Clinical Profile and Outcomes in Patients with Acute Pancreatitis attending a Teaching Hospital at Gandaki Province, Nepal

2020 ◽  
Vol 16 (3) ◽  
Author(s):  
Subash Bhattarai ◽  
Merina Gyawali
Keyword(s):  
Acute Pancreatitis ◽  
Severe Acute Pancreatitis ◽  
Age Groups ◽  
Data Entry ◽  
Kidney Injury ◽  
Severity Index ◽  
Clinical Profile ◽  
Cross Sectional ◽  
Systemic Complications ◽  
Keywords Alcohol

Background: Acute pancreatitis (AP) is inflammatory process of pancreas presenting with acute abdominal pain.The majority of patients have mild disease. Some patients develop local and systemic complications with increased morbidity and mortality. This study was undertaken to describe the clinical profile and outcomes in patients with acute pancreatitis.   Methods:  A cross-sectional hospital based study comprising of 62 consecutive patients with acute pancreatitis were enrolled between Jan 2019 to August 2020. Clinical profile at admission, complications and clinical outcomes including mortality were studied. Patients were classified into mild, moderately severe and severe acute pancreatitis based on revised Atlanta classification and modified CT severity index.  Data entry was done in Statistical Packages for the Social Sciences version 20. Results: The mean age of study subjects was 44±10.87 years with 43 (56%) males and 19 (44%) females (M:F=2.1:1). The commonest etiology of pancreatitis was alcohol (53.2%) followed by biliary pancreatitis (37.1%)  The most common presentation was abdominal pain (100%). The most common complication was pancreatic necrosis (21%) followed by acute kidney injury (19.4%) and pleural effusion (17.3%). Majority( 72.6%) was mild and 17.7% had severe acute pancreatitis. Mortality was seen in 6.5% patients. Mortality was observed in patients with persistent complications, organ failure, low serum calcium and high modified CT severity index.   Conclusions: Alcohol and gallstones were the two main etiologies of acute pancreatitis and were common in males, and in middle age groups. Majority presented with mild severity. Mortality was observed in some patients with severe acute pancreatitis.   Keywords: alcohol; biliary; CT severity index; mortality; outcome; pancreatitis          

scholarly journals Improved Outcome of Severe Acute Pancreatitis in the Intensive Care Unit

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Polychronis Pavlidis ◽  
Siobhan Crichton ◽  
Joanna Lemmich Smith ◽  
David Morrison ◽  
Simon Atkinson ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Pancreatitis ◽  
Intensive Care ◽  
Severe Acute Pancreatitis ◽  
Tertiary Care ◽  
Kidney Injury ◽  
Severity Index ◽  
Apache Ii Score ◽  
Tertiary Care Centre

Background. Severe acute pancreatitis (SAP) is associated with serious morbidity and mortality. Our objective was to describe the case mix, management, and outcome of patients with SAP receiving modern critical care in the Intensive Care Unit (ICU).Methods. Retrospective analysis of patients with SAP admitted to the ICU in a single tertiary care centre in the UK between January 2005 and December 2010.Results. Fifty SAP patients were admitted to ICU (62% male, mean age 51.7 (SD 14.8)). The most common aetiologies were alcohol (40%) and gallstones (30%). On admission to ICU, the median Acute Physiology and Chronic Health Evaluation (APACHE) II score was 17, the pancreatitis outcome prediction score was 8, and the median Computed Tomography Severity Index (CTSI) was 4. Forty patients (80%) tolerated enteral nutrition, and 46% received antibiotics for non-SAP reasons. Acute kidney injury was significantly more common among hospital nonsurvivors compared to survivors (100% versus 42%, ). ICU mortality and hospital mortality were 16% and 20%, respectively, and median lengths of stay in ICU and hospital were 13.5 and 30 days, respectively. Among hospital survivors, 27.5% developed diabetes mellitus and 5% needed long-term renal replacement therapy.Conclusions. The outcome of patients with SAP in ICU was better than previously reported but associated with a resource demanding hospital stay and long-term morbidity.

scholarly journals Serial estimation of serum myeloperoxidase in patients of acute pancreatitis: A pilot study

2021 ◽  
Vol 3 (2) ◽  
pp. 43-50
Author(s):  
Faraz Ahmed ◽  
Gursagar Singh Sahota ◽  
Vijay Kumar Singh ◽  
Anit Parihaar ◽  
Wahid Ali ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Pilot Study ◽  
Colorimetric Assay ◽  
Severe Disease ◽  
Severity Index ◽  
Prognostic Indicator ◽  
Cross Sectional ◽  
Systemic Complications ◽  
Abdominal Symptoms ◽  
The Mean

Acute pancreatitis (AP) is an inflammatory condition having varied presentation ranging from a mild self-limiting illness to a severe disease with multi organ failure. Excessive recruitment of leukocytosis is an important pathophysiological feature and Myelo-peroxidase (MPO) forms an important part of neutrophil induced inflammation. The current prognostic criteria are complex and cumbersome.: The present cross sectional pilot study serial estimation of plasma MPO levels were done at the time of admission and on 3, 7 and 14 days in patient of Acute Pancreatitis (n=64) patient with acute abdominal symptoms (n=15) otherthan acute pancreatitidand healthy volunteers (n=15). The values of serum MPO levels were correlated with Ransons`s score, Apache score, CT severity index and patient developing local and systemic complications due to acute pancreatitis. Serum MPO levels in (mU/ml) were measured by colorimetric Assay kit (bio Vision, USA). Statistical Analysis on SPSS (Windows version 21.0): The mean serum MPO levels were significantly high in patients of AP as compared to controls comprising of patients with acute abdominal conditions and healthy individuals (mean 12.73 vs 1.67 mU/ml. p< 0.001). The highest levels of serum MPO were observed on the first day of mild and severe AP. The mean MPO levels in mild diseases (n=21 patients) were 3-10 mU/ml and 10-20 mU/ml in severe AP (n=43 patients) who also experienced higher local complications and worse outcome in terms of mortality. MPO returned to normal levels within 7-10days in mild but were persistently raised in patients with severe diseases. The higher serum MPO levels correlated with more severe diseases, worse outcome and can be a simple and effective prognostic indicator in AP.

Diagnostic Accuracy of BISAP Score for Detecting Acute Pancreatitis Keeping Computed Tomography Severity Index as GS

2021 ◽  
Vol 15 (11) ◽  
pp. 3164-3165
Author(s):  
Mohammad Iltaf ◽  
Sana Akhtar ◽  
Dilaram Khan
Keyword(s):  
Computed Tomography ◽  
Acute Pancreatitis ◽  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Negative Predictive Value ◽  
Severe Acute Pancreatitis ◽  
Predictive Value ◽  
Gold Standard ◽  
Severity Index ◽  
Cross Sectional

Objective: To establish the diagnostic accuracy of BISAP in detecting the severe acute pancreatitis keeping computed tomography severity index as gold standard. Study Design: Cross-sectional study Place and Duration of Study: Department of Gastroenterology, Hayatabad Medical Complex, Peshawar from April 16th 2018 to 16th October 2018. Methodology: One hundred and twenty nine patients of age range of 18-60, of either gender having severe acute pancreatitis were included. While patients already diagnosed as severe acute pancreatitis and having known history of chronic pancreatitis were excluded. Patients were subjected to CT scan to confirm whether the severe acute pancreatitis is present or not. All CT scans were reported by single experiences radiologist. Results: There were 30.3% were males and 69.7% were females with mean age 42±11.03 years. BISAP had sensitivity 92.74%, specificity 80%, positive predictive value 99.13%, negative predictive value 20.76% and the overall diagnostic accuracy was 92.24%. Conclusion: BISAP had sensitivity 93.61%, specificity 100%, positive predictive value 100%, negative predictive value 40% and the overall diagnostic accuracy was 93.87% in severe acute pancreatitis keeping CT severity index as gold standard. Keywords: Accuracy, Severe acute pancreatitis, Computed tomography

24. Clinical profile & outcome of patients with severe acute pancreatitis

2018 ◽  
Vol 8 ◽  
pp. S112-S113
Author(s):  
Amit Bansal ◽  
Rajoo Singh Chinna ◽  
Sandeep Singh Sidhu ◽  
Kavita Saggar
Keyword(s):  
Acute Pancreatitis ◽  
Severe Acute Pancreatitis ◽  
Clinical Profile

scholarly journals An evaluation of compliance with the cigarettes and other tobacco products act 2003 in Koppal district, Karnataka

2019 ◽  
Vol 6 (7) ◽  
pp. 3113
Author(s):  
Vijaykumar P. Mane ◽  
Yuvaraj Bhanot Yenkanaik ◽  
Shankrappa Dhanapur ◽  
Sangappa Yallammanavar ◽  
Rashmi Sreenivasamurthy
Keyword(s):  
Tobacco Use ◽  
Sample Selection ◽  
Age Groups ◽  
Data Entry ◽  
Control Program ◽  
Sampling Technique ◽  
Cross Sectional Study ◽  
Cluster Sampling ◽  
Cross Sectional ◽  
Tobacco Products

Background: Tobacco is a major risk factor for a number of diseases affecting all age groups. One person dies every six seconds due to tobacco use and up to half of current users will eventually die of a tobacco-related disease. Government of India has enacted cigarette and other tobacco products act (COTPA) in the year 2003 to control tobacco use. The objective of study was to estimate the level of compliance to selected sections (4 to 9) of COTPA (cigarette and other tobacco products – prohibition of advertisement and regulation of trade and commerce, production, supply and distribution) act, 2003 in Koppal district, Karnataka.Methods: The present study was a cross sectional study conducted as an independent evaluation of COTPA act 2003 in Koppal district as per National Tobacco Control Program guidelines. Cluster sampling technique was used for sample selection and sample consisted of 158 public places, 102 educational institutional, 87 shops/ sell points and 60 tobacco products. Data entry and analysis was done using microsoft office excel 2013.Results: The prevalence of compliance to section 4, 5, 6A, 6B, 7, 8 and 9 of COTPA act 2003 in Koppal district were 80.3%, 96.5%, 98.9%, 64.8%, 53.3%, 63.3% and 50% respectively.Conclusions: Compliance level was poor especially in relation to display of health warnings on tobacco products which needs to be tackled through strict enforcement of the existing laws.

scholarly journals Clinical Profile and Underlying Cause of Acute Pancreatitis among a Group of Bangladeshi Patients

2020 ◽  
Vol 32 (1) ◽  
pp. 21-24
Author(s):  
ANM Saifullah ◽  
Madhu Sudan Saha ◽  
Bimal Chandra Shil ◽  
Ali Monsur Md Shariful Islam ◽  
Arifa Akhter ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Abdominal Pain ◽  
Gall Stone ◽  
Clinical Profile ◽  
Medical Emergency ◽  
High Morbidity ◽  
Cross Sectional ◽  
Medical College ◽  
North East ◽  
Medicine Today

Introduction:Acute Pancreatitis is a medical emergency, which is one of the most common conditions for hospital admission. Very few studies have yet investigated in Bangladesh. Objective of this study was to define demographic characteristics, clinical profile & underlying etiologies. Materials and Methods: This hospital based cross sectional descriptive study was performed in Sir Salimullah Medical College Mitford Hospital, Dhaka & North East Medical College, Sylhet, Bangladesh from January 2015 to December 2017. One hundred and five consecutive patients of acute pancreatitis (AP) were enrolled for this study. Clinical features and investigations were systematically recorded. Diagnosis of acute pancreatitis was made by the presence of the two of the three following criteria: i. abdominal pain consistent with the disease ii. serum amylase and /or lipase greater than three times from the upper limit of normal, and/or iii. characteristic findings of abdominal imaging. Results: Total of 105 patients took part in the study, of them 65 were male. The mean age was 42.76 ±15.88. Abdominal pain & vomiting was the most common mode of presentation. Gall stone and hypertriglyceridaemia were responsible of 20% of acute pancreatitis. Ascariasis also causes acute pancreatitis in two patients. Conclusion: Acute pancreatitis is a condition associated with high morbidity and mortality. Ascariasis also causes acute pancreatitis in endemic area. Patients usually respond conservative treatment but endoscopic treatment is effective in few cases. Surgery is rarely required. Medicine Today 2020 Vol.32(1): 21-24

scholarly journals A monoclonal anti-interleukin 8 antibody (WS-4) inhibits cytokine response and acute lung injury in experimental severe acute necrotising pancreatitis in rabbits

Gut ◽  
1998 ◽  
Vol 43 (2) ◽  
pp. 232-239 ◽  
Author(s):  
M O Osman ◽  
J U Kristensen ◽  
N O Jacobsen ◽  
S B Lausten ◽  
B Deleuran ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Acute Lung Injury ◽  
Lung Injury ◽  
Severe Acute Pancreatitis ◽  
Pancreatic Necrosis ◽  
Interleukin 8 ◽  
Systemic Complications ◽  
Duct Ligation ◽  
Tnf Α

Background—Interleukin 8 (IL-8) has recently been proposed to have an important role in mediating the development of the systemic sequelae associated with severe acute pancreatitis.Aims—To define the role of IL-8 in acute pancreatitis by neutralising its effects with a monoclonal anti-IL-8 antibody (WS-4), in a rabbit model of severe acute pancreatitis.Methods—Acute pancreatitis was induced by retrograde injection of 5% chenodeoxycholic acid into the pancreatic duct and duct ligation. Twenty rabbits were divided equally into two groups: acute pancreatitis controls received physiological saline and the treated group received WS-4, 30 minutes before induction of acute pancreatitis.Results—Pretreatment of animals with WS-4 resulted in significant down regulation of serum IL-8 and tumour necrosis factor α (TNF-α) from three to six hours after induction of acute pancreatitis (p=0.011 and 0.047 for IL-8 and 0.033 and 0.022 for TNF-α, respectively). In addition, a significant reduction in the CD11b and CD18 positive cells and the amount of interstitial neutrophil infiltration in the lungs from WS-4 treated animals was seen. In contrast, WS-4 did not alter the amount of pancreatic necrosis and the serum concentrations of amylase, lipase, calcium, and glucose.Conclusion—WS-4 cannot change the amount of pancreatic necrosis induced by injection of 5% bile acid, but does reduce the acute lung injury, presumably through inhibition of circulating IL-8 and TNF-α, and CD11b/CD18 in lung tissue. Therefore, a role of IL-8 in the progression of acute pancreatitis and the development of its systemic complications is suggested.

ID: 36: PEGASPARGASE INDUCED SEVERE PANCREATITIS. FRIEND OR FOE?

2016 ◽  
Vol 64 (4) ◽  
pp. 942.1-942 ◽  
Author(s):  
N Vyas ◽  
H Alkhawam ◽  
R Sogomonian ◽  
RA Ching Companioni ◽  
M Tiba ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Abdominal Pain ◽  
Severe Acute Pancreatitis ◽  
Lymphoblastic Leukemia ◽  
Kidney Injury ◽  
Leukemic Cells ◽  
Drug Induced ◽  
Severe Pancreatitis ◽  
Elevated Liver Enzymes ◽  
Wide Range

IntroductionPegaspargase (Oncaspar) is a modified version of L-asparaginase conjugated with polyethylene glycol. In leukemic cells, asparaginase hydrolyzes L- asparagine to ammonia and L-aspartic acid leading to depletion of asparagine. Despite its potential benefits there are a wide range of side effects. One rare but potentially deadly complication is severe pancreatitis.CaseThe patient was a 24 year old Mexican male with a history of Acute T-Cell Lymphoblastic Leukemia (ALL) on recent chemotherapy including pegaspargase, admitted for abdominal pain, found to have acute pancreatitis secondary to hypertriglyceridemia. Heart rate was 127 bpm, chest revealed decreased air entry in right lung bases, and a distended severely tender abdomen. Laboratory tests were remarkable for elevated liver enzymes ALP 360 U/L, AST 310 U/L, GGT 216 U/L, ALT 44 U/L, LDH 829 U/L, elevated lipase 228 U/L, and hypertriglyceridemia >3,000 mg/dL. Abdominal CT showed pancreatitis with necrosis; peripancreatic, intraperitoneal and extensive retroperitoneal fluid. Subsequently his severe pancreatitis was associated with acute kidney injury and respiratory failure which is illustrated by his (BUN 22 Creatinine 2.16, and persistent hypoxia.) According to the Atlanta Classification, patient is classified under severe acute pancreatitis.DiscussionPegaspargase is used for treatment of ALL and is gaining in popularity over Asparaginase therapy due to it having fewer incidences of hypersensitivity reactions and because of its long half life (367 hrs) allowing dosing every 14 days as opposed to Asparaginase which is dosed daily. Pegaspargase definitely has its benefits but we can't lose sight of one of its rare, but potentially deadly complications, pancreatitis. In one study nine of the 50 patients (18%) with ALL treated with pegaspargase were diagnosed to have pancreatitis. In contrast, only one out of 52 (1.9%) ALL patients who received native E. coli L-asparaginase during the same time period developed pancreatitis. One proposed mechanism of this drug-induced pancreatitis is hypertriglyceridemia, which is seen in our case. It is suggested that apolipoprotein E polymorphism may influence the development of hyperlipidemia in ALL patients receiving pegaspargase therapy.We report a case to increase the awareness of higher incidence of pegaspargase-induced pancreatitis, which is a rare but potentially deadly complication. Clinicians should monitor triglycerides while on treatment and suspect pancreatitis if patient develops abdominal pain. If pancreatitis occurs, therapy should be stopped and not reinstituted. For patients with hypertriglyceridemia without pancreatitis discontinuation of therapy should be considered.Abstract ID: 36 Figure 1Impression: Severe acute pancreatitis. Significant interval worsening.

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