Serum Lipase Levels Research Articles

Electrolytes and Enzymes Variations in Diabetic Keto Acidosis

Objective: This study aims to evaluate the levels of serum electrolytes and enzymes in diabetic ketoacidosis compared with age matched healthy control population. Method: Cross sectional study involving 94 individuals above the age 60 years in the population of Bengaluru, India between October 2017 to November 2019.Venous blood was collected from 47 type 2 diabetic ketoacidosis patients and from 47 healthy individuals and analyzed for sodium, chloride, potassium, phosphorous electrolytes and serum amylase and lipase enzymes. Results: Serum sodium, potassium and chloride levels were significantly low while serum phosphorous, amylase and lipase levels were significantly high compared to healthy control population. Conclusion: Frequent monitoring of these electrolytes and enzymes in mild stage of diabetic ketoacidosis may help in better treatment and thereby preventing it from progressing into severe diabetic ketoacidosis.

D-Limonene Promotes Anti-Obesity in 3T3-L1 Adipocytes and High-Calorie Diet-Induced Obese Rats by Activating the AMPK Signaling Pathway.

D-limonene (LIM) is a common monoterpene compound, principally found in citrus essential oils. This study investigated the anti-obesity effect of LIM on the 5′-adenosine monophosphate (AMP)-activated protein kinase (AMPK) signaling pathway in 3T3-L1 adipocytes and high-calorie diet-induced obese rats and confirmed the optimally effective dose of LIM. The 3T3-L1 adipocytes were treated with 0.05−0.4 mg/mL LIM for 10 days and oil red O and triglyceride (TG) content were used to determine the levels of lipid accumulation. The results showed that more than 0.05 mg/mL LIM inhibited lipid accumulation by reducing oil red O in 3T3-L1 adipocytes. Masses of 0.2 and 0.4 mg/mL LIM also decreased the TG contents in 3T3-L1 adipocytes. On the other hand, Wistar rats were given high-calorie diets, combined with LLIM (154 mg/kg) and HLIM (1000 mg/kg) treatments, for 16 weeks. The result shows that LLIM and HLIM decreased body weight, total fat tissue weight, and serum low-density lipoprotein-cholesterol (LDLc) levels. HLIM reduced serum TG and increased serum lipase and high-density lipoprotein-cholesterol (HDLc) levels. Moreover, the anti-obesity metabolic pathway showed that LIM (>0.05 mg/mL) in 3T3-L1 adipocytes and LIM (>154 mg/kg) in high-calorie diet-induced obese rats could activate the AMPK signaling pathway. The activated AMPK regulated the mRNA expression related to adipogenesis (PPARγ, C/EBPα, FABP4), lipogenesis (SREBP-1c, ACC, FAS), and lipolysis (ATGL, HSL) to inhibit obesity. This finding demonstrates that LIM has anti-obesity properties. Namely, it is seen that LIM acts by regulating the AMPK signaling pathway in 3T3-L1 adipocytes and high-calorie diet-induced obese rats. In terms of dose−response, LIM (154 mg/kg) would be an optimal effective dose for anti-obesity induced by a high-calorie diet.

Thrombosis of Extrasplanchnic and Splanchnic Venous System in Acute Pancreatitis- A Case with Rare Combination of Vascular Complication

Vascular complications in acute pancreatitis are common and seen in 25% of cases. While it is common to have venous thrombosis in the Superior Mesenteric Vein (SMV), portal vein, and splenic vein, thrombosis of extra-splanchnic vessels such as Inferior Vena Cava (IVC) and left renal vein due to acute pancreatitis is a rare entity, with more adverse outcomes. A 48-year-old male presented with severe epigastric pain, vomiting, and constipation for seven days. Outside Ultrasonography (USG) report was suggestive of acute pancreatitis. His serum amylase, serum lipase, and D-dimer levels were raised. Computed Tomography (CT) of abdomen and pelvis revealed acute necrotising pancreatitis with peripancreatic fluid collection and thrombosis of splenic vein, left renal vein, and IVC. Thrombosis in pancreatitis can occur due to pancreatic proteolytic enzymes which can cause intimal injury. An enlarged pancreas, walled-off necrosis, and pancreatic pseudocyst can compress veins, resulting in venous stasis. Pancreatitis has a systemic hypercoagulable or prothrombotic state. The patient was given symptomatic treatment along with an injection (inj.) of clexaine and monocef. He showed improvement in 10 days and was symptomatically well on follow-up. Early detection of these findings and targeted treatment for the same is crucial to prevent morbidity and mortality of such patients.

Protective effect of rivastigmine against lung injury in acute pancreatitis model in rats via Hsp 70/IL6/ NF-κB signaling cascade.

Acute lung injury (ALI) that develops as a result of AP can progress to acute respiratory distress syndrome. Some hypotheses are proposed to explain the pathophysiology of AP and its related pulmonary hazards. This experiment aimed to evaluate the mitigating action of rivastigmine (Riva) in lung injury that occurs on the top of acute pancreatitis (AP) induced in rats. Thirty-two male Wister rats were randomized to one of four groups: control, Riva-treated, acute pancreatitis (AP), and acute pancreatitis treated by Riva. Serum amylase and lipase levels were assessed. Pulmonary oxidative stress and inflammatory indicators were estimated. A pancreatic and pulmonary histopathological examination, as well as an immunohistochemical study of HSP70, was carried out. Riva significantly attenuated the L-arginine-related lung injury that was characterized by increased pulmonary inflammatory biomarkers (interleukin-6 [IL-6]), nuclear factor kappa B (NF-κB), tumor necrosis factor-α (TNF-α), increased pulmonary oxidative markers (total nitrite/nitrate [NOx]), MDA, decreased total antioxidant capacity (TAC), and reduced glutathione level (GSH)) with increased caspase-3 expression. Therefore, Riva retains potent ameliorative effects against lung injury that occur on the top of AP by relieving oxidative stress, inflammation, and apoptosis via HSP70/IL6/NF-κB signaling.

Preoperative predictor laboratory markers for complicated appendicitis: A retrospective analysis of single center experience

In this study, we aimed to investigate the pre-operative predictive role of the serum white blood cell and platelet counts, C-reactive protein (CRP), bilirubin, amylase, lipase, and sodium levels for complicated appendicitis in patients aged≥18 years. We retrospectively evaluated 574 patients (aged≥18 years) who underwent appendectomy due to acute appendicitis (AA) between March 2018 and March 2022 at our clinic. The patient population was divided into two groups as perioperative complicated and uncomplicated appendicitis and the preoperative predictor role of serum white blood cell counts, platelet counts, CRP, bilirubin, amylase, lipase, and sodium levels were compared for complicated versus uncomplicated appendicitis. In multivariate analyses, age>38 years, the timing of Emergency Department (ED) arrival to admission ≥2 days, CRP ≥3.36 mg/dL, and total bilirubin ≥0.76 mg/dL are independent risk factors for detecting complicated AA. Moreover, in the designed scoring system, the AUC: 0.877 (CI: 0.847-0.907) for perforated AA at scores below or above. Estimation of the complications of AA can help clinicians practically with the scoring system designed because of the determined predictive factors.

Sudden Death Due to Acute Hemorrhagic Pancreatitis: A Case Report

Sudden unexpected deaths pose a challenge for the forensic pathologists. Usually relates to cardiovascular causeand such deaths due to gastrointestinal related pathology are uncommon. Acute pancreatitis is a major etiology ofgastrointestinal sudden deaths. It is mainly associated with gallbladder stones and alcoholism. We report a caseof a 48-year-old man, chronic alcoholic, who was brought dead to hospital after complaints of abdominal painand vomiting. The postmortem examination revealed the death due to acute hemorrhagic pancreatitis. Literatureshows pancreatitis to be significantly associated with alcoholic liver disease. The present case reemphasizes theimportance of examination of retroperitoneal space during autopsy and how ancillary investigations such ashistopathology, chemical analysis, measuring serum amylase, lipase and vitreous glucose levels help in arrivingat final diagnosis.

Relationship of Serum Ghrelin, Amylase and Lipase with Insulin Level in Type 2 Diabetes mellitus patients

Background: Diabetes mellitus (DM) is a metabolic disorder known as hyperglycemia, which is brought on by impaired insulin secretion, inefficient insulin utilization, or both. Objectives: This study’s aim was to assess the lipase and amylase amylase pancreatic enzymes levels in sera of (T2DM) patients and healthy control subjects. Materials and Methods: A case-control research was conducted from December 2021 to March 2022 at the Hilla District Center for Diabetes and Endocrinology in Babylon, Iraq. It included a group of 39 patients with type 2 DM and 39 healthy people between the ages of 35 to 60 years. Results: Results were indicating a significant difference in FBS among groups, The mean levels of FBS for DM was (203.7 ± 72.3) mg/dL which was significantly greater than it was for the control group (88.6 ± 7.64) mg/dL,(P ≤ 0.001). The mean of HbA1c for DM (9.5 ± 2.35) was significantly higher than for control (4.9 ± 0.48), P ≤ 0.001. The mean levels of the Amylase and Lipase activity in the DM patients group were (71.4 ± 29.11) and (49.7 ± 14.69) (U/L). When compared to the control group’s mean values, which were (72.7 ± 27.19) and (42.0 ± 7.35) (U/L). The mean levels of Lipase activity were shown a significant difference in T2DM patients compared to the healthy control group, (P < 0.05). Conclusion: Increased serum level of lipase without any symptoms of pancreatitis was indicated in type II diabetes mellitus patients.

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.

Identification of novel immune-related targets mediating disease progression in acute pancreatitis.

Acute pancreatitis (AP) is an inflammatory disease with very poor outcomes. However, the order of induction and coordinated interactions of systemic inflammatory response syndrome (SIRS) and compensatory anti-inflammatory response syndrome (CARS) and the potential mechanisms in AP are still unclear. An integrative analysis was performed based on transcripts of blood from patients with different severity levels of AP (GSE194331), as well as impaired lung (GSE151572), liver (GSE151927) and pancreas (GSE65146) samples from an AP experimental model to identify inflammatory signals and immune response-associated susceptibility genes. An AP animal model was established in wild-type (WT) mice and Tlr2-deficient mice by repeated intraperitoneal injection of cerulein. Serum lipase and amylase, pancreas impairment and neutrophil infiltration were evaluated to assess the effects of Tlr2 in vivo. The numbers of anti-inflammatory response-related cells, such as M2 macrophages (P = 3.2 × 10-3), were increased with worsening AP progression, while the numbers of pro-inflammatory response-related cells, such as neutrophils (P = 3.0 × 10-8), also increased. Then, 10 immune-related AP susceptibility genes (SOSC3, ITGAM, CAMP, FPR1, IL1R1, TLR2, S100A8/9, HK3 and MMP9) were identified. Finally, compared with WT mice, Tlr2-deficient mice exhibited not only significantly reduced serum lipase and amylase levels after cerulein induction but also alleviated pancreatic inflammation and neutrophil accumulation. In summary, we discovered SIRS and CARS were stimulated in parallel, not activated consecutively. In addition, among the novel susceptibility genes, TLR2might be a novel therapeutic target that mediates dysregulation of inflammatory responses during AP progression.

The Protective Effect of Alpha-Lipoic Acid on Oxidative Stress and Proinflammatory cytokines in L-Arginine-Induced Acute Pancreatitis Male Rats

Acute pancreatitis (AP) is a common serious stirring disease of the pancreas characterized by strict abdominal twinge that lasts for days to weeks. Rats were injected with high dose of the amino acid L-arginine (500 mg/kg B.W.). The study has been done to induce acute pancreatitis (AP) by L-Arginine (Arg) and to investigate the effect of AP on body weight, body weight gain, serum amylase, lipase, oxidative stress and proinflammatory cytokine parameters. In addition, some histopathological changes in pancreas and intestine were examination in male rats. Serum amylase, lipase, IL-6, and TNF-α levels, and MDA levels significantly increased in rats with L-Arginine induced AP. However, the boy weight and body weight gain, serum GPx, SOD and CAT activity significantly reduced. In addition, some histological changes in pancreas and intestine were identified, reversed and improved with ALA treatment.

Evaluation of serum amylase and serum lipase as biochemical markers of pancreatic exocrine function in type II diabetes mellitus

Background: Diabetes mellitus is a metabolic ailment characterized by hyperglycemia in which there is a severe derangement of the endocrine functionality of the pancreas. Studies have demonstrated the association of pancreatic enzymes as biomarkers of exocrine function in DM-II. Material and methods: In this case-controlled study total 90 subjects were included, which were separated into two groups DM (n=45) and non-DM (n=45). The non-diabetic control group was age and sex-matched. After inclusion, written informed consent was acquired from all the individuals and they were investigated for serum amylase and lipase levels. Other routine investigations were also done. The data was then recorded and statistical analyses were done. Results: This study showed that mean amylase in DM group (44.69±15.57) was lesser than in non-DM group (60.69±21.67). Similarly, the mean lipase in DM group (35.44±11.30) was lesser than in non-DM group (48.47±12.73). With increase in Glycated haemoglobin, both enzyme levels decreased substantially when assessed with the non-DM groups. It was also showed that in patients with higher LDL (> 110) the serum amylase levels decreased further compared to the non-DM patients. Similar results were reported for serum lipase also.

The role of serum nesfatin-1 in a rat model of acute pancreatitis.

Acute pancreatitis (AP) is a disease that can still be fatal despite rapid advances in medicine. The relationship between serum nesfatin-1 levels and AP is still to be fully resolved. To investigate the utility of serum nesfatin-1 levels in the diagnosis of AP. Twenty-four male Sprague Dawley rats were divided into control, mild pancreatitis and severe pancreatitis groups (n = 8/group). Acute pancreatitis was induced by cerulein injection and the control group received saline injections. Then, the serum nesfatin-1, amylase, lipase, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) levels were determined. A pathologist blinded to the study scored the severity of pancreatitis. There was a considerable decrease in serum nesfatin-1 levels in parallel to the severity of pancreatitis, though there was no statistically significant relationship observed between pancreatitis and nesfatin-1. In addition, there was no significant difference in AST or ALT levels among the groups. However, a strong positive correlation between amylase and lipase levels was observed (p < 0.05). The severe pancreatitis group (group 3) had a higher lipase level and pathology score than mild pancreatitis group (group 2), and this difference was statistically significant. Serum nesfatin-1 may be used as a diagnostic and severity marker in pancreatitis in the future.

Biochanin A ameliorates caerulein-induced acute pancreatitis and associated intestinal injury in mice by inhibiting TLR4 signaling

Acute pancreatitis (AP) is an acute inflammatory abdominal disease frequently associated with intestinal barrier dysfunction. Biochanin A (BCA), a dietary isoflavone, has gained increasing interest with its pronounced biological activities. However, its potential beneficial effects on AP have not been demonstrated. Herein, we explored the protective effect of BCA on caerulein-induced AP in BALB/c mice and underlying mechanisms. BCA alleviated AP as evidenced by reduced serum amylase and lipase levels, pancreatic edema, pancreatic myeloperoxidase activity, and improved pancreatic morphology. Amelioration of pancreatic damage by BCA was associated with reduced levels of tumor necrosis factor-α, interleukin (IL)-1β, IL-6, and monocyte chemotactic protein-1 in both pancreas and colon. Moreover, BCA attenuated AP-associated barrier damage by upregulating the expression of tight junction proteins zonulin occluding (ZO)-1, ZO-2, occludin, and claudin-1. Concomitantly, the translocation of pathogenic bacteria Escherichia coli (E. coli) to pancreas was reduced by BCA. More importantly, reduction of E. coli dissemination by BCA inhibited the TLR4-MAPK/NF-κB signaling and NLRP3 inflammasome activation, thereby protecting against AP and related intestinal injury. Consistently, TLR4 inhibition by TAK-242 pre-treatment counteracted the anti-inflammatory effects of BCA in acinar cells. Taken together, our study extends beneficial effects of BCA to AP prevention, and dietary BCA supplement may be a potential strategy to safeguard AP.

Efficacy of EUS-Guided Necrosectomies in Patients with Walled-Off Pancreatic Necrosis

Abdominal pain is considered a cardinal feature of acute pancreatitis (AP), and abdominal imaging is only required to diagnose AP when the pain is atypical, or serum enzyme elevation does not match the clinical picture. While painless lipase elevation is being increasingly associated with worse outcomes in various diseases, the diagnostic approach to such elevation is so-far unclear. We thus aimed to learn the impact of pain on the diagnosis of AP.All patients presenting to the Mayo Clinic Arizona Hospital emergency department with a serum lipase ≥3x upper limit of normal between April 2016 and January 2020 were prospectively followed. Their charts were reviewed for the nature of pain, serum lipase levels on presentation, abdominal imaging, and whether a diagnosis of AP was made. Chronic pancreatitis was excluded.Among 320 patients, 85 (26.5%) had painless lipase elevation. These patients had abdominal imaging less often (56/85, 66%) than in those with abdominal pain (201/235, 83%; p = 0.001). The diagnosis of AP increased overall from 31/63 (49%) without imaging to 198/257 (77%) with imaging (P < 0.001). Imaging increased the diagnosis of AP in patients with painless lipase elevation from 2/29 (7%) without imaging to 16/56 (29%; p = 0.025) among those who were imaged.Painless lipase elevation >3-fold the upper limit of normal is common in emergency department patients. 1/3 to 1/4 of these may have AP. Abdominal imaging increases the diagnosis of AP in patients with painless lipase elevation. Therefore, abdominal imaging in such patients may help detect AP that otherwise eludes diagnosis.

PSUN270 Magnified Risk of Pancreatitis by GLP-1: A Case of Necrotizing Pancreatitis in a Patient on Dulaglutide with Baseline Elevated Triglycerides

Abstract Introduction Glucagon-like peptide 1 receptor agonists (GLP-1 RA), used in the treatment of diabetes mellitus, have been associated with pancreatitis in both animal studies and clinical trials. Furthermore, GLP-1 RA are associated with increased levels of serum lipase and amylase, possibly indicating resultant pancreatic inflammation.1 While there is debate on the actual degree of risk of pancreatitis in patients on GLP-1 RA, there may be individuals who are at higher risk due to baseline comorbidities that may have their risk of pancreatitis further potentiated by treatment with GLP-1 RA. We present a case in which a patient with baseline moderately elevated triglycerides on long term GLP-1 RA develops necrotizing pancreatitis after minimal alcohol intake. Case A 46-year-old man with type 2 diabetes mellitus, hyperlipidemia, and depression presented with one day history of severe right upper quadrant abdominal pain, nausea, and non-bloody, non-bilious vomiting. He also endorsed subjective fevers and chills, shortness of breath, chest pain, and constipation. He reported that he had drank one bottle of sparkling wine the day prior but denied drinking regularly. Labs and imaging were consistent with acute necrotizing pancreatitis with elevated lipase (502 U/L), elevated triglycerides (TG) (3,480 mg/dL), and CT abdomen/pelvis showing focal hypoattenuation/edema of the pancreatic head with surrounding fat stranding. Subsequent MRI abdomen showed evolving necrotic pancreatitis with focal area of nonenhancement in the pancreatic head. He denied any history of gallstones, recent trauma, diarrhea, weight loss, or prior pancreatitis. Review of his medications was notable for dulaglutide for management of his diabetes. He also had a history of consistently elevated TG to the mid-300s mg/dL as far back as 3 years ago. Patient was ultimately managed conservatively with intravenous fluids with resolution of symptoms and downtrend of lipase and triglycerides. He was discharged on fenofibrate and icosapent ethyl for further triglyceride control. Discussion While several META analyses have not shown significant association between GLP-1 RA and pancreatitis, there still is a proportion of patients who have developed pancreatitis on GLP-1 RA.2 Our patient had baseline elevated triglycerides, but they were below the typical threshold for treatment. With minimal alcohol consumption, he still developed pancreatitis. We suspect that his risk for pancreatitis was magnified by his GLP-1 RA. We believe that in patients such as ours who have baseline independent risk factors for pancreatitis, GLP-1 RA should be carefully considered before initiation. 1. Trujillo J. Safety and tolerability of once-weekly GLP-1 receptor agonists in type 2 diabetes. J Clin Pharm Ther. 2020;45 Suppl 1(Suppl 1): 43-60. doi: 10.1111/jcpt.13225 2. Monami M, Dicembrini I, Nardini C, Fiordelli I, Mannucci E. Glucagon-like peptide-1 receptor agonists and pancreatitis: a meta-analysis of randomized clinical trials. Diabetes Res Clin Pract. 2014;103(2): 269-275. doi: 10.1016/j.diabres.2014.01.010 Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Postoperative Day 3 Serum Lipase Level as an Easy and Reliable Predictor of Clinically Relevant Pancreatic Fistula after Pancreaticoduodenectomy

INTRODUCTION: Postoperative pancreatic fistula (POPF) represents the most common and feared complication after pancreatoduodenectomy (PD). POPF early detection could improve patient management and outcomes. Postoperative hyperlipasemia is used for the diagnosis of postoperative pancreatitis, but its role in predicting POPF needs to be proven. The aim of this study is to investigate the role of serum lipase (SL) in predicting POPF. METHODS: A prospective maintained database of patients who underwent PD between January 2012 and January 2020 was retrospectively analyzed. SL was measured on postoperative day (POD) 1, 2, and 3. The study groups were defined according to postoperative SL levels. Receiving operator characteristic (ROC) analysis was performed to assess the optimal cutoff of SL in predicting clinically relevant POPF (CR-POPF). The analysis was carried out using binary logistic regression analysis. RESULTS: One hundred fifteen patients fulfilled the inclusion criteria. The mean SL on POD 1, 2, and 3 were significantly higher in CR-POPF group (p < 0.01). The ROC analysis showed that, in the presence of SL ≥177 U/L on POD 1, 2, and 3, the negative predictive values for CR-POPF were 92.5%, 92.7% and 93.3%, respectively (Fig. 1). Notably, POD 3 SL ≥177 U/L was associated with 6-times higher odds of CR-POPF (odds ratio 6.89; p = 0.009).CONCLUSION: Postoperative SL on POD 1, 2, and 3 may be used to exclude the presence of CR-POPF. Notably, SL on POD 3 may represent an easy and reliable predictor of CR-POPF.

Propofol-Related Infusion Syndrome: A Clinical Review

Propofol-related infusion syndrome (PRIS) is a lethal condition characterized by multiple organ system failures. It can occur due to prolonged administration of propofol (an anesthetic) in mechanically intubated patients. The main presenting features of this condition include cardiovascular dysfunction with particular emphasis on impairment of cardiovascular contractility, metabolic acidosis, lactic acidosis, rhabdomyolysis, hyperkalaemia, lipidaemia, hepatomegaly, acute renal failure, and eventually mortality in most cases. The significant risk factors that predispose one to PRIS are: critical illnesses, increased serum catecholamines, steroid therapy, obesity, young age (significantly below three years), depleted carbohydrate stores in the body, increased serum lipids, and most importantly, heavy or extended dosage of propofol. The primary pathophysiology behind PRIS is the disruption of the mitochondrial respiratory chain that causes inhibition of adenosine triphosphate (ATP)synthesis and cellular hypoxia. Further, excess lipolysis of adipose tissue occurs, especially in critically ill patients where the energy source is lipid breakdown instead of carbohydrates. This process generates excess free fatty acids (FFAs) that cannot undergo adequate beta-oxidation. These FFAs contribute to the clinical pathology of PRIS. It requires prompt management as it is a fatal condition. The clinicians must observe the patient's electrocardiogram (ECG), serum creatine kinase, lipase, amylase, lactate, liver enzymes, and myoglobin levels in urine, under propofol sedation. Doctors should immediately stop propofol infusion upon noticing any abnormality in these parameters. The other essentials of management of various manifestations of PRIS will be discussed in this article, along with a detailed explanation of the condition, its risk factors, diagnosis, pathophysiology, and presenting features. This article aims to make clinicians more aware of the occurrence of this syndrome so that better ways to manage and treat this condition can be formulated in the future.

Ruthenium red attenuates acute pancreatitis by inhibiting MCU and improving mitochondrial function

Acute pancreatitis (AP) is a common inflammatory disease of the digestive system. Mitochondrial calcium uniporter (MCU) mediates mitochondrial uptake of Ca2+ and plays an important role in calcium homeostasis. However, it is undefined whether AP can be relieved by inhibiting MCU. This study aimed to study the therapeutic potential of Ruthenium red (RuR), a MCU inhibitor, in AP mice model and primary acinar cells. Cell injury and AP mice model was induced by caerulein. RuR alleviated CER-AP evidenced by reduced serum lipase, TNF-α, and pancreatic MPO levels, less severe pancreatic pathology damage, and decreased inflammatory cell infiltration. In freshly isolated pancreatic acinar cells, RuR diminished cell necrosis with effect on suppressing the expression of MCU. RuR also decreased levels of cytosolic calcium and ROS, preventing mitochondrial membrane potential loss, ATP depletion and MPTP opening. The present findings indicate that inhibit MCU by RuR has a beneficial effect in AP by preventing calcium overload, mitochondrial dysfunction, and cell necrosis.

Acute pancreatitis associated with immunoglobulin A vasculitis: report of fifteen cases.

Immunoglobulin A vasculitis (IgAV) is a systemic small vessel vasculitis common in children. Pancreatic involvement in IgAV is rare. The purpose of this study was to analyze the clinical characteristics of IgAV-related acute pancreatitis in children. Records of patients with IgAV-related acute pancreatitis admitted to our institution between January 2016 and December 2019 were reviewed. We summarized the clinical characteristics, laboratory characteristics, imaging findings, treatment, and outcomes of 15 children with IgAV-related acute pancreatitis. The patients' median age was 9.6years. Pancreatitis was the initial manifestation of IgAV in 3 patients. All patients had abdominal manifestations, including abdominal pain (15/15), vomiting (10/15), and gastrointestinal bleeding (7/15). Serum amylase and lipase levels were elevated in all patients. Serum amylase in 4 cases reached more than three-fold elevation and serum lipase in 14 cases reached more than three-fold elevation. Morphological abnormalities and abnormal signals of the pancreas were observed in 13 cases by magnetic resonance imaging. Pancreaticobiliary maljunction was seen in 3 cases by magnetic resonance cholangiopancreatography. Glucocorticoid therapy and intravenous immunoglobulins were used to treat acute pancreatitis in IgAV. All patients showed clinical improvement after treatment. During the follow-up period of 6-12months, all 15 cases with pancreatitis were cured without recurrence. Pancreatic involvement is rare in IgAV; however, this should be considered in IgAV patients with severe abdominal pain. The timely application of steroid therapy is important for IgAV-associated pancreatitis. Key Points • Acute pancreatitis is a rare complication of immunoglobulin A vasculitis (IgAV). • Acute pancreatitis can be the initial manifestation of IgAV. It is important to evaluate for pancreatitis while IgAV patients with severe abdominal pain. • A common image finding of IgAV-associated pancreatitis was swelling of the pancreas. • Glucocorticoid therapy and intravenous immunoglobulins is helpful in alleviating acute pancreatitis in IgAV.

Pancreatic Apoplexy: Fulminant Necrotizing Pancreatitis Leading to Completion Pancreatectomy Within 3 Days After Partial Pancreaticoduodenectomy.

Patient characteristics with postoperative acute necrotizing pancreatitis and completion pancreatectomy (CP) after pancreaticoduodenectomy (PD) remain unclear. Data from all patients who underwent a PD with need for CP (January 2011-December 2019) at a German University Hospital were analyzed regarding the indications and timing of CP, laboratory and histopathological findings, and overall outcome. Six hundred twelve patients underwent PD, 33 (5.4%) of them needed a CP. Indications were grade C pancreatic fistula with or without biliary leak (46% and 12%), biliary leak (6%), and hemorrhage due to pancreatic fistula (36%). Eight patients (24%) underwent CP within 3 days after PD. These fulminant courses ("pancreatic apoplexy") were accompanied by significantly higher levels of lactate dehydrogenase, C-reactive protein, serum amylase, serum lipase, drain amylase, and drain lipase compared with patients with CP after the third day. Pancreatic apoplexy was histologically associated with higher rates of pancreatic necrosis (P = 0.044) and hemorrhage (P = 0.001). A trend toward higher mortality was observed (75% vs 36%, P = 0.058). Pancreatic apoplexy, defined as fulminant necrotizing pancreatitis after PD leading to CP within 3 days, is associated with characteristic laboratory and histopathological findings and a trend to higher mortality.