Exogenous and endogenous mortality parameters as indicators of the sanitary and epidemiological status of the population of the region

Introduction. The concepts of the epidemiological transition and types of population health are applied to analyzing and evaluating the sanitary and epidemiological status of the population. Materials and methods. For many years of mortality, the dynamics of the male population of the Irkutsk region standardized indicators were used (European age standard). For identifying trends of changing mortality rates, an analytical alignment of the time series was used. It was a linear model by EXCEL’s standard tools (Microsoft Office 2007). The significance of the trend equation was calculated using F-test in IBM SPSS Statistics 23 (p < 0,05). Results. It has been established that the formation of various types of pathology and caused by this pathology mortality occurred under the influence of factors of different nature in the process of changes in social, environmental, epidemiological situations in the region. In the 1990 th and the first half of the 2000 th, high mortality rates in the class of diseases of the circulatory system and the class of external causes of morbidity and mortality were determined mainly by psychosocial disadvantage factors. By the class of Diseases of the respiratory system, there was noted a steady decrease in mortality rate from chronic diseases of the lower respiratory tract and pneumonia. It was probably due to an increase in the level and quality of medical care. A steady tendency to increase intensive and extensive mortality rates by class of Certain infectious and parasitic diseases was seen. That was caused by negative changes in infectious and epidemic processes under the influence of man-made pollution was noted. During 2005 - 2015 the digestive system’s share of the class of Diseases in the mortality structure increased. That is due to the prevalence of alcoholic liver disease, chronic alcoholic pancreatitis, complications of the ulcer of the stomach and duodenum. Conclusion. The combination of the identified patterns of the formation of intensive and extensive mortality rates determined by exogenous and endogenous factors made it possible to characterize the situation in the Irkutsk region as a relative sanitary and epidemiological disadvantage of the population.

Cytolysin-positive Enterococcus faecalis is elevated in patients with chronic alcoholic pancreatitis

Introduction: Patients with alcoholic hepatitis have an increase in cytolysin-producing Enterococcus faecalis that correlates with disease severity and mortality. Aim: To determine whether patients with chronic alcoholic pancreatitis have an elevated abundance of cytolysin-producing E. faecalis. Methods: Quantification by qPCR of cytolysin-producing E. faecalis in controls and patients with alcoholic hepatitis or pancreatitis. Results: Patients with alcoholic pancreatitis had a higher proportion of intestinal cytolysin-positive E. faecalis than healthy controls and patients with alcoholic hepatitis. Conclusion: Cytolytic E. faecalis may also be involved in this other alcohol-related complication and benefit from targeted microbiota editing strategies.

Alcoholic pancreatitis

Alcohol misuse is a common cause of pancreatitis, both acute and chronic. Alcoholic pancreatitis can present a significant diagnostic challenge for GPs, and a high index of suspicion must be maintained to avoid delayed or missed diagnoses. Management is multi-faceted and an enduring relationship between patient and GP ensures the best patient outcomes. This article will discuss both acute and chronic alcoholic pancreatitis, the diagnosis of alcohol-induced pancreatitis in its different forms and how to create a management plan that addresses symptom control as well as improving long term patient outcomes.

The role of alcohol metabolism enzymes in chronic alcoholic pancreatitis (review)

Алкогольный метаболизм является решающим биологическим фактором, значительно влияющим на злоупотребление алкоголем, развитие алкоголизма и алкогольное повреждение органов. Основной путь метаболизма этанола - это алкогольдегидрогеназный путь превращения в ацетальдегид, который переходит в митохондрии и окисляется до уксусной кислоты. Через этот путь проходит 80-90% всего этанола. За окисление 10-20% этанола отвечает алкогольоксидаза (цитохром P450), также называемая «микросомальная этанолокисляющая система» (MEOS/CYP2E1). Основные ферменты метаболизма алкоголя проявляют генетический полиморфизм и этническую изменчивость. В данном обзоре представлены достижения последних десятилетий в понимании функциональных полиморфных локусов генов ADH и ALDH и их метаболических, физиологических и клинических корреляций. Alcohol metabolism is a decisive biological factor that significantly affects alcohol abuse, the development of alcoholism and alcohol damage to organs. The main pathway of ethanol metabolism is the alcohol dehydrogenase pathway to acetaldehyde, which passes into the mitochondria and is oxidized to acetic acid. 80-90% of all ethanol passes through this path. Alcohol oxidase (cytochrome P450), also called microsomal ethanol oxidation system (MEOS/CYP2E1), is responsible for the oxidation of 10-20% of ethanol. The main alcohol metabolizing enzymes exhibit genetic polymorphism and ethnic variation. This review presents recent advances in understanding the functional polymorphisms of alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) and their metabolic, physiological, and clinical correlations.

Fistula of a pancreatic pseudocyst into the superior mesenteric and portal veins causing erythema nodosum and aseptic polyarthritis - case report and review of literature

Introduction. Extra-pancreatic complications of acute and chronic pancreatitis that do not relate to vital organs are rare. The most common include subcutaneous paniculitis, arthritis, bone marrow fat necrosis and vasculitis. These associated conditions have been termed Pancreatic Disease Syndrome (PDS), which can occur not only with pancreatitis but also in other pancreatic diseases. PDS is believed to be caused by circulating pancreatic enzymes, which can occur when the pancreas is in direct communication with the circulation. Pancreatic pseudocyst erosion into the superior mesenteric and portal veins is extremely rare; and there have only been 22 previously reported cases in literature. The authors endeavoured to describe a manifestation of PDS with formation of a pseudocystic-portal fistula, its complications, and propose adequate surgical management. Case outlin.e We present a 37-year-old man with chronic alcoholic pancreatitis and a pancreatic pseudocyst within the head of the pancreas which communicated with the main pancreatic duct on one side and eroded into the superior mesenteric and portal veins on the other, causing erythema nodosum-like vasculitis, and polyarthritis. The patient was initially treated conservatively, but subsequently required multiple arthrotomies and finally underwent pylorus preserving duodenopancreatectomy and direct repair of the affected veins. Conclusion. The majority of cases required aggressive surgical intervention due to heightened risk of hemorrhage. In patients who develop disseminated fat necrosis, an earlier surgical intervention can be justified. The authors would recommend that where practical a pylorus-preserving pancreaticoduodenectomy should be performed.

Clinicopathological features of Pseudocyst Pancreas and its Management: A Prospective and Retrospective Study

Background: Revised Atlanta Classification has veered a change in our understanding ofpseudocyst pancreas which mandates renewed inquiry into pseudocysts defined as per new criteria.The present study provides an overview of experience with Pseudocyst Pancreas for over a decade.Methodology: 100 cases of pseudocysts diagnosed over the last 10 years at GMC, Bhopal,conforming to the present definition were reviewed. Cysts with the inhomogeneous collection,debris, necrosis, or any other non-liquid component, specifically in those diagnosed before 2012were excluded. Relevant data were analyzed. Results: The majority were male (85%) in the agegroup of 40-50 years with alcohol-induced chronic pancreatitis (77%) being the most frequentetiology. Abdominal pain (40%), lump (30%), and abdominal tenderness (59%) were common atpresentation. 58% were in the Head of the pancreas, 29% in the Neck and Body, and 13% in theTail and surrounding areas. Mean cyst diameter was 8.6cm and volume 252cc. 85% were managedsurgically and 40% of those managed conservatively also needed surgical intervention eventuallydue to complications. History of chronic alcoholic pancreatitis, the large size of the cyst (≥6cm and≥60cc), and communication with the main pancreatic duct were highly predictive of surgicalintervention. Conclusion: Radiological characteristics along with the clinical picture may suggestappropriate intervention. Surgery remains the principal modality of treatment, with high successrates.

A case of splenic artery pseudoaneurysm rupture presenting as rectal bleeding in a regional hospital

Splenic artery pseudoaneurysm is a rare phenomenon most associated with chronic pancreatitis or previous trauma. Complications can include erosion and rupture into local structures, a situation that carries a reported mortality of 10–40%. A 58-year-old male with chronic alcoholic pancreatitis and a known splenic artery pseudoaneurysm presented to the emergency department of a regional hospital with rectal bleeding and sepsis. Computed tomography revealed a peri-splenic mass communicating with the splenic flexure. The patient was taken for an emergency splenectomy and left hemicolectomy and was confirmed to have rupture of the splenic artery aneurysm into the large bowel. This case presented with comparable features reported in the literature and demonstrates that access to emergency specialist surgical services in a regional setting offers the capability to manage rare, life threatening surgical emergencies.

Pancreatic ascites managed with a conservative approach: a case report

Background Pancreatic ascites refers to the massive accumulation of pancreatic fluid in the peritoneal cavity and is a rare entity. Chronic alcoholic pancreatitis is the most common cause. Ascites is commonly seen in patients with alcoholic liver disease and is usually a consequence of portal hypertension. Biliary pancreatitis, pancreatic trauma and cystic duplications of biliopancreatic ducts, ampullary stenosis, or ductal lithiasis are the remaining causes. Case presentation A 53-year-old Chhetri man, a chronic alcoholic, presented with epigastric pain and abdominal distension. He had made several previous visits to a local hospital within the past 6 months for a similar presentation. Serum alkaline phosphatase 248 IU/L, serum amylase 1301 IU/L, and lipase 1311 IU/L were elevated while serum calcium was decreased (1.5 mmol/l). Ascitic fluid amylase was elevated (2801 IU/L). A computed tomography scan of his abdomen revealed features suggestive of acute-on-chronic pancreatitis. The case was managed with a conservative approach withholding oral feedings, starting total parenteral nutrition, paracentesis, octreotide, and pigtail drainage. Conclusion Pancreatic ascites is a rare entity. Diagnosis is suspected with raised ascitic fluid amylase in the presence of pancreatic disease. Such cases can be managed by conservative approach or interventional approach. We managed this case through a conservative approach.

Associated Liver Disease in Alcoholic Chronic Pancreatitis

Background: Alcohol is a common etiological factor in the pathogenesis of both pancreatic and liver disease. The frequencies of associated liver histological change in patients with alcoholic chronic pancreatitis (AICP) vary from series to series. Significant proportion of patients with alcoholic pancreatitis does have histological changes in liver. Subjects and Methods: The study was conducted at Narayana Medical College & Hospital, Chintareddy Palem, Nellore, Andhra Pradesh on liver-biopsy specimens from 23 patients with chronic alcoholic pancreatitis subjected to operation for pain, from August 2015 to July 2016 and all the patients had undergone liver biopsy at the time of surgery for AICP. The patients were followed as part of a prospective study of 33 patients who had been treated for chronic pancreatitis. The pathologists were requested to report on alcohol related histological changes in the specimen. Results: There were 23 patients and all were men. Chronic pancreatitis was due to alcohol abuse in all patients. The median age at surgery was 39.8 years. The mean duration of alcohol abuse was 20.5 years (range 6-29 years).The average alcohol intake was 122gm 36gms/day. Three patients had jaundice for 3-6 months duration. None of the patients had any other risk factor for liver disease and none of them had clinical or biochemical evidence of liver disease. The histological reports were, 4 patients had alcoholic hepatitis, 2 severe steatohepatitis, 1 granulomatous hepatitis, 3 cholestasitc changes, one fatty liver and 12 had no significant pathology. None of the patients had cirrhosis. Thus significant alcoholic liver disease was present in 30.4% (7/23) of the patients. There was no increased incidence of post-operative mortality and morbidity in patients with liver pathology. Conclusion: As reported in many other series, chronic alcoholic pancreatitis is associated with histological changes in liver in significant proportion of patients. However its clinical significance and prognosis of these patients are unknown.

Combination of obesity and malnutrition in a patient with chronic alcoholic pancreatitis (case report)

Eating disorder with its two extreme manifestations — obesity and trophological insufficiency (TI) — is one of the common problems of modern society. TI is often diagnosed in patients with chronic pancreatitis (CP); it occurs due to a limited amount of food intake, malabsorption, diabetes mellitus, and chronic alcoholism. TI severity correlates with severity of malabsorption and depletion of nutrients degree. However, TI verification in patients with CP is difficult due to the lack of uniform diagnostic recommendations. Anthropometric technique, laboratory (determination of the level of lymphocytes, albumin) and instrumental (computed tomography, X-ray absorptiometry, magnetic resonance imaging) diagnostics are usually used. The article presents a case report of combination of such two opposite states as obesity and malnutrition in a patient with CP. The patient was hospitalized with CP exacerbation and alcohol abuse. Examination revealed exocrine pancreatic insufficiency and mild malnutrition. Enzyme replacement therapy and additional oral sip feeding with a positive effect were prescribed. Exocrine pancreatic insufficiency stopped after 10 weeks of treatment, but malnutrition remained and required a longer course of treatment. Relevance of this problem, main difficulties of diagnosis are presented in the article. Anthropometric indices, body mass index, lymphocytes, total protein, albumin need to be measured in all patients. Using only body mass index leads to hypodiagnosis of malnutrition in patients with CP.