The Extract of Viola odorata Flowers Improves the Biochemical, Pancreas Histological, and Insulin Resistance Parameters in an Animal Model of Diabetes

Background: The antioxidant defense in the pancreas is low because they are exposed to toxic substances daily. This study aimed to evaluate the ameliorating effect of Viola odorata flowers Extract (VOE) on the pancreas histology and function in Streptozotocin (STZ)-induced diabetic rats. Methods: Forty male rats were divided into five groups, consisting of controls; STZ; and STZ plus various doses of VOE (100, 200 or 400 mg/kg). The amylase, lipase, insulin and total antioxidant capacity levels were measured in the sera. The homeostatic model assessment of insulin resistance was also measured. The histopathological alterations of the rats’ pancreases were examined microscopically. Results: The serum amylase and total antioxidant activities were reduced in diabetic rats (P=0.001). Varying doses of VOE reduced the serum amylase and glucose levels, and increased the total antioxidant activities compared to that of the diabetic rats (P<0.05). There were no significant differences in the serum lipase and insulin levels among the groups. Treatment with VOE at all doses significantly lowered the insulin resistance compared to that of the diabetic group (P=0.001). Significant reductions were observed in the areas of the pancreatic Langerhans islets and the number of beta cells in the STZ group (P=0.001). Conclusion: This study demonstrated that VOE ameliorated the adverse effects induced by STZ in the rat’s pancreas in the short-term. These effects are likely to be due to the reduced insulin resistance and amylase activity, and increased total antioxidant activity along with the histopathological alterations in the pancreas.

Acute Mild Pancreatitis Following COVID-19 mRNA Vaccine in an Adolescent

A 17-year-old male was referred to the emergency room with sharp abdominal pain, pallor, sweating, and vomiting 12 h after the administration of his first Pfizer-BioNTech vaccine for coronavirus disease 2019 (COVID-19). He had abdominal pain, an increase in serum lipase value of > 3 times the upper limits of normal, and magnetic resonance imaging (MRI) findings consistent with acute mild pancreatitis (AP). He was started on treatment with fluid therapy and non-steroidal anti-inflammatory drugs for pain management, after which he recovered rapidly and was discharged on the fourth day after hospitalization. The available data are difficult to interpret as AP is a relatively frequent disease, but its occurrence after vaccination seems extremely rare. Although it is a rare event, AP should be considered after COVID-19 vaccination, especially in those exhibiting abdominal tenderness and vomiting, which should be promptly treated and adequately investigated.

Role of C-reactive protein in predicting the outcome of acute pancreatitis

Background: Acute pancreatitis is one of the most commonly encountered clinical entities in surgical practice and controversy still exists regarding the clinical features of acute pancreatitis. An early diagnosis, however, is regarded as mandatory for successful treatment. Over the years many Authors have proposed different scoring systems for the early assessment of the clinical evolution of acute pancreatitis. The most widely used scoring systems are often cumbersome and difficult to use in clinical practice because of their multi factorial nature. Thus, a number of unifactorial prognostic indices have been employed in routine hospital practice, such as C-reactive protein (CRP), serum amylase and serum lipase. These serum enzymes are easy to obtain in normal clinical practice and many authors consider them as reliable as multi factorial scoring systems.Methods: A hospital based observational prospective study was done with 30 patients to measure C reactive protein levels in patients of acute pancreatitis and evaluate if CRP levels predict the severity of pancreatitis.Results: In cases where CRP was raised >100 mg/dl on day 7 and beyond showed either a complication or increased duration of stay and delayed recovery. This correspondence of CRP with the clinical outcome co related well with other parameters like blood counts, serum lipase and amylase levels too.Conclusions: Hence, CRP can be a very useful uni factorial tool in assessing and thereby predicting the outcome in a case of pancreatitis.

Insights into Acute Pancreatitis Associated COVID-19: Literature Review

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) primarily affects the lungs, causing respiratory symptoms. However, the infection clearly affects all organ systems including the gastrointestinal system. Acute pancreatitis associated with coronavirus disease 2019 (COVID-19) has been widely reported Recent studies have discussed pancreatic compromise incidentally in asymptomatic patients, or in a form of clinical symptoms such as abdominal pain, nausea, or vomiting, which is further reflected in some cases with abnormal serum lipase and amylase levels It was suggested that upregulation of angiotensin-converting enzyme II cell receptors or inflammatory cytokines play a major role in predisposing pancreatic injury in SARS-CoV-2 positive patients To date, there is insufficient data to establish the causality of acute pancreatitis in SARS-CoV-2 infected cases. In this paper, we organize recent studies conducted to observe the frequency of acute pancreatitis associated with COVID-19 cases while highlighting present hypotheses, predisposing factors, and their effect on the outcome, and point to gaps in our knowledge.

Mesangial sclerosis in a patient with type 1 diabetes following simultaneous pancreas-kidney transplantation despite maintenance of normoglycemia: a case report

Background Simultaneous pancreas-kidney transplantation is considered a curative treatment for type 1 diabetes complicated by end-stage kidney disease. We report herein a case of mesangial sclerosis in a patient who underwent successful kidney-pancreas transplantation despite well-controlled glucose and excellent pancreatic allograft function. Case presentation A 76-year-old type 1 diabetic man who underwent a simultaneous pancreas-kidney transplantation 19 years prior presented with persistent nephrotic range proteinuria although creatinine was at his baseline (normal) level. Hemoglobin A1c and fasting glucose were well controlled without the use of insulin or oral antihyperglycemic agents. Serum lipase and amylase were within the reference range and there was no evidence of donor-specific antibodies. Kidney allograft biopsy was performed to evaluate proteinuria and showed diffuse capillary loop thickening and diffuse moderate to severe mesangial sclerosis resembling diabetic nephropathy. Conclusions This case demonstrates a case of mesangial sclerosis resembling diabetic nephropathy in a patient with good glucose control after simultaneous pancreas-kidney transplantation with excellent pancreatic allograft function.

Mediastinal Extension of a Pancreatic Pseudocyst: A Rare Intrathoracic Complication of Pancreatitis

Pancreatic pseudocysts are a common complication of pancreatitis. However, mediastinal extension of a pseudocyst is rare and often presents with atypical symptoms. We present a case of mediastinal extension of a pancreatic pseudocyst in a 56-year-old woman with a history of alcohol-related chronic pancreatitis, who presented with acute on chronic epigastric abdominal pain and atypical chest pain. Serum lipase was elevated, and imaging by contrast-enhanced computed tomography (CT) demonstrated a paraesophageal fluid collection. This collection was continuous with a peripancreatic pseudocyst and extended into the posterior mediastinum via the esophageal hiatus. Mediastinal extension of a pancreatic pseudocyst was confirmed by magnetic resonance imaging (MRI). The patient was managed conservatively in the hospital with parenteral nutrition therapy, pain control, and close imaging observation. The patient was discharged home to continue conservative management and close imaging follow-up. An initial follow-up CT examination 8 weeks after discharge revealed interval decrease in the posterior mediastinal collection but also interval development of loculated left pleural and pericardial effusions.

A novel treatment protocol in severe acute pancreatitis: the first double blinded comparative trial to assess efficiency of omega 3 fatty acid infusion

Background: For decades, the treatment of acute pancreatitis (AP) has been largely supportive. However, a therapeutic window for intervention using immune modulators exists between the onset of clinical symptoms and peak pro-inflammatory cytokine expression. Soybean oil derived ω-3 PUFA is shown to inhibit the formation of ω-6 PUFA derived pro-inflammatory eicosanoids and suppresses pro-inflammatory activity of nuclear transcription factors (NF-κβ); thus, bringing about a much-needed immune regulation, both locally and systemically. Our aim was to study the efficacy of ω-3 PUFA infusion in severe AP (SAP) and set a new treatment protocol.Methods: This, first of its kind, doubled blinded randomised control trial was undertaken to assess the efficacy of early ω-3 PUFA supplementation in patients with predicted SAP by using serum amylase, serum lipase and C-reactive protein (CRP) with BISAP and Marshal scoring systems as markers for clinical outcome. 60 such patients were randomised into two groups: 30 were given ω-3 PUFA infusion and 30 were given a placebo. Chi square test and unpaired t test were used for comparison.Results: ω-3 PUFA infusion was found to be highly significant (p<0.05) in bringing about clinical improvement, reduced progression of SAP, reduced hospital stay and prompt reversal of organ dysfunction and SIRS.Conclusions: ω-3 PUFA infusion is the future for the treatment of patients with SAP. This drug is cheap and easily available, has no known side effects, reduces the morbidity and mortality, reduces the duration of hospital stay; thus, resulting in overall reduced medical expenditure.

Chymase as a Novel Therapeutic Target in Acute Pancreatitis

Acute pancreatitis is still a life-threatening disease without an evidenced therapeutic agent. In this study, the effect of chymase in acute pancreatitis and the possible effect of a chymase inhibitor in acute pancreatitis were investigated. Hamsters were subcutaneously administered 3.0 g/kg of L-arginine to induce acute pancreatitis. Biological markers were measured 1, 2, and 8 h after L-arginine administration. To investigate the effect of a chymase inhibitor, a placebo (saline) or a chymase inhibitor TY-51469 (30 mg/kg) was given 1 h after L-arginine administration. The survival rates were evaluated for 24 h after L-arginine administration. Significant increases in serum lipase levels and pancreatic neutrophil numbers were observed at 1 and 2 h after L-arginine administration, respectively. Significant increases in pancreatic neutrophil numbers were observed in the placebo-treated group, but they were significantly reduced in the TY-51469-treated group. A significant increase in the pancreatic tumor necrosis factor-α mRNA level was observed in the placebo-treated group, but it disappeared in the TY-51469-treated group. Chymase activity significantly increased in the placebo-treated group, but it was significantly reduced by treatment with TY-51469. The survival rate significantly improved in the TY-51469-treated group. A chymase inhibitor may become a novel therapeutic agent for acute pancreatitis.

Expanded Dengue Syndrome Presenting as Acute Pancreatitis

Dengue is a painful, debilitating mosquito-borne disease(female mosquitoes of the Aedes genus, principally Aedes aegypti)caused by any one of four closely related dengue viruses.It is endemic in tropical and subtropical continent. World health organization (WHO) currently estimates there may be 50 -100 million dengue infections worldwide every year with over 2.5 billion people at risk of dengue. Symptomatic dengue virus infection may manifests as undifferentiated fever, classical dengue fever (with or without unusual hemorrhages), and dengue hemorrhagic fever(with or without shock). Expanded dengue syndrome (EDS) was coined by WHO in the year 2012 to describe cases, which do not fall into either dengue shock syndrome or dengue hemorrhagic fever. The atypical manifestations noted in expanded dengue are multisystemic and multifaceted with organ involvement, such as liver, brain, heart, kidney, central/peripheral nervous system, gastrointestinal tract, lympho reticular system. Here we present a case of 35 years old female without any comorbidities who was serologically diagnosed with dengue developed severe upper abdominal pain on 2ndafebrile day and eventually diagnosed as acute pancreatitis both by raised serum lipase and ultrasonographic evidence of swollen pancreas. She was treated conservatively and improved. Thus, all clinicians should keep in mind the possibility of acute pancreatitis as a part of expanded dengue syndrome.

Accuracy of Bisap Score to Predict Severe Acute Pancreatitis Keeping Ranson Score as Gold Standard

Objective: To ascertain the diagnostic accuracy of BISAP score to predict severe acute pancreatitis keeping Ranson score as gold standard Study design: Descriptive Cross Sectional study Place and duration of study: Surgical Department, Combined Military Hospital Rawalpindi from January 2017 to July 2017. Methodology: 65 patients having history indicative of acute pancreatitis, serum lipase and serum amylase were measured. Patients with confirmed diagnosis of acute pancreatitis who consented for taking part in the research and achieving the inclusion and exclusion criteria were enrolled for study. Patients were evaluated by adequate history and thorough examination. All patients are investigated for Ranson score and BISAP score and divided into mild and severe pancreatitis on the basis of BISAPS and Ranson scoring. Results: In our study, mean+sd age was 44.92+8.92 years. Frequency of severe acute pancreatitis was 32.3%. Diagnostic accuracy of BISAP score to predict severe acute pancreatitis keeping Ranson score as gold standard had 80.9% of sensitivity, 81% of specificity, 68% of PPV and 90% of NPV. Conclusion: BISAP score have an excellent accuracy for prediction of severe acute pancreatitis as Ranson score. BISAP score can be used as tool for recognition of severe acute pancreatitis within 24 hours in simple and precise manner. Keywords: Severe acute pancreatitis, Prediction, BISAP score, Ranson score, Accuracy