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American Journal of Transplantation :... Feb 2023The number of pancreas transplants in the United States was largely unchanged in 2021 at 963 transplants compared with 962 in 2020, showing that recovery from the...
The number of pancreas transplants in the United States was largely unchanged in 2021 at 963 transplants compared with 962 in 2020, showing that recovery from the COVID-19 pandemic was not as pronounced in pancreas transplantation as in other organs. The number of simultaneous pancreas-kidney transplants (SPKs) decreased from 827 to 820, whereas the number of pancreas-after-kidney transplants and pancreas transplants alone increased marginally to compensate. The proportion of patients with type 2 diabetes on the waiting list increased to 22.9% in 2021, compared with 20.1% in 2020. Consequently, the proportion of transplants in patients with type 2 diabetes increased from 21.3% in 2020 to 25.9% in 2021. The proportion of transplants in older recipients (aged 55 years or older) also increased to 13.5% in 2021 from 11.7% in 2020. Outcomes after SPK continue to be the best of the three categories of pancreas transplants: 1-year graft failure for kidney at 5.7% and pancreas at 10.5% for transplants performed in 2020. The proportion of pancreas transplants performed by medium-volume centers (11-24 transplants per year) increased sharply to 48.3% in 2021 from 35.1% in 2020, with a corresponding decrease in transplants in large-volume centers (25 or more transplants per year) to 15.9% in 2021 from 25.7% in 2020.
Topics: Humans; United States; Aged; Tissue and Organ Procurement; Diabetes Mellitus, Type 2; Graft Survival; COVID-19; Pancreas Transplantation; Pancreas
PubMed: 37132349
DOI: 10.1016/j.ajt.2023.02.005 -
Journal of Clinical Virology : the... Jul 2020There is an increasing number of confirmed cases and deaths caused by the Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) contributing to the Coronavirus... (Review)
Review
There is an increasing number of confirmed cases and deaths caused by the Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) contributing to the Coronavirus disease 2019 (COVID-19) pandemic. At this point, the need for further disease characterization is critical. COVID-19 is well established as a respiratory tract pathogen; however, recent studies have shown an increasing number of patients reporting gastrointestinal manifestations such as diarrhea, nausea, vomiting, and abdominal pain. The time from onset of gastrointestinal symptoms to hospital presentation is often delayed compared to that of respiratory symptoms. It has been noted that SARS-CoV-2 RNA can be detected in fecal matter for an extended period of time, even after respiratory samples have tested negative and patients are asymptomatic. In this article, SARS-CoV-2 and its disease COVID-19 will be reviewed with consideration of the latest literature about gastrointestinal symptomatology, the mechanisms by which the virus may inflict damage, and the possibility of viral replication contributing to a fecal-oral route of transmission.
Topics: Betacoronavirus; COVID-19; Coronavirus Infections; Diarrhea; Digestive System Diseases; Feces; Gastrointestinal Tract; Humans; Liver; Oxygen; Pancreas; Pandemics; Pneumonia, Viral; Respiration, Artificial; SARS-CoV-2; Virus Replication; Vomiting
PubMed: 32388469
DOI: 10.1016/j.jcv.2020.104386 -
Annals of Surgery Oct 2023The use and impact of antibiotics and the impact of causative pathogens on clinical outcomes in a large real-world cohort covering the entire clinical spectrum of...
OBJECTIVE
The use and impact of antibiotics and the impact of causative pathogens on clinical outcomes in a large real-world cohort covering the entire clinical spectrum of necrotizing pancreatitis remain unknown.
SUMMARY BACKGROUND DATA
International guidelines recommend broad-spectrum antibiotics in patients with suspected infected necrotizing pancreatitis. This recommendation is not based on high-level evidence and clinical effects are unknown.
MATERIALS AND METHODS
This study is a post-hoc analysis of a nationwide prospective cohort of 401 patients with necrotizing pancreatitis in 15 Dutch centers (2010-2019). Across the patient population from the time of admission to 6 months postadmission, multivariable regression analyses were used to analyze (1) microbiological cultures and (2) antibiotic use.
RESULTS
Antibiotics were started in 321/401 patients (80%) administered at a median of 5 days (P25-P75: 1-13) after admission. The median duration of antibiotics was 27 days (P25-P75: 15-48). In 221/321 patients (69%) infection was not proven by cultures at the time of initiation of antibiotics. Empirical antibiotics for infected necrosis provided insufficient coverage in 64/128 patients (50%) with a pancreatic culture. Prolonged antibiotic therapy was associated with Enterococcus infection (OR 1.08 [95% CI 1.03-1.16], P =0.01). Enterococcus infection was associated with new/persistent organ failure (OR 3.08 [95% CI 1.35-7.29], P <0.01) and mortality (OR 5.78 [95% CI 1.46-38.73], P =0.03). Yeast was found in 30/147 cultures (20%).
DISCUSSION
In this nationwide study of patients with necrotizing pancreatitis, the vast majority received antibiotics, typically administered early in the disease course and without a proven infection. Empirical antibiotics were inappropriate based on pancreatic cultures in half the patients. Future clinical research and practice must consider antibiotic selective pressure due to prolonged therapy and coverage of Enterococcus and yeast. Improved guidelines on antimicrobial diagnostics and therapy could reduce inappropriate antibiotic use and improve clinical outcomes.
Topics: Humans; Anti-Bacterial Agents; Prospective Studies; Saccharomyces cerevisiae; Pancreatitis, Acute Necrotizing; Pancreas
PubMed: 36728517
DOI: 10.1097/SLA.0000000000005790 -
The National Medical Journal of India 2021Tuberculosis (TB) of pancreas is a rare presentation in both immune-competent and immune-suppressed patients. Its presenting clinical features are usually vague and...
Tuberculosis (TB) of pancreas is a rare presentation in both immune-competent and immune-suppressed patients. Its presenting clinical features are usually vague and non-specific, while radiological features mimic other common pancreatic conditions such as malignancy, so it is often misdiagnosed. It commonly involves the head and the uncinate process of the pancreas. We report a middle-aged immune-compromised man who presented with left-sided tubercular pleural effusion and later was diagnosed as pancreatitis by clinical presentation and TB of pancreas on computed tomography of the abdomen.
Topics: Humans; Male; Middle Aged; Pancreas; Pancreatic Diseases; Pleural Effusion; Tomography, X-Ray Computed; Tuberculosis
PubMed: 34599118
DOI: 10.4103/0970-258X.326765 -
Le Infezioni in Medicina Dec 2020The gastrointestinal system may be affected by COVID-19 infection with an incidence variable from 3% up to 79%. Several works show that the pancreas, both in its... (Review)
Review
The gastrointestinal system may be affected by COVID-19 infection with an incidence variable from 3% up to 79%. Several works show that the pancreas, both in its exocrine and endocrine function, can be affected by this viral infection, although this organ has been poorly analyzed in this current epidemic context. This mini-review aims to provide a summary of available studies on exocrine pancreas involvement during COVID-19 infection. A search through MEDLINE/PubMed was conducted on the topic in hand. With regard to exocrine function, some studies highlight the presence of an associated hyperenzymemia (hyperamylasemia, hyperlipasemia), while others describe isolated and rare cases of acute pancreatitis. More attention should be paid to pancreatic impairment in subjects with COVID-19, as this may prove to be one of the elements aggravating its clinical course. Indeed, acute pancreatitis, especially when presenting in severe forms with hyperstimulation of the pro-inflammatory response, may represent a crucial factor in the progression of COVID-19, entailing both an increase in hospitalization days and in mortality rate.
Topics: COVID-19; Disease Progression; Humans; Hyperamylasemia; Lipase; Pancreas, Exocrine; Pancreatitis; SARS-CoV-2
PubMed: 33257624
DOI: No ID Found -
Mini Reviews in Medicinal Chemistry 2023Due to the importance of control and prevention of COVID-19-correlated long-term symptoms, the present review article has summarized what has been currently known... (Review)
Review
Due to the importance of control and prevention of COVID-19-correlated long-term symptoms, the present review article has summarized what has been currently known regarding the molecular and cellular mechanisms linking COVID-19 to important long-term complications including psychological complications, liver and gastrointestinal manifestations, oral signs as well as even diabetes. COVID-19 can directly affect the body cells through their Angiotensin-converting enzyme 2 (ACE-2) to induce inflammatory responses and cytokine storm. The cytokines cause the release of reactive oxygen species (ROS) and subsequently initiate and promote cell injuries. Another way, COVID-19-associated dysbiosis may be involved in GI pathogenesis. In addition, SARS-CoV-2 reduces butyrate-secreting bacteria and leads to the induction of hyperinflammation. Moreover, SARS-CoV-2-mediated endoplasmic reticulum stress induces de novo lipogenesis in hepatocytes, which leads to hepatic steatosis and inhibits autophagy via increasing mTOR. In pancreas tissue, the virus damages beta-cells and impairs insulin secretion. SARS-COV-2 may change the ACE2 activity by modifying ANGII levels in taste buds which leads to gustatory dysfunction. SARS-CoV-2 infection and its resulting stress can lead to severe inflammation that can subsequently alter neurotransmitter signals. This, in turn, negatively affects the structure of neurons and leads to mood and anxiety disorders. In conclusion, all the pathways mentioned earlier can play a crucial role in the disease's pathogenesis and related comorbidities. However, more studies are needed to clarify the underlying mechanism of the pathogenesis of the new coming virus.
Topics: Humans; COVID-19; SARS-CoV-2; Peptidyl-Dipeptidase A; Liver; Pancreas
PubMed: 36397624
DOI: 10.2174/1389557523666221116154907 -
Annual Review of Medicine Jan 2022Type 1 diabetes (T1D) is a chronic autoimmune disease characterized by insulin deficiency and resultant hyperglycemia. Complex interactions of genetic and environmental... (Review)
Review
Type 1 diabetes (T1D) is a chronic autoimmune disease characterized by insulin deficiency and resultant hyperglycemia. Complex interactions of genetic and environmental factors trigger the onset of autoimmune mechanisms responsible for development of autoimmunity to β cell antigens and subsequent development of T1D. A potential role of virus infections has long been hypothesized, and growing evidence continues to implicate enteroviruses as the most probable triggering viruses. Recent studies have strengthened the association between enteroviruses and development of autoimmunity in T1D patients, potentially through persistent infections. Enterovirus infections may contribute to different stages of disease development. We review data from both human cohort studies and experimental research exploring the potential roles and molecular mechanisms by which enterovirus infections can impact disease outcome.
Topics: Autoimmunity; Diabetes Mellitus, Type 1; Enterovirus; Enterovirus Infections; Humans; Insulin-Secreting Cells
PubMed: 34794324
DOI: 10.1146/annurev-med-042320-015952 -
The American Journal of the Medical... Jun 2020Emphysematous pancreatitis (EP) is an unusual medical emergency that presents with intraparenchymal pancreatic air in the setting of necrotizing infection. We aimed to...
BACKGROUND
Emphysematous pancreatitis (EP) is an unusual medical emergency that presents with intraparenchymal pancreatic air in the setting of necrotizing infection. We aimed to determine the differences in the epidemiology, etiology, clinical presentation, symptoms and outcome of EP between elderly and nonelderly patients.
MATERIALS AND METHODS
A PubMed search was performed using the keywords "emphysematous pancreatitis," "gas-forming pancreatitis" and "pancreatitis and pneumoperitoneum" from March 1959 to February 2019. Forty-two EP articles with 58 patients were enrolled in our study. We divided the patients into ≥65 (elderly, n = 25) and <65-year age groups (non-elderly, n = 33). Data on patient age, sex, comorbidities, symptoms, clinical findings, etiologies, laboratory results, treatments, outcomes and mortality were collected and analyzed using the Student's t test and chi-square test using IBM SPSS 20. P values < 0.05 (2-tailed) indicated statistical significance.
RESULTS
Alcohol- and biliary pancreatitis-related EP were 4.95- and 4-fold, respectively, more frequent in the elderly than in the nonelderly (36% versus [vs.] 9.1%, P < 0.05). Fever was more frequent in the nonelderly than in the elderly (69.7% vs. 36%, P < 0.05). The elderly presented with more severe shock status (68% vs. 33.3%, P < 0.05) and received more surgical interventions than the nonelderly (60% vs. 30.3%, P < 0.05).
CONCLUSIONS
Biliary pancreatitis is the most common type of EP in the elderly and has an atypical presentation with less fever, more severe shock, and more surgical interventions. In treating elderly patients with pancreatitis, immediate administration of adequate antibiotics, assisted drainage and early surgical intervention are needed to prevent shock.
Topics: Abdominal Pain; Adult; Aged; Aged, 80 and over; Emphysema; Female; Humans; Length of Stay; Male; Middle Aged; Pancreas; Pancreatitis, Acute Necrotizing; Shock
PubMed: 32317168
DOI: 10.1016/j.amjms.2020.03.007 -
Transplantation Proceedings May 2022The SARS-CoV-2 pandemic was a real test of doctors' abilities to adapt and respond to patients' needs. The course of infection varied from influenza-like symptoms to...
The SARS-CoV-2 pandemic was a real test of doctors' abilities to adapt and respond to patients' needs. The course of infection varied from influenza-like symptoms to severe infections with multi-organ failure and death. Therefore, the possibility of vaccination against the COVID-19 virus brought great hope. Since 2004, 240 pancreas and pancreas with kidney (simultaneous pancreas and kidney transplantation, pancreas after kidney, pancreas transplants alone) transplants were performed in our center. Currently, 130 transplant patients are under the care of the transplant clinic. All patients were informed about the possibility of vaccination against SARS-CoV-2 with the mRNA vaccine. The aim of the study was to evaluate the development of antibodies to SARS-CoV-2 in patients who had previously undergone transplantation. Fifty-three patients were vaccinated with the full double dose and 37 patients received an additional third dose. The level of antibodies in the IgM and IgG classes was assessed in patients' serum. The level of antibodies was assessed before administration of the vaccine and then after administration of the first and second doses. Most patients had no response to vaccination after 1 dose of the vaccine and 21 patients achieved therapeutic antibody levels after the full dose of vaccination. However, the highest titer of immunoglobulins was found in recipients who received the third dose. The use of vaccinations is safe and can protect the group of patients after pancreas transplantation from serious complications of SARS-CoV-2 infection despite the use of immunosuppressive drugs.
Topics: Antibodies, Viral; COVID-19; COVID-19 Vaccines; Humans; Pancreas; SARS-CoV-2; Transplant Recipients; Vaccination; Vaccines; Vaccines, Synthetic; mRNA Vaccines
PubMed: 35437149
DOI: 10.1016/j.transproceed.2022.03.002 -
JPMA. the Journal of the Pakistan... Oct 2022To determine the outcome of hepato-pancreato-biliary patients who were operated upon during the pandemic under a safety protocol devised to minimise the risk of...
OBJECTIVE
To determine the outcome of hepato-pancreato-biliary patients who were operated upon during the pandemic under a safety protocol devised to minimise the risk of coronavirus disease-2019 infection in patients and staff during the perioperative period.
METHODS
The retrospective study was conducted at the Hepato-Pancreatico-Biliary (HPB) Unit of Bahria International Hospital Orchard, Lahore, Pakistan, in February 2021, and comprised data of all patients who were discussed in the multidisciplinary meeting of the Unit between May 1 and December 31, 2020. The coronavirus disease-2019 screening protocol was a negative polymerase chain reaction test just before admission and a second negative test 24-48 hours pre-surgery. All patients had computed tomography scan of chest to rule out atypical pneumonia due to coronavirus disease-2019 infection. Surgery was deferred for positive patients for at least 2 weeks until their test was negative. Surgeries were carried out with full personal protective equipment. Further testing was carried out if clinically indicated. Data was collected of 30-day coronavirus disease-2019-related morbidity and mortality. Data was analysed using SPSS 20.
RESULTS
Of the 44 patients, 29(65.9%) were males and 15(34.1%) were females. Overall, 32(72.7%) patients were aged >40 years, 8(18.2%) were aged 20-40 years and 4(9%) were aged <20 years. Of the total, 7(15.09%) patients were found to be positive for coronavirus disease-2019 during preoperative screening. Among them, 5(71.4%) had successful surgery post-recovery, 1(14.3%) died without surgery due to pulmonary complications related to coronavirus disease-2019 and 1(14.3%) patient was lost to follow-up. Among the 42(95.5%) patients who underwent any procedure, 2(4.7%) patients turned positive for coronavirus disease-2019 in the postoperative period. There was 1(2.4%) mortality in the 30-day post-operative period which was not related to coronavirus disease-2019. Complications were seen in 5(11.90%) patients. Three (9.3%) out of 32 staff members were found to be asymptomatic carriers.
CONCLUSIONS
Hepato-pancreatico-biliary surgery could be safely carried out during coronavirus disease-2019 pandemic if strict safety protocols were followed.
Topics: Female; Humans; Male; Biliary Tract Surgical Procedures; COVID-19; Pancreas; Pandemics; Retrospective Studies; Young Adult; Adult
PubMed: 36660989
DOI: 10.47391/JPMA.4290