High Lipase Levels Research Articles

Growth, biochemical indexes, and intestinal microbiota response of red tilapia (Oreochromis spp.) under different densities and feeding frequencies in the land-based aquaculture tank

Red tilapia (Oreochromis spp.) has been favored by farmers in recent years because of its superior growth performance and competitive market price, but there is a lack of experimental data related to growth and health of red tilapia in land-based aquaculture tanks. In this study, red tilapia (initial weight 27.62 ± 2.43 g) was cultured with three stocking densities (30, 40, or 50 fish/m3, named 30F,40F and 50F) in the culture mode for 60 days, including two feeding frequencies (2 or 3 times/day, named 2 T and 3 T), and various growth and metabolic parameters were assessed along with the intestinal microbiome analysis. The 30 fish/m3 groups achieved the better weigh gain rate and specific growth rate (p < 0.05). The growth rate and condition factor of 40F groups were close to those of 30F groups, the yield of 40F groups were not significantly different from that of 50F groups (p > 0.05), and it had the highest survival rate (p < 0.05). The 3 T groups has a higher growth rate and yield but also has a higher rate of feed conversion (p < 0.05). The 30F groups had higher lipase levels, but a higher fat content in this group, more lipids were observed in the liver, and resulted in higher blood glucose levels (p < 0.05). The 40F groups showed healthier physiological and biochemical indicators, as its total cholesterol, lysozyme and antioxidant enzymes levels were similar to those of the 30F groups (p > 0.05), alkaline phosphatase, amylase and trypsin levels were higher than those of the other groups, and aspartate transaminase levels were the lowest (p < 0.05). The 50F groups had higher cortisol, alanine transaminase and malondialdehyde levels, lower lysozyme and digestive enzyme activities, and blood cell infiltration in the liver (p < 0.05). In terms of different feeding frequencies, the 3 T groups had higher crude protein content, catalase and total superoxide dismutase levels, wider villus width and lower blood glucose level, while the 2 T groups had higher triglyceride, total cholesterol, lysozyme, alkaline phosphatase and some digestive enzymes activities (p < 0.05). From the perspective of intestinal microbiota. The 40F groups had a better intestinal flora, and 40F-3T groups observed a better balance of flora, while 40F-2T groups had more digestion-related flora. Considering the growth rate, health status, and yield, the optimum culture condition was determined to be stocking density of 40 fish/m3, and feedings 3 times/day were recommended. The experiment provided theoretical basis and experimental data for red tilapia culture in land-based aquaculture tank mode.

Association between pancreatic lipase levels and coronavirus disease 2019

Aims: Elevated pancreatic enzyme can be observed in the course of coronavirus disease-2019 (COVID-19) due to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Here, we aimed to determine the frequency of lipase elevation in the course of COVID-19 and examine its effect on disease outcomes. &#x0D; Methods: Of 42742 patients with the positivity of SARS-CoV-2 reverse transcriptase-polymerase chain reaction test (RT-PCR), 3167 undergoing lipase tests were included. The relationship between patients’ clinical features, development of acute pancreatitis (AP), and mortality rates was investigated. &#x0D; Results: Higher lipase levels than normal limits were found in 399 (12.6%) patients. Lipase levels were three times higher than the normal limit in 119 (3.8%) patients; compared to the rest of the patients, patients’ age (62.8±17.9 vs 52.1±17.9 years, p

Risk factors for pancreatic necrosis in acute pancreatitis in obese patients

Background. Acute pancreatitis is an aseptic inflammation of the pancreas with diverse complications and further development of necrosis of the gland, parapancreatic tissue and possible addition of secondary infection. A significant number of biochemical markers that can be predictors of pancreatitis complications are still being researched. However, most of them are expensive and their indicators are increased only in the first 24–48 hours after the onset of the disease, so they are not used in daily clinical routine. The purpose of this study is to evaluate the factors that indicate an elevated risk of necrosis in acute severe pancreatitis. Materials and methods. A retrospective analysis of 80 patients with acute pancreatitis was performed via creation of a multivariate logistic regression model. Results. The dependence of the risk of pancreatic necrosis on the following factor signs was found: lipase at the onset of the disease (cut-off value = 599.6 U/l, area under the receiver operating characteristic curve (АUС) = 0.72 (95% confidence interval (СІ) 0.57–0.88)), severity of the disease, fibrinogen on day 3 of the disease (cut-off value = 9.7, АUС = 0.65 (95% СІ 0.48–0.81)), C-reactive protein (cut-off value = 175.7 mg/L, AUC = 0.70 (95% CI 0.54–0.86)), and intra-abdominal mean capillary perfusion pressure on the first day of the disease (cut-off value ≤ 63.3 mm Hg, АUС = 0.88 (95% СІ 0.77–0.99)). The autopsy results revealed the presence of necrosis and microthrombosis of the pancreas. Conclusions. Factors that may indicate an increased risk of pancreatic necrosis were high levels of lipase, fibrinogen on the third day of the disease, C-reactive protein, decreased intra-abdominal mean capillary perfusion pressure, severity of the disease, and the presence of portosplenomesentric thrombosis.

Linezolid-Induced Pancreatitis Associated with Lactic Acidosis and Relative Hypoglycemia: A Rare Case Report.

Linezolid is known to cause side effects, including nausea, diarrhea, and headaches of short duration. As extended use of linezolid is becoming more common, additional rare side effects should be considered. A 68-year-old man hospitalized for osteomyelitis developed severe abdominal pain and altered mental status following five weeks of linezolid therapy. Laboratory studies showed very high lipase levels, lactic acidosis not responding to resuscitation, and relative hypoglycemia. All common causes of pancreatitis were ruled out, and a trial of linezolid withdrawal was done resulting in drastic improvement in the patient's clinical status. For patients on extended course of linezolid who develop abdominal pain, drug-induced pancreatitis should be considered as a side effect, and a trial of withdrawal of linezolid should be undertaken. Linezolid can be associated with a rare but serious triad of adverse effects of pancreatitis, hypoglycemia, and lactic acidosis.Possible risk factors include a prolonged course of linezolid, renal dysfunction, and sepsis.

Factors affecting the recurrence of acute cholecystitis after treatment with percutaneous cholecystostomy

BackgroundThe aim of this study was to determine the recurrence rate of patients who did not have interval cholecystectomy after treatment with percutaneous cholecystostomy and to investigate the factors that may affect the recurrence.MethodsPatients who did not undergo interval cholecystectomy after percutaneous cholecystostomy treatment between 2015 and 2021 were retrospectively screened for recurrence.Results36.3% of the patients had recurrence. Recurrence was found more frequently in patients with fever symptoms at the time of admission to the emergency department (p = 0.003). Recurrence was found to be more frequent in those who had a previous cholecystitis attack (p = 0.016). It was determined that patients with high lipase and procalcitonin levels had statistically more frequent attacks (p = 0.043, p = 0.003). It was observed that the duration of catheter insertion was longer in patients who had relapses (p = 0.019). The cut-off value for lipase was calculated as 15.5, and the cut-off value for procalcitonin as 0.955, in order to identify patients at high risk for recurrence. In the multivariate analysis for the development of recurrence, presence of fever, a history of previous cholecystitis attack, lipase value higher than 15.5 and procalcitonin value higher than 0.955 were found to be risk factors.ConclusionsPercutaneous cholecystostomy is an effective treatment method in acute cholecystitis. Insertion of the catheter within the first 24 h may reduce the recurrence rate. Recurrence is more common in the first 3 months following removal of the cholecystostomy catheter. Having a previous history of cholecystitis attack, fever symptom at the time of admission, elevated lipase and procalcitonin are risk factors for recurrence.

Misunderstood Gastric Perforation of a Pancreatic Acinar Cell Carcinoma: A Wolf in Sheep’s Clothing

A 70-year-old man was admitted to the Emergency Department (ED) for marked asthenia and severe anemia. In addition, a high level of lipase was found. During hospitalization, a locally advanced gastric cancer was diagnosed, with endoscopic evidence of a large polyploid formation originating under the cardias that occupied most of the gastric lumen. A total body CT scan was performed before surgery; the tumor affected the posterior gastric wall, with tenacious infiltration of the pancreatic body. Therefore, we performed a total gastrectomy with esophageal jejunum anastomosis and reconstruction of intestinal continuity according to Roux, distal spleno-pancreatectomy, and cholecystectomy. At histology, a pancreatic acinar cell carcinoma (PACC) with full thickness infiltration of the gastric wall was diagnosed. Acinar cell carcinomas are highly aggressive neoplasms, and surgical resection, when feasible, is the treatment of choice regardless of size, also because the role of neoadjuvant or adjuvant chemo- or radiotherapy remains uncodified.

S1796 Pancreatitis, Panniculitis and Polyarthralgia Syndrome: A Rare Complication of Pancreatic Pathology

Introduction: Pancreatitis, panniculitis, and polyarthritis (PPP) syndrome is a rare syndrome consisting of multiorgan extra-pancreatic manifestations of pancreatitis due to high serum lipase levels. Patients can often have little to no abdominal symptoms. The syndrome can also mimic infectious etiologies leading to misdiagnosis, mistreatment, and the possibility of deterioration. Case Description/Methods: A 64-year-old male with a history of alcohol abuse presented with painful nodular purulent lesions in his legs and bilateral joint pain in his hips and shoulders. NSAIDs and glucocorticoids did not provide relief. He was initially diagnosed with erythema nodosum. The patient had an elevated Erythrocyte Sedimentation Rate of 75 mm/h, C-reactive protein of 5.7 mg/dL, slightly elevated transaminases, and elevated Lipase of 2328 U/L. A basic metabolic profile and complete blood count were unremarkable. A computed tomography scan of the abdomen showed acute pancreatitis with peripancreatic inflammatory changes. It also showed partial occlusion thrombosis of the portal and superior mesenteric veins. Notably, the patient did not have any abdominal pain on presentation. MRI of the left calcaneus showed bone edema suggesting radiographic evidence of osteomyelitis. The patient was treated with a prolonged course of broad-spectrum antibiotics without improvement. A biopsy of the panniculitis lesions showed lobular panniculitis and ghost cells which were pathognomonic for pancreatic panniculitis. (Figure) Hence, the cause of panniculitis and bone necrosis was thought to be due to the intravascular leakage of lipase due to PPP syndrome. The patient’s polyarthralgia was described due to the deposition of free fatty acids in joints following fat autodigestion. Discussion: After the diagnosis of PPP syndrome, the patient was largely asymptomatic. This case highlights the importance of bone biopsy in diagnosing osteomyelitis. Reactive changes in bone on imaging could be seen in other non-infectious pathologies such as PPP syndrome, as highlighted in this case. The delayed diagnosis led to poor antibiotic stewardship and delay in treatment. This case also demonstrates the importance of a multidisciplinary team in identifying and managing a rare disease.Figure 1.: a. H&E stain of panniculitis lesion biopsy showing ghost cell (arrow) with a background of inflammation suggesting pancreatic panniculitis b. Partial thrombosis of portal vein (arrow) on CT of abdomen (coronal view) c. Partial thrombosis of superior mesenteric vein (arrow) in transverse view of CT abdomen d. Reactive bone changes on MRI of left foot (arrows).

Effect of Ayurvedic Medicines in the Management of Acute Recurrent Pancreatitis

This case report presents the treatment outcome of a 9-year-old diagnosed case of acute recurrent pancreatitis (ARP). The patient has suffered recurrent severe abdominal pain, vomiting, and constipation for the past 3 years. The high amylase and lipase levels in the serum, ultrasonography, and magnetic resonance cholangiopancreatography findings confirmed the diagnosis of ARP. The patient regularly took allopathic medicines, yet she had recurrent abdominal pain episodes that required hospitalization. The patient was treated with Ayurveda medicines, including Kamadudha Rasa (Mukta Yukta), Agnitundi Vati (twice daily before meals), and Nityam tablet at bedtime for 3 weeks. In the third week, the treatment was modified by replacing Agnitundi Vati with Kravyad Rasa and Kankayana Vati. The 8-month continued therapy resulted in complete clinical recovery. No adverse reactions or untoward effects due to Ayurveda interventions were reported during the treatment. There was no recurrence after a 90-day follow-up. Based on the results obtained in this case study, a clinical trial on Ayurvedic management of ARP may be planned to prove the efficacy of Ayurveda treatment regimen in treating ARP empirically.

Tempering–preservation treatment inactivated lipase in wheat bran and retained phenolic compounds

AbstractWheat bran is rich in functional ingredients, but the high level of lipase limits its applications. Tempering–preservation treatment (at 70–90 °C with moisture of 20%–40% for 1–4 h) was exploited for stabilising wheat bran and its effect on polyphenols was investigated. The results showed that more lipase was inactivated at higher tempering moisture, temperature and longer time. The optimum condition for inactivation of wheat bran lipase was 30% moisture and 90 °C for 4 h. The inactivation rate reached 93.8% with a residual enzyme activity of 0.264 U g−1. Under the optimum condition, the sum of free phenolic acids rose from 25.4 to 55.8 µg g−1. As for bound phenolic acids, there was a slight increase of hydroxybenzoic acid derivatives but a slight decrease of hydroxycinnamic acid derivatives. The total contents of phenolic acids before and after stabilisation were not significantly different. This study showed the possibility of using tempering–preservation as an efficient method for inactivation of wheat bran lipase while maintaining its phenolic compounds, which could be used in the production of whole wheat flour.

Pancreatico-Pleural Fistula: A Rare Complication of Chronic Pancreatitis

Abstract: Pancreatico-pleural Fistula is rare complication of chronic pancreatitis and it occurs in considerably less number of patients. We present a case of left sided pleural effusion that was attributable to pancreatico-pleural fistula. A 30-year old alcoholic patient who had worsening dyspnea, hemoptysis and intractable cough. Diagnosis is difficult due to the prevalance of respiratory symptoms than symptoms due to pancreatitis. Diagnosis is concluded by the detection of high level of amylase and lipase in pleural fluid and by ERCP. It had been managed by placing a stent on main pancreatic duct at the site of leakage by ERCP along with giving octreotide for 7 days. The patient’s symptoms was improved throughout hospitalization. Key words: Pancreatico-pleural fistula, Chronic pancreatitis, Pleural effusion, Amylase, Lipase.

Histological structure of the digestive tract and digestive enzymatic activity of juvenile Pacific seahorse (Hippocampus ingens)

The histological structure, histochemical features, and enzymatic activity of the digestive tract of juvenile Pacific seahorse (Hippocampus ingens) are described to provide information during the cultivation of this species. Serial histological sections were stained with either hematoxylin-eosin, alcian blue-PAS, toluidine blue, Sudan black, Masson's trichome, and ninhydrin-Schiff to describe the general features and the presence of glycogen, mucopolysaccharides, lipids, muscle layers, and proteins, respectively. The enterocytes height and the mucosal villi height in the esophagus and intestines were measured. Additionally, the digestive enzymes trypsin, chymotrypsin, lipase, amylase, aminopeptidase, acid phosphatase, and alkaline phosphatase activities were recorded. The esophagus showed two distinctive regions, the anterior with numerous mucous cells secreting acid mucins and the posterior with longitudinal folds and no mucous cells. The intestine was differentiated into three regions. The anterior showed goblet cells secreting acid and neutral mucins, while the middle and posterior regions presented goblet cells secreting only acid mucins. The activity of aminopeptidase, chymotrypsin, and amylase showed low levels, while the trypsin and acid phosphatase activity levels were intermediate. Lipase and alkaline phosphatase showed the highest activities. The results point that juvenile H. ingens presents a digestive structure similar to other teleost species. The high levels of lipase suggest that juvenile H. ingens have high requirements for lipids during this stage.

Oxidative stress tolerance contributes to heterologous protein production in Pichia pastoris

BackgroundPichia pastoris (syn. Komagataella phaffii) is an important yeast system for heterologous protein expression. A robust P. pastoris mutant with oxidative and thermal stress cross-tolerance was acquired in our previous study. The robust mutant can express a 2.5-fold higher level of lipase than its wild type (WT) under methanol induction conditions.ResultsIn this study, we found that the robust mutant not only can express a high level of lipase, but also can express a high level of other heterogeneous proteins (e.g., green fluorescence protein) under methanol induction conditions. Additionally, the intracellular reactive oxygen species (ROS) levels in the robust mutant were lower than that in the WT under methanol induction conditions. To figure out the difference of cellular response to methanol between the WT and the robust mutant, RNA-seq was detected and compared. The results of RNA-seq showed that the expression levels of genes related to antioxidant, MAPK pathway, ergosterol synthesis pathway, transcription factors, and the peroxisome pathway were upregulated in the robust mutant compared to the WT. The upregulation of these key pathways can improve the oxidative stress tolerance of strains and efficiently eliminate cellular ROS. Hence, we inferred that the high heterologous protein expression efficiency in the robust mutant may be due to its enhanced oxidative stress tolerance. Promisingly, we have indeed increased the expression level of lipase up to 1.6-fold by overexpressing antioxidant genes in P. pastoris.ConclusionsThis study demonstrated the impact of methanol on the expression levels of genes in P. pastoris and emphasized the contribution of oxidative stress tolerance on heterologous protein expression in P. pastoris. Our results shed light on the understanding of protein expression mechanism in P. pastoris and provided an idea for the rational construction of robust yeast with high expression ability.

Compressive idea of manifestation and biochemical relation of acute pancreatitis in tertiary care hospital

Background: Acute pancreatitis is a sudden inflammation that lasts for a short time. It may range from mild discomfort to a severe, life-threatening illness. Methods: It was Prospective and observational study. All the patients admitted in medicine department and ICU and diagnosed as acute pancreatitis. Study period was January 2018 to September 2019. And sample size was 30. Investigation was done in the department of Biochemistry. Results: The prevalence rate of acute pancreatitis was higher in male than female with a ratio of 1.72:1 and we found maximum patients were in the age group of 41-50 years. While analysing the biochemical parameters we found very obvious a high lipase, amylase and triglyceride level in the study subjects accounting most of the cases as these biochemical parameters are directly related to acute pancreatitis. Conclusion: Pancreatic necrosis may lead to the development of pancreatic pseudocysts or tissue abscess, common complications associated with pancreatitis. A better understanding of the nature of cardiac dysfunction in this setting may allow more accurate diagnosis, prognostication, and management.

Unusual association between scrotal swelling and abdominal pain

A 54-year-old man experienced acute dull pain radiating from the left lower abdominal area for 3 days after binge drinking. He had an underlying condition of diabetes, hyperlipidemia, and alcohol abuse. The pain worsened following intake of food and water, and the pain was observed to progressively radiate toward the left inguinal area accompanied by swelling of the scrotum (Figure 1A). He visited the emergency department; the laboratory examination revealed leukocytosis (white blood cell count, 14 000 cells/mm3) and mild anemia (hemoglobin, 13.6 g/dL). Biochemical examination showed increased triglyceride levels (823 mg/dL) and increased lipase levels (104 U/L, normal range: 19-47). Ultrasound performed by a urologist suggested hydrocele without testicular torsion, epididymitis, or epididymo-orchitis (Figure 1B). This was followed by an abdominal computed tomography (CT) scan (Figure 2). What is the likely diagnosis of this patient? Based on the acute onset of symptoms and the progression of the clinical status, the differential diagnoses included testicular torsion, strangulated hernia, and epididymitis. The abdominal CT scan revealed pancreatic fat stranding with fluid accumulation in the left pararenal space along the left abdomen and extending into the left inguinal canal (Figure 2, arrows). Based on the clinical, laboratory, and imaging findings, a diagnosis of pancreatic hydrocele was established. The patient was placed on fluid supplement. The pain gradually improved, and he was discharged 5 days later. His scrotal swelling also gradually subsided during the 1-month follow-up period. Pancreatic hydrocele refers to scrotal swelling associated with acute pancreatitis.1-3 It is a rare complication of acute pancreatitis and is caused by the effusion of pancreatic juices into the inguinal canal along the retroperitoneal tract. This rare complication resembles other acute scrotal conditions such as testicular torsion, appendicular torsion, and epididymitis. Abdominal CT is useful for diagnosis, and ultrasound-guided aspiration of scrotal fluid showing high amylase and lipase levels can assist in confirming the presence of this condition. Treatment is generally conservative. Surgical drainage or debridement is rarely required.3 The authors declare no conflict of interest.

Fatal case of pancreatic panniculitis caused by occult neuroendocrine tumor in the corresponding organ: A case report and review of the published work

Pancreatic panniculitis (PP) is a rare clinical variant of subcutaneous fat necrosis, developing in patients with a variety of pancreatic diseases such as acute or chronic pancreatitis, tumors and cysts. The tumor-associated PP represents a noteworthy skin manifestation of underlying internal malignancies, also known as dermadrome. Among causative pancreatic tumors, acinar cell carcinoma is the most frequent malignancy; however, little is known about how the origin of tumor cells and progression stage of pancreatic tumors potentially contribute to the establishment of panniculitis. Here, we present a 69-year-old Japanese male case of clinically aggressive PP on the bilateral legs, whose skin lesions developed prior to the diagnosis of occult pancreatic tumor and liver metastasis. Moreover, the immunopathology of the pancreatic lesion revealed neuroendocrine tumor (NET), a rare pathological variant. Skin lesions immediately spread to the upper limbs with extensive ulcerations and necrosis, accompanied by high levels of serum lipase and elastase, but not with other pancreatic enzymes. He died 2months after the initial development of the skin lesion due to rapid deterioration of general condition. We reviewed 14 cases, including ours, of PP with NET in the pancreas thus far reported, to identify the clinicopathological characteristics regarding to what extent this rare complication could reflect the clinical course of pancreatic tumors and overall prognosis. Our published work review found that the disease has a significant male predominance (male:female, 13:1) and cases with occult pancreatic tumors died within 4months after the development of their skin lesions. Our case was the poorest prognostic outcome. This report emphasizes that dermatologists should recognize PP with NET, reflecting a fatal prognosis, and to make a prompt diagnosis.

Acute Pancreatitis Caused by COVID-19 in a Child: A Case Report

Coronavirus disease 2019 (COVID-19) occurs in children as well as adults and it is mainly associated with symptoms of respiratory and gastrointestinal infections. The patient was a 13-year-old child who had no symptoms of a respiratory infection and complained of abdominal pain and vomiting. A COVID-19 polymerase chain reaction (PCR) test was requested, which was positive. Based on laboratory test results indicating high serum amylase and lipase levels and imaging findings, acute pancreatitis was diagnosed, and after supportive treatment, the patient was discharged in good general condition. During the SARS-CoV-2 pandemic, children who refer to medical centers with gastrointestinal symptoms and pancreatitis should be checked for COVID-19.

Marked Elevation of Lipase in COVID-19 Disease: A Cohort Study.

INTRODUCTION:Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing the pandemic of coronavirus disease 2019 (COVID-19) is a global health crisis. Possible pancreatic involvement has recently been observed in these patients; however, its significance is unclear. The aim of this study was to evaluate the association of significantly elevated lipase with disease outcomes.METHODS:Data about demographics, symptoms, laboratory values, and clinical outcomes were collected for 1,003 consecutive patients testing positive for COVID-19. Elevated lipase was defined as greater than 3 times the upper limit of normal (>3 × ULN). Baseline characteristics among patients with or without elevated lipase were compared using Fisher exact test or Student t-test for categorical or numerical variables, respectively. Logistic regression was used to evaluate the association of lipase levels with primary clinical outcomes (intensive care unit admission and intubation) adjusted for age, sex, body mass index, history of diabetes, and hypertension.RESULTS:Of 1,003 patients with COVID-19, 83 had available lipase levels and were all admitted to the hospital. Of 83, 14 (16.8%) had elevated lipase (>3 × ULN), which was associated with higher rates of leukocytosis (P < 0.001) and abnormal liver enzymes (P < 0.01). Compared with lower lipase levels (<3 × ULN), patients with elevated lipase had higher rates of ICU admission (92.9% vs 32.8%; P < 0.001) and intubation (78.6% vs 23.5%; P 0.002). In a multivariable-adjusted model, higher lipase levels were significantly associated with admission to the ICU and rate of intubation.DISCUSSION:Lipase elevation is seen in COVID-19 and is associated with worse disease outcomes.

Pancreatic ketoacidosis-a rare case report

Euglycemic Pancreatic Ketoacidosis is a syndrome of high anion gap acidosis in which the high anion gap is due to elevated serum ketone bodies comprising of acetone, aceto- acetate and beta hydroxyl-butyrate, due to increased peripheral adipose tissue breakdown by elevated serum lipase as a consequence of acute pancreatitis with normal blood glucose levels. There are multiple causes for ketonuria and/or ketonemia with or without acidosis like uncontrolled diabetes mellitus, usually of the insulin dependent type (diabetic ketoacidosis), lactic acidosis, prolonged starvation (starvation ketosis), ethanol ingestion (alcoholic ketoacidosis), sepsis, pregnancy and vomiting. Our patient was not a known diabetic and his blood glucose were always within normal limits, so this ketoacidosis cannot be attributed to Diabetes Mellitus. It cannot be attributed to starvation as our patient was not fasting when he got admitted and furthermore ketoacidosis is not a frequent manifestation of starvation adding to it that we transfused adequate amount of DNS and resumed oral intake during our observation period. It cannot be attributed to vomiting as our patient had only two episodes of vomiting. Our patient does not have any liver or kidney pathology and there is no history or evidence of alcohol intoxication. But, acute pancreatitis without diabetes-mellitus, causing ketoacidosis is a very rare presentation which is caused by high levels of pancreatic lipase in the circulation.

ANNE SÜTÜNDE SABUNUMSU TAT: OLGU SUNUMU

<div><!--block-->It is known that refusing to breastfeed is a situation which can occur&nbsp; for many reasons. Some studies have reported that the soapy taste of frozen milk causes refusal to breastfeed in infants. Higher levels of lipase in breast milk can cause a soapy taste after having been stored. This study focuses on a 4 months old boy who refused breast milk for a week. He was born with his twin at 31 weeks and his birthweight was 2130 grams. The weight of the baby, who was only fed with breast milk, was 6200 grams. There were no pathological findings during the physical examination and no changes in the environment or the daily routine of his family. His mother was nursing his twin sibling in the NICU and our patient was fed frozen-thawed milk. The mother noticed that her frozen-thawed milk had a soapy taste. The lipase activity in frozen breast milk was found to be 2345 U/l. The mother was advised to mix freshly expressed breast milk with the stored milk. It was discovered that the baby did not reject the breast milk. The soapy taste in breast milk should be considered when babies are intolerant to the frozen milk of mothers. More research is needed to determine the etiology of the soapy taste in breast milk which is especially associated with higher lipase activity.&nbsp;</div>

Serum lipase amylase ratio in predicting the etiology of acute pancreatitis

Background: Acute pancreatitis remains a major cause of significant morbidity and mortality. Alcoholism and biliary tract stone disease are the main causes in up to 80% of cases. The diagnosis of acute pancreatitis is based on the correlation of clinical, biochemical, and radiological criteria. Serum lipase and amylase have been used to diagnose acute pancreatitis with values greater than three times the upper limit of normal being diagnostic. Objective: The aim is to study the value of serum lipase: amylase ratio in predicting the etiology of acute pancreatitis. Materials and Methods: This prospective study was conducted in a tertiary care hospital in North-East India during a 2-year period. The serum lipase/amylase ratio has been evaluated in 52 patients (31 acute alcoholic pancreatitis, 19 acute gallstone pancreatitis, 2 idiopathic). Results: Analysis of data showed that patients with acute alcoholic pancreatitis had higher serum lipase levels (2722.5 ± 285.7, mean ± standard deviation) compared to acute gallstone pancreatitis (1565.21 ± 198.2). On the other hand, acute gallstone pancreatitis patients had higher serum amylase (862.3 ± 105.5) compared to acute alcoholic pancreatitis patients (683.03 ± 618.31). Determination of lipase: amylase ratio showed that out of 31 patients of acute alcoholic pancreatitis 22 patients (71%) had lipase: amylase ratio ≥3. Out of 19 patients of acute gallstone pancreatitis, 17 patients (89.5%) had lipase: amylase ratio Conclusion: Serum lipase: amylase ratio fixed at 3.0 can assist in differentiating acute biliary pancreatitis from acute alcoholic pancreatitis. The lipase: amylase ratio ≥3 is observed in alcoholic acute pancreatitis while biliary pancreatitis has ratio