Significant Elevations in Serum Lipase in the Emergency Department: When It is Not Pancreatitis!
To the Editor. Serum lipase levels are widely and exclusively used in the diagnosis of acute pancreatitis, as it is a central component of the Revised Atlanta Criteria. Significant elevations in serum lipase can however be found in association with other pathologies, without evidence of pancreatitis. The purpose of this short report is to provide a brief overview of the potential etiologies behind significant elevations in serum lipase levels in a tertiary care center in Lebanon. Using a retrospective cross-sectional study design conducted at the Emergency Department (ED) of the American University of Beirut Medical Center, we reviewed 4,967 cases of adult patients (age> 18) who visited the ED during a one-year period between January 1 and December 31, 2016, and had a serum lipase ordered.
This study identifies a novel mechanism underlying the pathogenesis of AP by which IL-6 promotes TMEM16A expression via IL-6R/STAT3 signaling activation, and TMEM16A overexpression increases IL-6 secretion via IP3R/Ca2+/NFκB signaling activation in pancreatic acinar cells. TMEM16A inhibition may be a new potential strategy for treating AP.Graphical abstractA positive activation loop between TMEM16A and the IP3R/ Ca2+/NFκB/IL-6 pathway is important for Ca2+ elevation, NFκB activation and IL-6 release, and thus cooperatively promotes the pathogenesis of AP.
Editor's Summary by Howard Bauchner, MD, Editor in Chief of JAMA, the Journal of the American Medical Association, for the January 21, 2020 issue
This randomized clinical trial compares the effects of pancreatic drainage surgery within 6 weeks vs a stepped medical-endoscopy-surgical approach on pain score and relief over 18 months among patients with chronic pancreatitis.
Chronic pancreatitis is characterized by pancreatic endocrine and exocrine insufficiency, along with persistent, and in some cases, unrelenting pain. While pancreatic insufficiency is effectively managed with pharmacologic intervention, the pain associated with this condition is difficult to control and commonly leads to severe consequences for the patient. A search of ClinicalTrials.gov for chronic pancreatitis revealed 152 studies, nearly all of which consist of interventions for pain. The current modalities, including pain medication, pancreatic enzyme replacement, behavioral therapy, endoscopic treatment, and surgery, ...
ConclusionThis report describes the first identification and functional characterization of a heterozygous variant in theLPL that predisposed to recurrent HTG ‐APIP. Our findings confirm a major genetic contribution to the etiology of individual predisposition to HTG‐APIP.
AbstractBackground There is a limited data on the radiation dose from computed tomography (CT) in patients with acute pancreatitis (AP). The present study evaluated the radiation dose from CT scans in patients with AP.MaterialA retrospective review of CT reports of patients with AP was conducted. The type of CT scan (non-contrast vs. single-phase vs. biphasic CT) was recorded. The mean number of CT scans and cumulative radiation dose was calculated. The indications and abnormalities on biphasic CT scans were recorded. The radiation doses between different types of the scan were compared.Results495 CT studies in 351 patie...
ConclusionsThese findings suggest that the IRF7-IFN-I-IL-33 axis activated in pDCs drives pathogenic innate immune responses associated with type 1 AIP.
Conclusion: Combined CVVHDF with plasmapheresis is an effective treatment for patients diagnosed with germanium poisoning and associated multiple organ dysfunctions. PMID: 31951756 [PubMed - as supplied by publisher]
CONCLUSION: The determination of a single laboratory marker, which is the level of metalloproteinase-2 or metalloproteinase-9, is characterized by sensitivity and specificity comparable to that of multifactor prognostic scoring systems. PMID: 31950805 [PubMed - in process]
CONCLUSION: CT is helpful in predicting GIF in patients with AP. PMID: 31950804 [PubMed - in process]