scholarly journals Clinical Characteristics and Prognosis of Idiopathic Acute Pancreatitis

2021 ◽  
Vol 12 (3) ◽  
pp. e0019
Author(s):  
Tzvika Porges ◽  
◽  
Tali Shafat ◽  
Iftach Sagy ◽  
Dan Schwarzfuchs ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Study Groups ◽  
Primary Diagnosis ◽  
Lipid Lowering ◽  
Western World ◽  
Drug Induced ◽  
Idiopathic Pancreatitis ◽  
Idiopathic Acute Pancreatitis ◽  
One Year ◽  
Idiopathic Disease

Objective: Acute pancreatitis is a serious diagnosis with an increasing incidence in the Western world. In this study we sought to investigate the incidence of idiopathic AP and to compare clinical and prognostic characteristics of idiopathic cases with cases of AP with known etiology. Methods: In this retrospective study of adult hospitalized patients diagnosed with acute pancreatitis between 2012 and 2015, a comparison was made between admissions of patients with known etiology and those for whom no cause was found. Primary outcome was defined as composite outcome of 30-day mortality and complications. Results:Among 560 admissions of 437 patients with a primary diagnosis of acute pancreatitis, the main factors identified were gallstones (51.2%) and idiopathic pancreatitis (35.9%), with alcohol ranked third at only 4.8%. Mortality rate within 30 days of hospitalization was 2.9% and within one year was 7.1%. Use of lipid-lowering, anti-hypertensive, and anti-diabetic medications was more frequent among patients with “idiopathic” disease (70%, 68%, and 33% versus 59%, 56%, and 27%, respectively). Patients admitted with idiopathic AP, in comparison to patients with known AP etiology, had milder disease with shorter hospital stay (3 days versus 4, respectively), and less re-admission in 30 days (7.5% versus 21.2%). Idiopathic AP patients had better prognosis in terms of 30-day death and complication (HR 0.33, 95% CI 0.08–0.40, P<0.001). Conclusion: Idiopathic disease is common among acute pancreatitis patients; the two study groups differed in severity of disease and prognosis. Common use of medications with doubtful value suggests possible under-diagnosis of drug-induced acute idiopathic pancreatitis.

Role of Alanine Aminotransferase in Determining the Biliary Etiology in Acute Pancreatitis

2021 ◽  
Vol 18 (2) ◽  
pp. 44-47
Author(s):  
Shiv Vansh Bharti ◽  
Anup Sharma
Keyword(s):  
Acute Pancreatitis ◽  
Alanine Aminotransferase ◽  
Reference Value ◽  
Alcoholic Pancreatitis ◽  
Biliary Pancreatitis ◽  
Drug Induced ◽  
Abdominal Ultrasonography ◽  
Excessive Alcohol Consumption ◽  
Idiopathic Pancreatitis ◽  
Definitive Therapy

Introduction: Acute pancreatitis a disorder that has numerous causes and an obscure pathogenesis. It can be a serious abdominal emergency associated with significant morbidity and mortality. Cholelithiasis is most common cause of acute pancreatitis and excessive alcohol consumption is second most frequent cause which together account for approximately 80% of underlying etiology. The detection of biliary etiology is crucial to delivery of definitive therapy to prevent repeated attacks of acute pancreatitis. During an attack of acute pancreatitis, elevation of alanine aminotransferase to >150 IU/L is a predictive factor for biliary cause of acute pancreatitis. Aims: To investigate the predictive value of raised alanine aminotransferase in determining biliary etiology in patients presenting with acute pancreatitis. Methods: A prospective study was done among 70 patients who were admitted in surgery department over a period of one year with diagnosis of acute pancreatitis. Peak alanine aminotransferase within 48 hours of presentation was recorded. The diagnosis was based on typical clinical presentation of acute pancreatitis combined with an increase in serum amylase levels ≥ 3 times the upper limit of the laboratory reference value. All biliary cases were confirmed by abdominal ultrasonography. Results: The mean age of the patients was 47.9 ±15.7 years (19-88 years). Acute pancreatitis was common in 31-40 years of age group. Among them, 40(57.1%) were male and 30(42.9%) were female. Forty two (60%) patients had biliary pancreatitis, 20(28.5%) had alcoholic pancreatitis, 2(2.8%) patients had drug induced pancreatitis and 6(8.5%) patients had idiopathic pancreatitis. Mean alanine aminotransferase for biliary pancreatitis was 205.9U/L, while cases with other etiologies (alcoholic 58.4U/L; drug induced 62.6 U/L; and idiopathic 48.3 U/L) showed significantly lower values (p=0.001). Conclusion: An elevated alanine aminotransferase strongly supports a diagnosis of gallstones in acute pancreatitis.

scholarly journals Biliary Sludge: A Risk Factor for ‘Idiopathic’ Pancreatitis?

1996 ◽  
Vol 10 (6) ◽  
pp. 385-388 ◽  
Author(s):  
Paul J Marotta ◽  
James C Gregor ◽  
Donald H Taves
Keyword(s):  
Acute Pancreatitis ◽  
Case Control Study ◽  
Liver Enzymes ◽  
Significant Proportion ◽  
Case Control ◽  
Control Group ◽  
Idiopathic Pancreatitis ◽  
Biliary Sludge ◽  
Idiopathic Acute Pancreatitis ◽  
Control Study

Idiopathic acute pancreatitis is common. Recent evidence suggests that biliary sludge may be the etiology in many patients with this disorder. In this case-control study, admission ultrasound examinations of patients with idiopathic pancreatitis, patients with acute alcohol-associated pancreatitis and a control group were compared. Biliary sludge was found in seven of 21 patients (33%) with idiopathic pancreatitis, two of 25 (8%) with acute alcohol-associated pancreatitis and one of 63 controls (1.6%). Comparison of idiopathic pancreatitis patients with both acute alcohol-associated pancreatitis patients and controls for the presence of sludge revealed odds ratios of 31.0 (95% CI 3.5 to 273) and 5.8 (95% CI 1.1 to 32.0), respectively. Also observed was a trend towards higher levels of liver enzymes, bilirubin and amylase in patients with idiopathic pancreatitis who had sludge identified. This study provides further evidence linking biliary sludge with a significant proportion of patients with idiopathic acute pancreatitis.

Abstract WP287: Characteristics of Incident and Recurrent Stroke in Taiwan, 2000 to 2011

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Meng Lee ◽  
Yi-Ling Wu ◽  
Bruce Ovabiagele
Keyword(s):  
Ischemic Stroke ◽  
Recurrent Stroke ◽  
Antiplatelet Agents ◽  
Primary Diagnosis ◽  
Western World ◽  
Research Database ◽  
Risk Factor Management ◽  
Taiwan National Health Insurance ◽  
One Year ◽  
Prevalence Of Diabetes Mellitus

Background: The burden of stroke is comparatively greater in Asian countries than in the Western world. While there has been a documented recent decline in the incidence of stroke in several Western nations due to better risk factor management, much less is known about the nature and trajectory of stroke in Asia over the last decade. Objective: To explore risk factors, medication use, incidence, and one-year recurrence of stroke in Taiwan. Methods: We conducted a nationwide cohort study by retrieving all hospitalized patients (≥ 18 years) with a primary diagnosis of ischemic stroke between 2001 and 2011 from Taiwan National Health Insurance Research Database. Results: A total of 291,381 first-ever ischemic stroke patients were enrolled between 2000 and 2011. The average age was about 70 years and approximately 58.6% of them were men. While prevalence of diabetes mellitus and hyperlipidemia, as well as use of statins, antiplatelet agents, and oral anticoagulant agents for atrial fibrillation significantly increased; incidence (142.3 vs. 129.5 per 100,000 in 2000 and 2011, respectively; Figure 1) and one-year recurrence (9.6% vs. 7.8% in 2000 and 2011, respectively; Figure 2) of stroke declined during this period of time. Conclusion: Over the last decade in Taiwan, rates of primary ischemic stroke and one-year recurrent stroke decreased by 9% and 18% respectively.

scholarly journals P14: DOXYCYCLINE: A RARE CAUSE OF DRUG INDUCED PANCREATITIS

2016 ◽  
Vol 64 (3) ◽  
pp. 822.3-823
Author(s):  
M Pourmorteza ◽  
H Virk ◽  
D Yoon ◽  
I Riaz ◽  
A Rai ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Fatty Infiltration ◽  
Abdominal Ultrasound ◽  
Liver Function Tests ◽  
The Body ◽  
Drug Induced ◽  
Serum Lipase ◽  
Idiopathic Pancreatitis ◽  
Rebound Tenderness ◽  
Lipid Panel

Purpose of StudyDrug-induced pancreatitis (DIP) is a rare clinicopathologic entity. We report a 58-year-old female who developed DIP secondary to administration of doxycycline.Methods UsedA 48 year old female with a history of hypertension presented to the hospital with complains of nausea/vomiting, right upper-quadrant gnawing abdominal pain, 8/10 in intensity with radiation to the back. She denied exacerbating factors, use of alcohol, tobacco and drug. Patient also denied diarrhea, constipation and changes in skin or stool color. On examination patient was hypertensive (155/95) with a heart rate of 102. She had epigastric/right upper quadrant tenderness on superficial palpation, hypoactive bowel sounds without any palpable organs, rebound tenderness or rigidity. Serum lipase was elevated at 2508 IU/L, negative pregnancy and insignificant urinalysis findings. Liver function tests, lipid panel, chemistry panel and hematologic panel were within normal limits. Radiologic investigations with abdominal ultrasound depicted mild proximal dilatation of the common bile duct with smooth tapering of the duct distally indicating status post-cholecystectomy. Contrast enhanced computed tomography scan revealed mild enlargement of the body of the pancreas with adjacent peripancreatic fatty infiltration consistent with acute pancreatitis. Upon further questioning patient explains recent diagnosis (7 days) of tibial orthopedic hardware infection as she was prescribed doxycycline 200 mg twice a day in anticipation of irrigation of infected site. After confirmation, and discontinuation of doxycycline, our patient recovered and has been disease-free for over a month.Summary of ResultsDrug-induced pancreatitis is uncommon etiology of acute pancreatitis, which is responsible for 0.1%–2% of all the acute pancreatitis cases. Among adverse drug reactions, pancreatitis is often-ignored because of the difficulty in implicating a drug as its cause.ConclusionsIn our vastly evolving pharmacotherapy world, DIP should be included in the differential of idiopathic pancreatitis, especially after other common causes have been ruled out.

scholarly journals Role of alanine aminotransferase in determining the biliary etiology in acute pancreatitis

2016 ◽  
Vol 18 (3) ◽  
pp. 30
Author(s):  
Shailesh Simkhada ◽  
Parashuram Mishra
Keyword(s):  
Acute Pancreatitis ◽  
Predictive Value ◽  
Alanine Aminotransferase ◽  
University Teaching ◽  
Alcoholic Pancreatitis ◽  
P Value ◽  
Biliary Pancreatitis ◽  
Drug Induced ◽  
Excessive Alcohol Consumption ◽  
Idiopathic Pancreatitis

Background: Acute pancreatitis (AP) is a common surgical presentation and a leading cause of morbidity and mortality worldwide. Gallstones and excessive alcohol consumption are the most frequent causes of AP. Aim of this study was to investigate the predictive value of raised ALT (Alanine aminotransferase) in determining biliary etiology in patients presenting with acute pancreatitis.Materials and Methods: All patients admitted in the surgical ward of Tribhuvan University Teaching Hospital with the diagnosis of AP were studied prospectively over a period of 1 year between 2014and 2015. Peak ALT within 48 h of presentation was recorded. Etiology was determined on the basis of history, Abdominal Ultrasound (AUS) and other relevant investigations.Results: A total of 80 patients of AP were included in the study. Among them, 46 (57.5%) patients had biliary pancreatitis, 18(22.5%) had alcoholic pancreatitis, 4(5%) patients had drug induced pancreatitis and 12(15%) patients had idiopathic pancreatitis. 46(57.5%) were male and 34(42.5%) were female. Mean ALT for biliary pancreatitis was 212.5U/L, for alcoholic was 58 U/L, for drug induced was 71 U/L and for idiopathic was 43 U/L. When compared between biliary and non-biliary pancreatitis, it was statistically significant( p value < 0.00). Biliary was the most common etiology followed by alcoholic. The sensitivity, specificity, positive predictive value(PPV) and negative predictive value(NPV) of alanine aminotransferase with cut off of 100 U/L for biliary pancreatitis was 65%, 94%, 91.5% and 72.8% respectively.Conclusion: An elevated ALT strongly supports a diagnosis of gallstones in Acute Pancreatitis.

scholarly journals A246 THE GLOBAL INCIDENCE OF ACUTE PANCREATITIS IS INCREASING OVER TIME: A SYSTEMATIC REVIEW AND META-ANALYSIS

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 304-306
Author(s):  
J Iannuzzi ◽  
J H Leong ◽  
J Quan ◽  
J A King ◽  
J W Windsor ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Data Extraction ◽  
Meta Analysis ◽  
Temporal Trends ◽  
Western World ◽  
Common Disease ◽  
Biliary Disease ◽  
Comprehensive Overview ◽  
Annual Percent Change ◽  
Over Time

Abstract Background Acute pancreatitis is a common disease with significant associated morbidity and mortality. Historically, acute pancreatitis has been considered a disease with multiple etiologies and risk factors but is driven by alcohol and biliary disease. Multiple studies have shown that the incidence of acute pancreatitis is increasing globally among both adults and children. Aims The purpose of this study was to assess temporal trends in incidence of acute pancreatitis globally. Methods We performed a systematic literature search to identify population-based studies reporting the annual incidence of acute pancreatitis. Abstracts were independently assessed in duplicate to identify applicable papers for full-text review and data extraction. Joinpoint temporal trend analyses were performed to calculate the average annual percent change (AAPC) with 95% confidence intervals (CI). The AAPCs were pooled in a meta-analysis to capture the overall and regional trends in acute pancreatitis incidence over time. Temporal data were summarized in a static map and an interactive, web-based map to illustrate global differences. Results Forty-five studies reported the temporal incidence of acute pancreatitis (static map provided, online interactive map: https://kaplan-acute-pancreatitis-ucalgary.hub.arcgis.com/). The incidence of acute pancreatitis has increased from 1961 to 2016 (AAPC = 2.89%; 95% CI: 2.26, 3.52; n=41). Increasing incidence was observed in North America (AAPC = 2.71%; 95% CI: 1.93, 3.50; n=10) and Europe (AAPC = 2.79%; 95% CI: 1.95, 3.63; n=24). The incidence of acute pancreatitis was stable in Asia (AAPC = −0.28%; 95% CI: −5.03, 4.47; n=2). Conclusions This meta-analysis provides a comprehensive overview of the global incidence of acute pancreatitis over the last five decades and demonstrates a steadily rising incidence over time in most countries of the Western world. More studies are needed to better define the changing incidence of acute pancreatitis in Asia, Africa and Latin America. Funding Agencies None

scholarly journals The One-Year In Vivo Comparison of Lithium Disilicate and Zirconium Dioxide Inlays

Materials ◽  
2021 ◽  
Vol 14 (11) ◽  
pp. 3102
Author(s):  
Rini Behera ◽  
Lora Mishra ◽  
Darshan Devang Divakar ◽  
Abdulaziz A. Al-Kheraif ◽  
Naomi Ranjan Singh ◽  
...  
Keyword(s):  
Zirconium Dioxide ◽  
Clinical Performance ◽  
Lithium Disilicate ◽  
Study Groups ◽  
Resin Cement ◽  
Internal Surfaces ◽  
Colour Match ◽  
One Year ◽  
The One

The objective of the present study was to evaluate the one-year clinical performance of lithium disilicate (LD) and zirconium dioxide (ZrO2) class II inlay restorations. Thirty healthy individuals who met the inclusion criteria were enrolled for the study. The patients were randomly divided into two study groups (n = 15): LD (IPS e.max press) and ZrO2 (Dentcare Zirconia). In the ZrO2 group, the internal surfaces of the inlays were sandblasted and silanized with Monobond N (Ivoclar, Leichsteistein, Germany). In the LD group, the internal surfaces of the inlays were etched with 5% hydrofluoric acid. The ceramic inlays were cemented with self-cure resin cement (Multilink N). Clinical examinations were performed using modified United State Public Health Codes and Criteria (USPHS) after 2 weeks, 4 weeks, 6 months and 1 year. The one-year survival rate was evaluated. In total, one failure was observed in the ZrO2 group. The survival probability after 1 year for the ZrO2 inlays was 93%, and for the LD inlays was 100%, which was statistically insignificant. The differences between both groups for most USPHS criteria (except for colour match) were statistically insignificant. Within the imitations of the present study, the lithium disilicate- and zirconia dioxide-based inlays exhibited comparable clinical performances. However, the colour and translucency match was superior for the lithium disilicate restorations.

The Epidemiology of Idiopathic Acute Pancreatitis, Analysis of the Nationwide Inpatient Sample From 1998 to 2007

Pancreas ◽  
2013 ◽  
Vol 42 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Yijun Chen ◽  
Yulia Zak ◽  
Tina Hernandez-Boussard ◽  
Walter Park ◽  
Brendan C. Visser
Keyword(s):  
Acute Pancreatitis ◽  
Nationwide Inpatient Sample ◽  
Idiopathic Acute Pancreatitis

scholarly journals Trimethoprim-Sulfamethoxazole-Induced Aseptic Meningitis: A Rare Presentation of Commonly Used Antibiotic

2019 ◽  
Vol 2019 ◽  
pp. 1-3
Author(s):  
Salem Agabawi
Keyword(s):  
Supportive Care ◽  
Aseptic Meningitis ◽  
Antimicrobial Agents ◽  
Medical Condition ◽  
Care Facility ◽  
Health Care Facility ◽  
Early Recovery ◽  
Drug Induced ◽  
Rare Presentation ◽  
One Year

Drug-induced aseptic meningitis is a rare medical condition with trimethoprim-sulfamethoxazole being one of the most common antimicrobial agents associated with it. Here, I report a case of a 56-year-old male who presented to a health care facility with shock and meningitis-like syndrome in two occasions, one year apart following an exposure to trimethoprim-sulfamethoxazole for treatment of skin/soft tissue infection. Investigations did not reveal an infectious etiology in the two presentations. The patient improved with supportive care and withdrawal of the offending agent. In the two admissions, the patient improved following stopping the offending drug in addition to supportive care. The diagnosis of trimethoprim-sulfamethoxazole-induced aseptic meningitis was the most likely explanation for this case. Trimethoprim-sulfamethoxazole-induced aseptic meningitis is rare although it is a life-threatening side effect of TMP/SMX; therefore, the clinicians should keep the diagnosis of drug-induced aseptic meningitis in the differential diagnosis of aseptic meningitis in the appropriate clinical setting as early withdrawal of the culprit drug and supportive measurements will lead to early recovery.

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