute pancreatitis. Abdominal ultrasound shows the gall bladder was without stones. The patient was admitted with diagnosis of mild acute pancreatitis and underwent conservative management. Patient condition was improved and discharged on same pre-admission antidiabetic medication with OPD follow-up. 3 weeks later she presented to the emergency department complaining from acute epigastric pain radiating to the back and association of nausea and vomiting. With tenderness in epigastric area laboratory workup revealed an elevated serum lipase and amylase. Abdominal CT scan confirmed acute interstitial pancreatitis. After 3 days of conservative management she was improved and discharged but this time her diabetologist discontinue empagliflozin and she was started on insulin. She was following up with her diabetologist in outpatient clinic and there was no history of recurrence of pancreatitis. Drug induce pancreatitis are rare cause but must be considered. It is therefore important to determine the underlying etiology of acute pancreatitis to prevent occurrence, recurrence, and the complications of pancreatitis. FDA and Health Canada have identified a potential safety issue and possible association between SGLT-2 inhibitors and acute pancreatitis but Further studies are required to investigate this association. This case report emphasized the possible association between SGLT2 inhibitors and acute pancreatitis. Physicians must be aware about this side effect as a possible cause of acute pancreatitis after exclusion of most common etiologies. Also, physician should inform the patient about the side effects of SGLT2 and the symptoms of acute pancreatitis and advised them to stop SGLT-2 inhibitors use in case such symptoms occur. Further studies are required to investigate this association.

Elevation of Serum Amylase and Lipase Levels in Diabetic Ketoacidosis without Acute Pancreatitis: A Case Report and Literature Review

Serum amylase and lipase levels are commonly used as diagnostic markers for acute pancreatitis, but elevated levels of these enzymes can also occur in other conditions. We report a case of a 45-year-old male with a known history of type 2 diabetes who presented with nausea, vomiting, and abdominal pain. Laboratory investigations revealed hyperglycemia, ketonemia, metabolic acidosis, and elevated levels of serum amylase and lipase. However, imaging studies did not reveal any evidence of acute pancreatitis or other abdominal pathology. The patient was diagnosed with diabetic ketoacidosis and managed with fluid resuscitation, insulin therapy, and correction of metabolic acidosis. The serum amylase and lipase levels gradually normalized, supporting the diagnosis of diabetic ketoacidosis without complicated with acute pancreatitis. This case highlights the importance of considering alternative diagnoses in the setting of elevated serum amylase and lipase and appropriate management of diabetic complications to prevent the development of more severe conditions.

Easily missed pediatric handlebar injury.

A 12-year-old girl, who fell from her bicycle, presented to the emergency department with severe epigastric pain and vomiting. Physical examination revealed torso contusion with a circular handlebar bruise over the upper anterior abdomen (Fig. 1a). Focused assessment with sonography for trauma (FAST) revealed no obvious fluid accumulation. Laboratory tests indicated elevated serum amylase (252 U/L) and lipase (>400 U/L) levels. Therefore, intravenous contrast-enhanced computed tomography (CT) with oral water-soluble contrast medium was performed to assess for any internal traumatic injury.

Significant elevations of serum amylase caused by macroamylase: Case reports and detection possibilities.

The presence of isolated elevated serum amylase levels can be caused by high molecular mass complexes. We describe 13 cases of hyperamylasemia detected in adult patients without clinical symptoms of a pancreatic disorder. Five of them were thoroughly examined using different tools for the detection of macrocomplexes. We performed both screening and more advanced methods of macroamylase detection, including polyethylene glycol precipitation, sample storage at 4°C and separation by gel filtration. The presence of macroamylase in the suspected samples was confirmed by the methods described, except for the sample storage at 4°C. In this method, the enzyme activity did not decrease. The polyethylene glycol precipitation activity (% PPA) averaged 89.1% for amylase, whereas the control samples averaged 30.7%. Gel filtration chromatography confirmed an IgA macroamylase peak in three samples and an IgG macroamylase peak in two samples. The presence of macroamylase should be suspected whenever the clinical history and condition of the patient do not match the measured enzyme value to avoid diagnostic errors and unnecessary invasive examinations. The presence of macrocomplexes is considered a benign process that may occur in apparently healthy individuals. Cooperation between clinicians and laboratory staff is necessary.

Analysis of the risk factors and prognosis for severe fever with thrombocytopenia syndrome associated encephalopathy

ObjectiveSevere fever with thrombocytopenia syndrome (SFTS) is frequently associated with neurological injury, but there are currently few relevant studies. The goal of this study was to look at the risk factors for SFTA-associated encephalopathy (SFTSAE) and the short- and long-term prognosis of such patients. MethodsWe retrospectively studied 145 patients with SFTS who were treated at our hospital between May 2019 and November 2021. Clinical characteristics were collected, and patients were divided into two groups based on whether there was neurological injury during the disease: SFTSAE group and non-SFTSAE group. Univariate analysis was used to compare the differences in clinical data and outcomes between two groups, and multivariate Logistic regression analysis was used to reveal the independent risk factors for SFTSAE, and the predictive efficacy was assessed using the receiver operating characteristic (ROC) curve. Furthermore, survivors of SFTSAE were contacted by phone 6 months after discharge to assess the case fatality rate and quality of life. ResultsThe prevalence of SFTSAE was 22.7% (33/145). Bleeding symptoms, D-dimer level and blood amylase level were all independent risk factors for SFTSAE (P < 0.05). The combined AUC of these three factors was 0.969. Patients with SFTSAE had a 45.4% in-hospital mortality rate, and survivors had a largely normal quality of life after discharge. ConclusionPatients with SFTSAE frequently have multiple organ dysfunction, a high mortality rate, and a favorable long-term prognosis for survivors. Clinical manifestations of bleeding symptoms, elevated serum amylase, and elevated D-dimer were all independent risk factors for SFTSAE.

TO STUDY THE ROLE OF C-REACTIVE PROTEIN TO PREDICT THE RISK OF PANCREATIC NECROSIS

INTRODUCTION Acute pancreatitis is an inammation of pancreas of variable severity. Its severity varies from mild to severe attacks like necrotizing pancreatitis which has bad prognosis. C-reactive protein is an inammatory mediator synthesized in the liver and is raised in acute pancreatitis. To study t AIM OF THE STUDY he role of C-reactive protein in predicting the risk of pancreatic necrosis and other severe complications of acute pancreatitis. MATERIALS AND METHODS Ÿ Study setting: The study was conducted on patients admitted in the Department of General Medicine with features suggestive of Acute Pancreatitis. Ÿ Study period: The study was conducted between November 2021 to October 2022 Ÿ Sample size: The present study included 50 patients admitted in the Department of General Medicine with features suggestive of Acute Pancreatitis. INCLUSION CRITERIA1)Patients of any age and either sex presenting with acute pain abdomen and fourfold elevation of Serum Amylase and/or Serum Lipase. EXCLUSION CRITERIA 1)Patients with ischemic heart disease and angina 2)Patients with prior history of fever before onset of pain 3)Patients with chronic infectious diseases and known case of collagen vascular disease. RESULTS Based on 5th day CRP values 50 patients are divided into 3 groups, 1st group(n-30) CRP less than 100mg/dl, 2nd group(n-8) CRP levels between 100-200mg/dl, 3rd group(n-12) CRP levels more than 300mg/dl. The development of necrotizing pancreatitis in correlation with CRP was out of 30 patients in the 1st group, 4(13.33%) developed necrotizing pancreatitis, in the 2nd group, out of 8 patients, 4(50%) developed necrotizing pancreatitis, in the 3rd group, out of 12 patients, all 12(100%) of them developed necrotizing pancreatitis. CRP CONCLUSION levels peaked at 5th day of illness and cut off value of 150mg/dl can be taken above which pancreatic necrosis can be predicted with high probability. This value has a specicity of 80%. CRP values above 200mg/dl has a specicity of 100%.

Correlation of Acute Inflammatory Markers with Oxidative Stress Markers in Patients with Chronic Pancreatitis: A Cross-sectional Study

Introduction: Chronic Pancreatitis (CP) is a long-standing inflammation of the pancreas that presents as episodes of acute inflammation or chronic damage, leading to alterations in the organ’s normal structure and function. Numerous studies have focused on inflammatory and oxidative stress markers in Acute Pancreatitis (AP), but similar studies in CP are rare. Aim: The aim of this study was to compare the serum levels of acute inflammatory and oxidative stress markers in CP patients with healthy controls, and to investigate the correlation between acute inflammatory markers and oxidative stress markers. Materials and Methods: This cross-sectional study was conducted at Jawaharlal Institute of Postgraduate Medical Education Research (JIPMER), Puducherry, India, from January 2018 to December 2021. Forty-five patients diagnosed with CP, based on clinical manifestations, Contrast-Enhanced Computed Tomography (CECT) of the abdomen, and histopathology reports, were enrolled along with 45 healthy controls. Serum biochemical parameters, including inflammatory markers such as high-sensitive C-Reactive Protein (hs-CRP), Interleukin-6 (IL-6), and Tumour Necrosis Factor-alpha (TNF-α), as well as oxidative stress parameters such as Malondialdehyde (MDA), Total Antioxidant Status (TAO), and Total Oxidant Status (TOS), were measured. The Oxidative Status Index (OSI) was calculated. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS) version 21.0. Results: There were no significant differences in age and gender between the two groups. None of the individuals in the control group had diabetes, and their Body Mass Index (BMI) was within normal limits. Patients exhibited leukocytosis, hypoproteinemia, and hypoalbuminemia. Although all patients presented with pain, none had recent acute pain episodes or elevated serum amylase levels. Compared to healthy individuals, CP patients showed significantly elevated serum concentrations of inflammatory and oxidative stress markers, as well as OSI. Serum antioxidant (TAO) levels were significantly reduced in patients compared to controls. Inflammatory and oxidative stress markers were positively correlated with age, smoking and alcohol intake. There was a positive correlation between acute inflammatory markers and oxidative stress markers in patients with CP. Conclusion: Serum inflammatory and oxidative stress markers were significantly elevated in patients with CP as compared to controls, indicating key roles in patients with CP.

Comparative Evaluation of Harmless Acute Pancreatitis Score (HAPS) and Bedside Index of Severity in Acute Pancreatitis (BISAP) Scoring System in the Stratification of Prognosis in Acute Pancreatitis.

Acute pancreatitis is a common disease in patients presenting to the emergency room in any hospital. The most common causes are alcohol ingestion and gallstone disease. Diagnosis is usually based on clinical findings and elevated serum amylase and lipase levels. Imaging is often not necessary but may be used to confirm the diagnosis or rule out any other pathology or to evaluate for any complications. The majority of patients will have a mild, self-limiting disease but others may develop a severe fulminant course with organ failure. These patients are at high risk of developing complications, morbidity or mortality. Treatment of acute pancreatitis includes supportive treatment with antibiotics, fluids, analgesics and early enteral feeding. Several scores have been developed to predict the course of pancreatitis and help make informed decisions, monitoring and timely intervention. The majority of them are complicated, require extensive and expensive interventions or require time. Harmless acute pancreatitis score (HAPS) is one such score that is easy to calculate and is done at the time of admission, bedside index of severity in acute pancreatitis (BISAP) is another one requiring more parameters. The parameters used to calculate it are easily available and can be done at a majority of healthcare facilities in developing countries.HAPS thus seems to be a good option in aiding doctors in assessing acute pancreatitis. It may be considered as a standard scoring for acute pancreatitis for early and effective management. We have tried to study and compare the superiority of HAPS over BISAP in predicting prognosis in acute pancreatitis.

Post-Pancreatectomy Acute Pancreatitis—The New Criteria Fail to Recognize Significant Presentations

BackgroundPost-pancreatectomy acute pancreatitis (PPAP) is a newly described clinical entity defined as elevated serum amylase sustained ≥ 48 h postoperatively, radiological findings consistent with acute pancreatitis, and associated clinically relevant features. This study aimed to investigate the incidence of PPAP and the rate of major complications after pancreatoduodenectomy (PD) in patients with only transiently elevated serum amylase. MethodsA retrospective single-center observational study was conducted including consecutive patients ≥ 18 years of age undergoing PD at Karolinska University Hospital, between 2008 and 2020. Serum amylase on postoperative day (POD) 1 and 2 and records from computer tomography were analyzed and correlated with postoperative major complications by logistic regressions. ResultsOf some 1078 patients that underwent PD, 284 exhibited sustained elevated serum amylase (according to PPAP criteria) and 183 transiently elevated serum amylase on either POD1 or POD2. Of the patients with sustained elevated levels, 43% (n = 123) developed major complications, but only 6.3% (n = 18) showed findings consistent with acute pancreatitis on imaging. Of the 183 cases that exhibited only transiently elevated serum amylase on either POD1 or POD2, 32% (n = 58) developed major complications. ConclusionSustained hyperamylasemia was observed in 26% of patients after PD, and an additional 17% of patients had a transient elevation of serum amylase postoperatively. Acute pancreatitis after PD may be underdiagnosed, partly by overlooking transiently elevated serum amylase and partly by requiring imaging that potentially fails to recognize mild but complication-prone acute pancreatitis.

Audit of amylase and lipase requests in suspected acute pancreatitis and cost implications, South Africa.

BackgroundThe internationally accepted criteria for the diagnosis of acute pancreatitis (AP) requires two of the three following features to be present: characteristic abdominal pain, elevated serum amylase and/or lipase enzymes, or consistent imaging results. However, sensitivity and specificity can vary depending on the population and cut-off values used.ObjectiveThis study evaluated the suitability of amylase and lipase as first-line diagnostic biomarkers of suspected AP for the local population served by Tygerberg Hospital, South Africa.MethodsThis retrospective analysis was conducted in June 2019 using all amylase and/or lipase request data from December 2018. Patient clinical data were included in sensitivity and specificity analyses of amylase, lipase or dual requests for diagnosis of AP. Cost per test data were obtained from the National Health Laboratory Service and used to calculate the total cost of the tests and potential savings.ResultsSensitivity for lipase was 90.0% compared to 50.0% for amylase. Specificity was similar for singular measurements of lipase and amylase. Dual measurement of amylase and lipase showed no improvement in sensitivity (83.3%) and only a minor increase in specificity (97.4%) compared with measurement of lipase alone. The estimated savings was R2522.85 ($174.98 USD), with a potential annual cost saving of R84 423.74 ($5855.69 USD).ConclusionLipase was shown to be a more sensitive biomarker compared to amylase for the screening of AP, providing evidence for laboratories to educate local staff and promote improved requesting practices by clinicians. Additionally, preventing unnecessary dual requests may reduce costs.

The utility of serum amylase as a prognostic marker in multiple myeloma.

Ectopic production of amylase by tumor cells is known since 1951. Elevated amylase in multiple myeloma (MM) was first described in 1988. It has been postulated that translocation of chromosome 1, where amylase gene is situated, is responsible for ectopic production from the malignant plasma cells. Anecdotal reports have shown hyperamylasemia in MM to be associated with extensive bone disease, rapid progression, and shorter survival. Serum amylase estimation is a ubiquitous test. This prospective study was conducted to ascertain the degree of elevated amylase, its clinical utility, and implications in MM patients. In an 18-month period, all consenting patients with newly diagnosed or relapsed MM were tested for serum amylase levels. The study excluded patients with elevated lipase, abnormal creatinine clearance, and evidence of intestinal obstruction or perforation. Patients with amylase value >100 U/L were designated to have "elevated amylase level" for the purpose of this study. We enrolled 58 patients with MM, of which 29.3% (n = 17) were found to have elevated serum amylase levels. The median age of patients with elevated amylase was 65 years. The male-to-female ratio was 1.9:1. There was no statistical association between age, gender, type of heavy chain class, light chain, or high-risk cytogenetics. Among patients with the International Staging System (ISS), Stages I, II, and III, 20.8% (n = 5), 31.3% (n = 5), and 41.2% (n = 7) were noted to have elevated amylase levels. A statistically significant association was noted between the presence of extramedullary disease (EMD) and elevated amylase level (P = 0.028). Higher mortality (29.4% versus 17%) and shorter mean survival of (30.2 ± 3.3 months versus 51.7 + 4.9 months) were recorded in patients with elevated amylase levels in comparison to those with normal levels. Elevated serum amylase level in MM is indicative of advanced ISS stage, the presence of EMD, higher risk of mortality, and shorter survival. Serum amylase can be used as a cost-effective tool in myeloma management.

The Elevation of Pancreatic Enzymes in Serum and Their Distribution at Different Stages of Renal Insufficiency Among Diabetic Patients Attending Goba Referral Hospital.

IntroductionAcute pancreatitis is auto-cell destruction that is manifested by increased leakage of amylase and lipase into circulation. During pancreatitis, the activity of serum amylase and lipase is elevated three times above the upper limit of the normal range. This elevation was observed in both prediabetic and diabetic patients. Severe acute pancreatitis can result in acute kidney injury and other multi-organ dysfunction, which is one of the reasons for death.ObjectiveThis study aimed to evaluate the elevation of serum amylase and lipase and their distribution at different stages of renal insufficiency among diabetic patients.MethodsThis study included 286 diabetic patients (36 type 1 and 250 type 2), and data were collected from May 1 to June 30, 2019. The study design used was an institution-based cross-sectional study. A face-to-face interview was used to collect data, and serum creatinine, amylase, and lipase levels were measured using a chemistry analyzer. For data entry and statistical analysis, respectively, Epidata software version 3.02 and SPSS version 21 were used.ResultsThe mean serum amylase among diabetic patients suffering from G3b and G4 was 106.79 IU/L ± 118.18 IU/L and 104.85 ± 90.42 IU/L, respectively. Their mean serum lipase activity was 105.07 IU/L ± 127.54 IU/L and 106.98 IU/L ± 88.35 IU/L, respectively. Serum lipase activity was elevated above the normal range and three times above the upper limit of the normal range with a magnitude of 11.2% and 4.2%, respectively. Similarly, 9.1% and 0.7% of diabetic patients had increased serum amylase above the normal range and three-fold above the normal range, respectively.ConclusionAs glomerular filtration decreases, particularly in moderate-to-severe chronic kidney disease, serum amylase and lipase activity rise above the upper limit.

The uncommon diagnosis of hiatal hernia associated pancreatitis: A case report.

Introduction and importanceHiatal hernia (HH) contents commonly include stomach, transverse colon, small intestine, and spleen but herniation of the pancreas is an extremely rare phenomenon, even rarer when HH is associated with acute pancreatitis.Case presentationA 56-year-old female with hypertension and gastroesophageal reflux disease presented with abdominal pain, vomiting and chest discomfort evolving for 24 h. Physical examination revealed left-upper quadrant tenderness without guarding. Blood tests showed elevated serum amylase and lipase levels.An abdominal CT scan demonstrated a large type-IV hiatal hernia involving the entire stomach, transverse and right colon, small intestine, duodenum as well as the head, body and the tail of pancreas. The pancreas was enlarged consistent with pancreatitis. Patient clinical status improved with conservative treatment.Clinical discussionThe stomach is the most common organ to herniate through the diaphragm and pancreatic herniation is extremely rare with only few cases in the literature. Even rarer when associated with acute pancreatitis. This diagnosis is a major diagnostic and therapeutic challenge that has to be evoked in elderly presenting with chest pain and a negative cardiopulmonary evaluation. The ideal treatment is still unclear, however, conservative treatment is the initial management and surgery may be considered in case of recurrent episodes of acute pancreatitis.ConclusionHH associated with acute pancreatitis is a major diagnostic and therapeutic challenge. Clinicians should consider this rare diagnosis in every case of chest pain with negative cardiopulmonary evaluation.

Zinc phosphide (rodenticide) poisoning: A case report of deliberate self-harm in an eleven-year-old

Zinc Phosphide(Zn3P2) is a common rodenticide freely available in Nigeria for use against rodents. Occasionally human consumption occurs either accidentally or intentionally with potential consequences of multiorgan toxicity and death. An 11-year-old boy consumed an unknown quantity of zinc phosphide marketed as Push Out® with the intention of committing suicide and killing some members of the family as his response to chastisement for a misdemeanour. Patient presented in the hospital 4 days after ingestion of zinc phosphide with a history of profound vomiting and abdominal pain. Laboratory evaluation showed evidence of hepatic dysfunction, acute kidney injury and elevated serum amylase. He was managed conservatively and discharged home after two weeks of admission. We report this case to emphasise the need for Paediatricians to consider ingestion of rodenticides as a differential diagnosis of hepatoxicity and pancreatic enzyme elevation, as well as to highlight the possibility of suicide among children. There is need to control the indiscriminate use of rodenticides, strengthen public health education on poisoning as well as establish Poison Information Centres in our environment.

Reorienting of pramipexole as a promising therapy for acute pancreatitis in a rat model by suppressing TLR4\NF-κB p65\NLRP3 inflammasome signaling.

Acute pancreatitis (AP), a disorder of global importance, has a growing incidence and prevalence, particularly in the Western world. Its complications include pseudocysts and chronic pancreatitis. Pramipexole (PMX), a D2/3 receptor selecting agonist used in Parkinsonism, was reported to have anti-inflammatory effects. This study explored the potential curative role of PMX in an l-arginine-induced acute pancreatitis rat model in addition to a possible mechanistic pathway. Rats were divided randomly into three groups: control, l-arginine, and l-arginine+PMX. Seven days after AP induction, rats were decapitated and estimated for serum amylase, lipase, glucose, pancreatic inflammatory mediators toll-like receptor-4, nuclear factor κ B p65, serum tumor necrosis factor-α, NOD-, LRR and pyrin domain- containing protein 3 (NLRP3) inflammasome, caspase-1, interleukin 1β, oxidative biomarkers malondialdehyde, myeloperoxidase, nitrite/nitrate, reduced glutathione, and the apoptotic marker caspase-3, with pancreatic histopathological changes. l-arginine-mediated AP was proved by elevated serum lipase and amylase and pancreatic inflammatory, oxidative, and apoptotic markers with infiltration of inflammatory cells usinghematoxylin and eosinstain. PMX improved all these adverse signs of AP greatly. PMX might be considered an innovative therapy for AP due to its remarkable antioxidant, antiapoptotic, and anti-inflammatory effects, which are attributed to the suppression of the NLRP3 inflammasome and its downstream inflammatory cytokines.

Comparative assessment of two imaging modalities and their application in the evaluation of pancreatic/peripancreatic changes due to acute pancreatitis

Aim: Comparison of two imaging modalities and their application in the evaluation of pancreatic/peripancreatic changes due to acute pancreatitis.Materials and Methods: The present comparative study was performed on 100 patients suspected of acute pancreatitis confirmed by elevated serum amylase and serum lipase levels, between November 2015 to May 2017 in the Department of Radiodiagnosis in Victoria Hospital and Bowring and Lady Curzon Hospital attached to Bangalore Medical College and Research Institute, Bengaluru. All patients underwent a real-time ultrasound scan of the abdomen using a curvilinear transducer of 2 to 6 MHz of Philips IU22 and triple-phase contrast-enhanced computed tomography of the abdomen by Philips INGENUITY 128 slice CT in Victoria hospital or Siemens SOMATOM 6 slice CT present in Bowring hospital.Results: Most patients with acute pancreatitis (~30%) belonged to the age group 41-50 years while 28% each belonged to the age group 31-41 and 41-50 years respectively. Amongst males (n=88), 72% (n=64) were cases of acute pancreatitis and 28% (n=24) were the cases of acute on pancreatitis. On the other hand, of 12 females, 58% (n=07) were the cases of acute pancreatitis and 42% (n=05) were the cases of acute on chronic pancreatitis. Both ultrasonography (US) and MDCT were able to delineate normal-sized pancreas, increased size of head and body of pancreas and atrophic pancreas. While the US was able to identify only 17 cases, CT was able to detect 55 with a sensitivity of ~31%, which was statistically significant (p

Prevalence and prognosis of increased pancreatic enzymes in patients with COVID-19: A systematic review and meta-analysis

IntroductionThe prevalence of increased pancreatic enzymes (elevated serum amylase and/or lipase) and its relationship to clinical outcomes in patients with coronavirus disease 2019 (COVID-19) infection is not known. MethodsA systematic review and meta-analysis of relevant studies reporting prevalence and impact of increased pancreatic enzymes (defined as an elevation in amylase and/or lipase levels above the upper limit of normal [ULN] value) in COVID-19 was undertaken. ResultsA total of 36,496 patients from 21 studies were included for this meta-analysis. The overall prevalence and mortality for increased pancreatic enzymes (>ULN) in COVID-19 were 25.4% (95% CI, 15.8%–36.2%) and 34.6% (95% CI, 25.5%–44.4%), respectively. The overall prevalence and mortality for increased pancreatic enzymes (>3 × ULN) were 6.1% (95% CI, 3.6%–9.2%) and 39.2% (95% CI, 18.7%–61.6%), respectively. Patients with increased pancreatic enzymes, including elevated serum lipase or amylase of either type, had worse clinical outcomes, including need for ICU admission, mechanical ventilation and mortality. DiscussionIncreased pancreatic enzymes is frequent and may exacerbate the consequences of COVID-19 infection.