Serum Lipase Levels Research Articles

Risk factors of asparaginase-associated pancreatitis in children with acute lymphoblastic leukaemia

Background: Acute lymphoblastic leukaemia (ALL) is the top childhood cancer, with survival rates of 80–85%. Attention now focuses on treatment complications. Pancreatitis, linked to Asparaginase in ALL therapy, remains poorly understood despite its recognition. The main objective of the study was to identify the risk factors of pancreatitis in children with acute lymphoblastic leukemia receiving L-Asparaginase during induction chemotherapy. Methods: A prospective observational study was conducted at BSMMU's Paediatric Haematology and Oncology Department from March 2018 to February 2019. Newly diagnosed ALL cases in children aged 1 to 17.9 years were included, excluding those <1 or >18 years, with prior pancreatitis, or relapsed cases. Informed consent was obtained from parents/legal guardians. Diagnosis relied on clinical, CBC, bone marrow and immunophenotyping. Induction chemotherapy followed the UK ALL 2003 protocol for 35 days, with regular follow-ups monitoring abdominal symptoms and laboratory markers. USG of the abdomen was performed if pancreatitis symptoms or elevated serum amylase/lipase occurred post-L-asparaginase administration. Results: Among 80 patients, pancreatitis affected 3 (3.8%) after the 2nd, 3rd and 7th doses of L-asparaginase, independent of individual or cumulative dosing, induction phase or concomitant medications. Age, sex, initial WBC count, ALL lineage, treatment regimen and CNS status were not statistically linked to pancreatitis incidence. Clinical manifestations included abdominal pain, tenderness, nausea, vomiting and fever, alongside elevated serum amylase and lipase levels, supported by consistent ultrasonographic findings. Despite these symptoms, no pancreatitis-related mortalities were observed, however, overall mortality during induction therapy reached 20%, unrelated to pancreatic complications. Conclusions: In this study no significant risk factor could be identified for developing pancreatitis in ALL patients treated with asparaginase. Further studies with large sample size are required to predict who will develop pancreatic toxicity from asparaginase.

CIP2A inhibitors TD52 and Ethoxysanguinarine promote macrophage autophagy and alleviates acute pancreatitis by modulating the AKT-mTOR pathway

BackgroundAcute pancreatitis (AP) is a prevalent and serious condition within the digestive system, with approximately 20 % to 30 % of cases advancing to severe acute pancreatitis (SAP). During the initial phases of SAP, macrophages are activated in response to the substantial amounts of acinar cell contents and damage-associated molecular patterns (DAMPs) resulting from acinar cell destruction. Subsequently, activated macrophages release a significant array of pro-inflammatory factors that exacerbate the progression of SAP. Cancerous inhibitor of protein phosphatase 2A (CIP2A) is an oncogenic protein that is intimately linked to immune regulation. While the role of CIP2A in T-cell-mediated specific immune responses has been reported, its function and mechanism in macrophages, a component of non-specific immunity, have not been widely studied. This research fills this knowledge gap by elucidating the critical role of CIP2A in regulating macrophage autophagy and inflammation. This finding not only expands our understanding of CIP2A in immune modulation but also provides a new scientific basis and potential application prospects for targeting CIP2A in the treatment of AP. MethodsWe established AP using a combination of palmitoleic acid with anhydrous ethanol or using caerulein alone. The effects of TD52 and Ethoxysanguinarine (Etho) on SAP were evaluated through serological, histopathological, and tissue inflammation observations. The effect of TD52 on macrophage activation in vitro was examined using primary macrophages (PMs) and RAW264.7 cells. ResultsWe found that TD52 and Etho inhibit CIP2A expression while reducing the levels of serum amylase, lipase, and inflammatory cytokines, thereby alleviating the pathological symptoms of SAP. Additionally, TD52 could reduce the infiltration of macrophages into pancreatic tissue. Therefore, we established a model of macrophage inflammatory response mimicking the pathophysiological process of AP and detected changes in inflammation, apoptosis, and autophagy through pre-treatment of macrophages with TD52. The results show that inhibiting CIP2A expression decreases the release of inflammatory cytokines and reduces apoptosis in macrophages. Further exploration revealed that TD52 promoted macrophage autophagy regulation and inhibited the AKT-mTOR pathway to modulate macrophage activation. ConclusionIn summary, our findings indicate that TD52 and Etho can alleviate the severity of SAP. TD52 can block the AKT-mTOR pathway to promote macrophage autophagy, thereby improving SAP. Thus, CIP2A may serve as one of the molecular targets in SAP, highlighting its potential as a therapeutic option.

HPB SO57 - Imaging in Acute Pancreatitis: Are We Getting It Right?

Abstract Background Guidelines indicate that routine use of imaging is unwarranted in patients with acute uncomplicated pancreatitis presenting with abdominal pain and increased serum amylase or lipase levels without signs of severe disease. Moreover, early CT scans may fail to accurately reflect disease severity and provide no diagnostic advantage. Method We performed a retrospective clinical audit at a district general hospital in the United Kingdom to find out the current practice regarding the use of imaging in patients presenting with acute pancreatitis. The patients were studied from January 2023 to March 2023 for the 1st cycle, and from April 2024 to May 2024 for the 2nd cycle. The list was identified by the clinical audit department – adult patients who presented to the A&E with symptoms of acute pancreatitis were included. Results Between January - March 2023, 44 patients presented to A&E with symptoms of acute pancreatitis. Of these, 25 (56%) had a CT-scan within 72-hours, with 80% showing evidence of acute pancreatitis —1 with pancreatic necrosis, 7 with intra-peritoneal fluid, & 5 with peri-pancreatic fat-stranding. The study revealed poor compliance with standards, prompting efforts to raise awareness. Findings were shared at the departmental audit meeting, & posters were displayed in A&E and GeneralSurgery departments. In the 2nd-cycle (April-May 2024), 32 patients presented, with 14 (53%) having a CT-scan within 72-hours & all had serum amylase levels checked, with 11 within normal limits. Conclusion This closed-loop clinical audit demonstrated that with appropriate measures and improved awareness of current guidelines, there can be increased compliance to the guidelines by the clinicians. This, in turn, reduces the risk of radiation exposure to patients and optimizes the use of CT scans.

A Case Report of Suspected Acute Pancreatitis with Elevated Serum Lipase

Objective: This study aimed to report the case of a patient with suspected acute pancreatitis who presented with elevated serum lipase levels and acute abdominal pain.Methods: A 26-year-old male presented with acute abdominal pain, vomiting, and elevated serum lipase levels. Anjung-san was administered along with acupuncture, moxibustion, and cupping therapy. The patient’s symptoms were evaluated daily using the numerical rating scale, abdominal palpation, and blood tests for pancreatic enzyme levels.Results: Following treatment, the patient’s symptoms, including abdominal pain, vomiting, and nausea, improved, and serum lipase levels returned to normal. No significant complications were observed during the hospital stay.Conclusion: Korean medicine treatment may effectively manage symptoms and reduce serum enzyme levels in patients with suspected acute pancreatitis.

Genotypes of carboxypeptidase A1 and gamma-glutamyltransferase 1 may be useful tools for the diagnosis and the predictor of worrisome features of intraductal papillary mucinous neoplasm in Japan.

This study aimed to clarify whether several single-nucleotide polymorphisms (SNPs)-related chronic pancreatitis such as carboxypeptidase A1 (CPA1), carboxypeptidase B1 (CPB1), Gamma-glutamyltransferase 1 (GGT1), G-protein-coupled receptor Class C Group 6 Member A (GPRC6A), and serine protease inhibitor, Kazal type 1 (SPINK-1) genotypes were associated with clinical characteristics of patients with intraductal papillary mucinous neoplasm (IPMN) and worrisome features of IPMN. We enrolled 100 patients with IPMN and 116 patients as a control. Serum p-amylase, lipase, trypsin, phospholipase A2 (PLA2), and elastase-1 levels were measured. An Olympus EUS (GF-UCT 260) was used to perform endosonography in 100 patients with IPMN. Total EUS score was evaluated using endosonography. DNA was isolated from the duodenal tissue using a commercial system and polymerase chain reaction (PCR) was performed on 7500 Fast PCR System. There were no associations between glucose tolerances, lipid levels and genotypes of CPA1, GGT1, GPRC6A, and SPINK-1 in patients with IPMN. CPA1 genotype was significantly associated with the pathophysiology of IPMN. Then, GGT1 genotype was also significantly associated with EUS total score and the size of cyst more than 20 mm and more than 30 mm as one of worrisome features of IPMN. Genotypes of carboxypeptidase A1 and gamma-glutamyltransferase 1 may be useful tools for the diagnosis and the predictor of worrisome features of IPMN.

Bufalin alleviates inflammatory response and oxidative stress in experimental severe acute pancreatitis through activating Keap1-Nrf2/HO-1 and inhibiting NF-κB pathways

Severe acute pancreatitis (SAP) is a prevalent acute inflammatory disease that is clinically manifested by systemic inflammation dysregulation, resulting in a significantly elevated mortality rate. Bufalin has been verified to have potent pharmacological properties, including analgesic, anti-tumor and anti-inflammatory effects. However, it remains unclear whether bufalin inhibits SAP. Thus, we aim to explore the impact of bufalin in SAP rats and to evaluate the potential mechanisms of action. In addition to analyzing serum biochemistry and pancreatic tissue pathology, we elucidated its mechanisms of action through enzyme-linked immunosorbent assay (ELISA), immunohistochemical analysis, Western blot, and quantitative real-time PCR. The results demonstrated that bufalin dose-dependently reversed the elevation of serum Amylase (Amy) and Lipase (LPS) levels in SAP rats, alleviating pancreatic tissue pathological damage. Bufalin exhibited potent antioxidant effects by reducing malondialdehyde (MDA) levels, decreasing Superoxide dismutase (SOD) and glutathione(GSH) consumption, inhibiting the interaction of Keap1-Nrf2, and increasing HO-1 expression. Furthermore, bufalin inhibited TNF-α, IL-6, IL-1β, p-NF-κB-p65, p-IκBα, and NF-κB-p65 expression, while enhancing IκBα expression, ultimately confirming its anti-inflammatory effects on SAP. In summary, our findings suggest that bufalin exerts anti-inflammatory and antioxidant actions in NaT-SAP rats by inhibiting NF-κB and activating the Keap1-Nrf2/HO-1 pathway. This study represents the inaugural application of bufalin in NaT-induced SAP rats, indicating its potential as an effective therapeutic agent for SAP patients.

Risk factors and a prediction model for pain recurrence after pancreatic stent removal in painful chronic pancreatitis.

Endoscopic pancreatic stenting (EPS) is an effective treatment modality for painful chronic pancreatitis. However, little is known about the factors that cause pain recurrence after stent removal, and there are no clear criteria for stent removal. We aimed to develop a prediction model for pain recurrence by identifying its risk factors. We retrospectively reviewed 95 patients who underwent EPS due to pain for the first time using a single plastic stent between January 2007 and July 2022 at our institute. Univariate and multivariate stepwise Cox proportional hazards models were used to identify the risk factors for pain recurrence, and a prediction model was developed based on the identified factors. Of the 95 enrolled patients, 89 (93.7%) achieved pain relief and 73 (76.8%) did stent removal. Of the 69 patients with a follow-up period ≥6 months after stent removal, 29 (42.0%) had pain recurrence during the median follow-up period of 59 months. Serum lipase level (p = 0.034) and pancreatic parenchymal thickness (p = 0.022) on computed tomography or magnetic resonance imaging were identified as independent risk factors for pain recurrence. The prediction model based on the identified factors had good discrimination ability, with a concordance index of 0.74, and could stratify pain recurrence rates. We identified the risk factors and developed a new prediction model for pain recurrence following stent removal. This model might be useful for decision-making in pancreatic stent management, such as deciding whether to remove a pancreatic stent, continue EPS, or convert to surgery.

Involvement of heparanase in the pathogenesis of acute pancreatitis: Implication of novel therapeutic approaches.

Acute pancreatitis (AP) is a common gastrointestinal disease with high morbidity and mortality rate. Unfortunately, neither the etiology nor the pathophysiology of AP are fully understood and causal treatment options are not available. Recently we demonstrated that heparanase (Hpa) is adversely involved in the pathogenesis of AP and inhibition of this enzyme ameliorates the manifestation of the disease. Moreover, a pioneer study demonstrated that Aspirin has partial inhibitory effect on Hpa. Another compound, which possesses a mild pancreato-protective effect against AP, is Trehalose, a common disaccharide. We hypothesized that combination of Aspirin, Trehalose, PG545 (Pixatimod) and SST0001 (Roneparstat), specific inhibitors of Hpa, may exert pancreato-protective effect better than each drug alone. Thus, the current study examines the pancreato-protective effects of Aspirin, Trehalose, PG545 and SST0001 in experimental model of AP induced by cerulein in wild-type (WT) and Hpa over-expressing (Hpa-Tg) mice. Cerulein-induced AP in WT mice was associated with significant rises in the serum levels of lipase (X4) and amylase (X3) with enhancement of pancreatic edema index, inflammatory response, and autophagy. Responses to cerulein were all more profound in Hpa-Tg mice versus WT mice, evident by X7 and X5 folds increase in lipase and amylase levels, respectively. Treatment with Aspirin or Trehalose alone and even more so in combination with PG545 or SST0001 were highly effective, restoring the serum level of lipase back to the basal level. Importantly, a novel newly synthesized compound termed Aspirlose effectively ameliorated the pathogenesis of AP as a single agent. Collectively, the results strongly indicate that targeting Hpa by using anti-Hpa drug combinations constitute a novel therapy for this common orphan disease.

Serum trypsin as an early predictor of post-endoscopic retrograde cholangiopancreatography pancreatitis.

Serum amylase (AMY) levels measured 2-6 h after ERCP are a predictor of post-ERCP pancreatitis (PEP). Trypsin is one of the pancreatic enzymes elevated in the development of PEP. The study assessed whether serum trypsin (TRY) can predict early-stage PEP. This prospective study included patients who underwent ERCP from June 2022 to May 2023. TRY, AMY, serum pancreatic AMY (P-AMY), and serum lipase (LIP) levels were measured immediately after ERCP and 2 h later. The primary outcome was the diagnostic abilities of TRY levels measured immediately (0 h-TRY) and 2 h after (2 h-TRY) ERCP to predict PEP (compared with the other serum pancreatic enzymes). Of 130 patients analyzed, 18 developed PEP. The sensitivity and specificity of 0 h-TRY were 83.3% and 69.6%, respectively, and those of 2 h-TRY were 88.9% and 72.3%, respectively. The area under the curve (AUC) for 0 h-TRY was significantly higher than that for 0 h-AMY (p = .006) and 0 h-P-AMY (p = .012), whereas the AUCs for 0 h-TRY and 0 h-LIP did not differ significantly (p = .563). The AUC for 2 h-TRY for predicting PEP was significantly higher than that for 2 h-AMY (p = .025), whereas there was no significant differences between the AUCs for 2 h-TRY and 2 h-P-AMY(p = .146), or between those for 2 h-TRY and 2 h-LIP (p = .792). The median increase ratio (expressed as a ratio relative to baseline) in TRY was highest among all of serum pancreatic enzymes tested immediately after ERCP (5.35, 1.72, 1.94, and 4.44 for TRY, AMY, P-AMY, and LIP, respectively). Measuring TRY immediately after ERCP is useful for the early prediction of PEP.

Parameters Predictive of Propofol-Associated Acute Pancreatitis in Critically Ill Patients with COVID-19 Pneumonia: A Retrospective Cohort Study.

Propofol, a commonly used agent for short- and long-term sedation, is associated with acute pancreatitis. The main indirect mechanism of propofol-associated acute pancreatitis is by inducing hypertriglyceridemia. Patients with severe coronavirus disease 2019 (COVID-19) pneumonia often require prolonged mechanical ventilation and sedation. We examined the incidence rate of acute pancreatitis among critically ill adults with COVID-19 pneumonia on mechanical ventilation receiving propofol. In addition, we attempted to determine cutoff levels of serum triglycerides and doses of propofol that are predictive of propofol-associated acute pancreatitis. This was a multicenter retrospective cohort study using a large dataset of hospitalized patients with COVID-19. The collected data included the number of days on propofol, cumulative doses of propofol, peak levels of serum triglycerides, serum lipase levels, and abdominal imaging findings. We used receiver-operating characteristic analysis in conjunction with Youden's index to identify the optimal thresholds for propofol administration parameters and levels of triglycerides that would provide maximal sensitivity and specificity for predicting acute pancreatitis. Out of 499 critically ill patients with COVID-19 pneumonia, 154 met the inclusion criteria. Six (4%) patients had suspected acute pancreatitis based on elevated serum lipase levels. Cutoff values greater than 688 mg/dL for peak level of triglycerides, 4.5 days on propofol, 3007 mg/day for average daily propofol dose, and 24 113 mg for cumulative propofol dose were associated with high risk of suspected acute pancreatitis. The negative predictive values for suspected acute pancreatitis using these cutoffs ranged from 98% to 100%. Propofol use in critically ill COVID-19 patients is associated with a low incidence rate of acute pancreatitis. We identified cutoff values for serum triglycerides and cumulative propofol dose that are linked to higher risk of propofol-associated pancreatitis. More research is needed to examine the true incidence of propofol-associated pancreatitis and help develop optimal cutoff values for certain parameters to help guide safe propofol administration.

A LATE COMPLICATION OF BLUNT TRAUMA IN A CHILD: HEMORRHAGIC PANCREATIC PSEUDOCYST

Trauma is the most important cause of morbidity and mortality in the pediatric population. Pancreatic injury is relatively rare but has high morbidity and mortality when the diagnosis is delayed. However, diagnosis of pancreatic trauma is difficult. Ultrasound is limited for diagnosing pancreatic injury. Magnetic resonance imaging (MRI) is very useful for detecting direct and secondary signs of pancreatic injury and its complications such as abscess, fistula, pancreatitis, and pseudocyst. We presented a 10-year-old boy with a hemorrhagic pancreatic pseudocyst due to blunt trauma that happened a week ago. His laboratory findings showed elevated serum amylase and lipase levels. In abdominal ultrasonography, bilobular thick-walled fluid collections in the pancreatic parenchyma and peripancreatic location were observed. MRI showed hemorrhagic pseudocysts in the pancreas and pancreatic duct injury. The pseudocysts were treated by cysto-gastrostomy. Children should be carefully evaluated for pancreatic injury and late complications such as hemorrhagic pancreatic pseudocyst to reduce mortality after blunt trauma.

A clinical study correlating the serum levels of lactate dehydrogenase, C-reactive protein, and lipase with the severity and related complications of acute pancreatitis

ABSTRACT Background: In addition to Ranson’s criteria, computed tomography severity index (CTSI), and Acute Physiology and Chronic Health Evaluation II score, the presence of local or systemic complications can predict severe acute pancreatitis (AP). However, proper evaluation by these one-time scores is available after 48 h following admission. Aims and Objectives: This study aims to correlate AP severity and related consequences with serum levels of lipase, C-reactive protein (CRP), and lactate dehydrogenase (LDH). Methods: A prospective analysis was performed on 60 patients with AP who were admitted to the surgical unit. Data on patients’ clinical and radiological evaluations, serum levels of CRP, LDH, and lipase, as well as hematological tests, were gathered and examined. Results: The most common cause of AP, gallstone pancreatitis, affected adults between the ages of 30 and 55, with a female predominance (56.67%). According to the Chi-square test, there was a significant correlation between the Ranson’s score and the CTSI. Similar to this, a very high test of significance for serum CRP levels (>150 mg/l) was seen with both Ranson’s score and the CTSI. Only 15% of patients had severe AP, whereas 85% of cases had mild AP. The majority of the patients (93.4%) recovered with supportive medical care, four (6.7%) needed surgery (necrosectomy/drainage), and one (1.6%) died. Conclusion: The serum CRP level is a good predictor of severe AP. It can be used as an early severity indicator along with the CTSI.

Non-pancreatic hyperlipasemia: A puzzling clinical entity.

Increased lipase level is a serological hallmark of the diagnosis of acute pancreatitis (AP) but can be detected in various other diseases associated with lipase leakage due to inflammation of organs surrounding the pancreas or reduced renal clearance and/or hepatic metabolism. This non-pancreatic hyperlipasemia (NPHL) is puzzling for attending physicians during the diagnostic procedure for AP. It would be clinically beneficial to identify the clinical and laboratory variables that hinder the accuracy of lipase diagnosis with the aim of improve it. A more precise description of the NPHL condition could potentially provide prognostic factors for adverse outcomes which is currently lacking. To perform a detailed clinical and laboratory characterization of NPHL in a large prospective patient cohort with an assessment of parameters determining disease outcomes. A Hungarian patient cohort with serum lipase levels at least three times higher than the upper limit of normal (ULN) was prospectively evaluated over 31 months. Patients were identified using daily electronic laboratory reports developed to support an ongoing observational, multicenter, prospective cohort study called the EASY trial (ISRCTN10525246) to establish a simple, easy, and accurate clinical scoring system for early prognostication of AP. Diagnosis of NPHL was established based on ≥ 3 × ULN serum lipase level in the absence of abdominal pain or abdominal imaging results characteristic of pancreatitis. A total of 808 patients [male, n = 420 (52%); median age (IQR): 65 (51-75) years] were diagnosed with ≥ 3 × ULN serum lipase levels. A total of 392 patients had AP, whereas 401 had NPHL with more than 20 different etiologies. Sepsis and acute kidney injury (AKI) were the most prevalent etiologies of NPHL (27.7% and 33.2%, respectively). The best discriminative cut-off value for lipase was ≥ 666 U/L (sensitivity, 71.4%; specificity, 88.8%). The presence of AKI or sepsis negatively affected the diagnostic performance of lipase. NPHL was associated with a higher in-hospital mortality than AP (22.4% vs 5.1%, P < 0.001). In multivariate binary logistic regression, not lipase but increased amylase level (> 244 U/L) and neutrophil-to-lymphocyte ratio (NLR) (> 10.37, OR: 3.71, 95%CI: 2.006-6.863, P < 0.001), decreased albumin level, age, and presence of sepsis were independent risk factors for in-hospital mortality in NPHL. NPHL is a common cause of lipase elevation and is associated with high mortality rates. Increased NLR value was associated with the highest mortality risk. The presence of sepsis/AKI significantly deteriorates the serological differentiation of AP from NPHL.

Vitamin B6 ameliorates acute pancreatitis by suppressing the caspase3 signaling pathway

BackgroundAcute pancreatitis (AP) is a prevalent exocrine inflammatory disorder of the pancreas characterized by pancreatic inflammation and injury to acinar cells. Vitamin B6 (VB6) is a vital nutrient that plays a significant role in preserving human health and has anti-inflammatory and anti-apoptotic effects.MethodsThis study aimed to explore the potential pancreatic protective effects of VB6 in mitigating pancreatic inflammation and apoptosis induced by taurocholate sodium (TLCS) in an AP model and to assess the underlying mechanism of action. AP was induced in Sprague‒Dawley (SD) rats through TLCS administration and lipopolysaccharide (LPS)-treated AR42J cells, followed by treatment with VB6.ResultsVarious parameters associated with AP were assessed in both plasma and pancreatic tissues. VB6 has been shown to ameliorate the severity of AP through various mechanisms. It effectively reduces the levels of serum amylase, lipase, and inflammatory factors, thereby mitigating histological injury to the pancreas. Moreover, VB6 inhibited pancreatic apoptosis by downregulating bax expression and up-regulating Bcl2 expression in TLCS-treated rats. Additionally, VB6 suppressed the expression of caspase3. The anti-inflammatory and anti-apoptotic effects of VB6 observed in LPS-treated AR42J cells are consistent with those observed in a rat model of AP.ConclusionsThese results suggest that VB6 exerts anti-inflammatory and anti-apoptotic effects through inhibition of the caspase3 signaling pathway and has a protective effect against AP.

Evaluation of serum amylase, lipase, triglyceride, total protein and albumin levels in HIV patients on anti-retroviral drugs in NAUTH Nnewi, south eastern Nigeria

Evaluation of serum amylase, lipase, triglyceride, total protein and albumin levels in HIV patients on anti-retroviral drugs in NAUTH Nnewi, south eastern Nigeria

Acute pancreatitis: A narrative review.

Acute pancreatitis is a common cause of acute abdominal pain and can range from mild oedema to severe necrosis of the pancreas. It has a significant impact on morbidity, mortality and financial burden. The global prevalence of pancreatitis is substantial, with the highest rates observed in central and eastern Europe. Diagnosing acute pancreatitis involves considering clinical symptoms, elevated serum amylase and/or lipase levels, and characteristic imaging findings. The causes of acute pancreatitis include obstructive disorders, such as gallstones and biliary sludge, alcohol consumption, smoking, drug-induced pancreatitis, metabolic disorders, trauma, medical procedures, infections, vascular diseases and autoimmune pancreatitis. Appropriate management of acute pancreatitis involves determining the severity of the condition, providing supportive care, addressing the underlying cause, and preventing complications. Advances in classifying the severity of acute pancreatitis and implementing goal-directed therapy have contributed to a decrease in mortality rates. Understanding its prevalence, aetiology and management principles is crucial for clinicians to appropriately diagnose and manage patients with acute pancreatitis.

Customized Ayurvedic management of Agnyashaya shotha (Subacute Pancreatitis): An experience

Subacute Pancreatitis (SAP), a rapidly developing inflammatory condition, is surgically manageable. Based on the clinical presentation and symptomatology, the manifestation of SAP can be termed as Agnyashaya Shotha (AS). The present case report is on a year-old manifestation of untreated SAP with severe gastro-duodenitis (~Agnyashaya shotha pradhana Grahani roga) in a young male. The previous Ultrasonography (USG) impression of the abdomen revealed “SAP” and the Upper Gastrointestinal (UGI) endoscopy report stated “severe gastroduodenitis.” The serum amylase and lipase levels were 141 U/L and 108 U/L, respectively. He was clinically treated with a customized and simple Ayurveda intervention for five days. The intervention involved oral proprietary polyherbal formulations along with the internal therapy of Matrabasti (~a form of unctuous enema) and Pathya (~wholesome dietary regimen), based on the treatment principles of Grahani roga (~disorders of lower gastrointestinal tract). He became asymptomatic and was discharged after five days of intervention. Furthermore, the USG impression of the abdomen revealed “no evidence of abnormalities” and his serum amylase was reduced to 59 U/L. Although at the time of discharge, the UGI endoscopy and serum lipase level could not be investigated due to the patient’s unwillingness, the case seemed to be worthy of reporting. Thus, the adoption of current therapeutic intervention along with proper Pathya based on Ayurveda principles might have managed the present case of SAP. Although the present case had its limitations, it significantly helped in understanding SAP, its pathogenesis, and management in the view of rationalized fundamental theories of Ayurveda.

Isorhamnetin Alleviates Mitochondrial Injury in Severe Acute Pancreatitis via Modulation of KDM5B/HtrA2 Signaling Pathway.

Severe acute pancreatitis (SAP), a widespread inflammatory condition impacting the abdomen with a high mortality rate, poses challenges due to its unclear pathogenesis and the absence of effective treatment options. Isorhamnetin (ISO), a naturally occurring flavonoid, demonstrates robust antioxidant and anti-inflammatory properties intricately linked to the modulation of mitochondrial function. However, the specific protective impact of ISO on SAP remains to be fully elucidated. In this study, we demonstrated that ISO treatment significantly alleviated pancreatic damage and reduced serum lipase and amylase levels in the mouse model of SAP induced by sodium taurocholate (STC) or L-arginine. Utilizing an in vitro SAP cell model, we found that ISO co-administration markedly prevented STC-induced pancreatic acinar cell necrosis, primarily by inhibiting mitochondrial ROS generation, preserving ATP production, maintaining mitochondrial membrane potential, and preventing the oxidative damage and release of mitochondrial DNA. Mechanistically, our investigation identified that high-temperature requirement A2 (HtrA2) may play a central regulatory role in mediating the protective effect of ISO on mitochondrial dysfunction in STC-injured acinar cells. Furthermore, through an integrated approach involving bioinformatics analysis, molecular docking analysis, and experimental validation, we uncovered that ISO may directly impede the histone demethylation activity of KDM5B, leading to the restoration of pancreatic HtrA2 expression and thereby preserving mitochondrial function in pancreatic acinar cells following STC treatment. In conclusion, this study not only sheds new light on the intricate molecular complexities associated with mitochondrial dysfunction during the progression of SAP but also underscores the promising value of ISO as a natural therapeutic option for SAP.

Liver resection volume-dependent pancreatic strain following living donor hepatectomy

The liver and pancreas work together to recover homeostasis after hepatectomy. This study aimed to investigate the effect of liver resection volume on the pancreas. We collected clinical data from 336 living liver donors. They were categorized into left lateral sectionectomy (LLS), left lobectomy, and right lobectomy (RL) groups. Serum pancreatic enzymes were compared among the groups. Serum amylase values peaked on postoperative day (POD) 1. Though they quickly returned to preoperative levels on POD 3, 46% of cases showed abnormal values on POD 7 in the RL group. Serum lipase levels were highest at POD 7. Lipase values increased 5.7-fold on POD 7 in the RL group and 82% of cases showed abnormal values. The RL group’s lipase was twice that of the LLS group. A negative correlation existed between the remnant liver volume and amylase (r = − 0.326)/lipase (r = − 0.367) on POD 7. Furthermore, a significant correlation was observed between POD 7 serum bilirubin and amylase (r = 0.379)/lipase (r = 0.381) levels, indicating cooccurrence with liver and pancreatic strain. Pancreatic strain due to hepatectomy occurs in a resection/remnant liver volume-dependent manner. It would be beneficial to closely monitor pancreatic function in patients undergoing a major hepatectomy.

Clinical and Biochemical Characteristics of Acute Pancreatitis Patients Attended in a Tertiary Hospital of Bangladesh

Introduction: Acute pancreatitis is a complex, life- threatening disease resulting from acute inflammation of the pancreas which causes considerable morbidity and mortality among the patients. Objectives: To find out the clinical and biochemical characteristics of acute pancreatitis patient attended at the Combined Military Hospital (CMH) Dhaka. Methods: This observational study was conducted at CMH Dhaka among 40 patients of acute pancreatitis admitted from 1st January 2013 to 30th June 2013. Data were collected through face-to-face interview using a pre-tested semi- structured questionnaire and review of the hospital records. Results: Highest number of the respondents (42.5%) belongs to the age group of 20-39 years. The mean age was 44.90 years (±13.46) years and 60.0% of them were male. More than half (57.5%) of the respondents had monthly income in the 20001 to 50000 Taka with average of 31,650(±15,255.60) Taka. All the patients presented with pain in the abdomen which was followed by nausea/ vomiting (82.5%), abdominal distention (72.5%). On examination, it was revealed that all the respondents had abdominal tenderness which was followed by muscle guard (10.0%), ascites (7.5%) and jaundice (5.0%). Almost half (47.50%) of the respondents developed acute pancreatitis due to stone in the gall bladder which was followed by idiopathic origin (30.0%). Eighty five percent of the patients had severe symptoms and rest (15%) had mild symptoms. All the respondents had elevated serum amylase level and 82.5% had elevated serum lipase level. Conclusion: Acute pancreatitis mostly affect young adult male. Most common clinical presentations are upper abdominal pain, nausea/vomiting and abdominal tenderness. Gallstone is the commonest cause of the condition. Serum amylase is the most important biochemical abnormality found in acute pancreatitis. JAFMC Bangladesh. Vol 19, No 1 (June) 2023: 38-41