Impact of low-molecular-weight heparin in the treatment of moderately severe and severe acute pancreatitis; a randomized, single blind, phase 3 control trial.

INTRODUCTION: Acute pancreatitis is inflammation of pancreatic parenchyma which is an emergency condition. It is classified as mild, moderately severe, and severe categories. In severe acute pancreatitis, mortality is up to 10%-30%. Pancreatic abscess increases the mortality to 40%, and infected pancreatitis carries 100% mortality without surgical drainage. Anti-coagulant, anti-inflammatory and anti-protease activities of low-molecular-weight heparin are involved in preventing pancreatic necrosis and curbing the adverse outcomes of acute pancreatitis. AIM: To determine the effect of low-molecular-weight heparin on the outcome of moderately severe and severe acute pancreatitis. MATERIALS AND METHODOLOGY: Hospital based, single centre, randomized, single blind, phase 3 control trial. First 140 patients with moderately severe and severe acute pancreatitis admitted in hospital in the given period who met the inclusion and exclusion criteria were taken. 70 patients were placed in the control and the trial group each by simple randomization (closed envelope method). The control group received conventional treatment for pancreatitis & the trial group received 1mg/kg body weight Enoxaperin, subcutaneously, 12 hourly for seven days along with the conventional treatment. Progression of disease in Computed Tomography Severity Index and incidence of pancreatic necrosis were the main outcomes studied at the end of 7 days of treatment. RESULTS: 1386 acute abdomen cases were screened, of which 269 were diagnosed with acute pancreatitis. 147 patients with acute pancreatitis met the selection criteria and 7 were dropouts. Recruitment started on April 9, 2021 and closed on December 5, 2021. Computed Tomography Severity Index progressed in 22(31.40%) patients in control group and 6(8.6%) patients in the trial group and 18(25.71%) in the control group and 4(5.71%) in the trial group showed the presence of necrosis. The differences are significant (P value is 0.001 in each). No adverse events were seen. CONCLUSION: Use of low-molecular-weight heparin in early stage of moderately severe and severe acute pancreatitis significantly reduces the chance of disease progression and pancreatic necrosis.

Tumor-induced osteomalacia: experience from three tertiary care centers in India.

Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome characterized by recalcitrant hypophosphatemia. Reports from the Indian subcontinent are scarce, with most being single center experiences involving few patients. Herein, we conducted a retrospective analysis of 30 patients of TIO diagnosed at three tertiary care hospitals in India. Patients with persistent hypophosphatemia (despite correction of hypovitaminosis D), normocalcemia, elevated alkaline phosphatase, low TmP/GFR and elevated or 'inappropriately normal' FGF23 levels were labeled as having TIO. They were sequentially subjected to functional followed by anatomical imaging. Patients with a well-localized tumor underwent excision; others were put on phosphorous and calcitriol supplementation. The mean age at presentation was 39.6 years with female:male ratio of 3:2. Bone pain (83.3%) and proximal myopathy (70%) were the chief complaints; 40% of cases had fractures. The mean delay in diagnosis was 3.8 years. Tumors were clinically detectable in four patients (13.3%). The mean serum phosphate was 0.50 mmol/L with a median serum FGF23 level of 518 RU/mL. Somatostatin receptor-based scintigraphy was found to be superior to FDG-PET in tumor localization. Lower extremities were the most common site of the tumor (72%). Tumor size was positively correlated with serum FGF23 levels. Twenty-two patients underwent tumor resection and 16 of them had phosphaturic mesenchymal tumors. Surgical excision led to cure in 72.7% of patients whereas disease persistence and disease recurrence were seen in 18.2% and 9.1% of cases, respectively. At the last follow-up, serum phosphate in the surgically treated group was significantly higher than in the medically managed group.

Fibrogenesis Imperfecta Ossium and Response to Human Growth Hormone: A Potential Therapy.

Context: Fibrogenesis imperfecta ossium (FIO) is a rare bone disease manifested by generalized bone pain, fragility fractures, progressive disability, and extensive mineralization defect seen in bone biopsy specimens. The pathogenesis of the disease is unknown and currently there is no effective treatment. Objective: To report on the effect of recombinant human growth hormone (rhGH) therapy in FIO. Design: An observational study in two patients. Setting: Endocrinology clinic in an academic institution. Patients or Other Participants: Two siblings with FIO. Intervention(s): rhGH was administered subcutaneously at a dose of 1 U daily for 1 year. Main Outcome Measures: Changes in clinical, biochemical, radiological, and bone histological (i.e., light and transmission electron microscopy, and histomorphometry) investigations. Results: Except for an elevated serum alkaline phosphatase level, results of routine biochemical, hematological, and hormonal investigations were normal in both patients. Radiographs showed pseudofractures and bone scans revealed a "beheaded" tracer activity pattern (i.e., superscan without uptake in the skull). Bone biopsy specimens showed severe mineralization defect simulating osteomalacia with disorganized collagen fibril alignment. Treatment with rhGH was followed by clinical, biochemical, and radiological improvement in both the patients, with substantial improvement in the mineralization defect, most likely due to rhGH-induced improvement in collagen fibril arrangement. Conclusion: We report on two brothers with FIO and demonstrate clinical improvement and restoration of normal bone pathology with rhGH therapy. We suggest that rhGH is a potential therapy for FIO for which no effective therapy currently exists.

Jejuno-jejunal intussusception: An unusual presentation of malignant melanoma.

Jejuno-jejunal intussusception is a rare mode of metastatic melanoma presentation, with only six cases being reported in the English medical literature to date. We present a case of a 55-year-old female who presented to us with features of obstruction. On exploration, it was discovered that she had jejuno-jejunal intussusception, with enlarged blackened mesenteric lymph nodes. Resection and anastomosis were performed. On further histopathological examination, a lesion was found to be a metastatic malignant melanoma.

A report on biocompounds from palm fossil of India.

The occurrence of a large number of fossil woods having resemblance in anatomical features with the modern palm genus, Phoenix L in Deccan Intertrappean fossil flora of Maastrichtian-Danian age (i. e. Late Cretaceous and Earliest Tertiary (65-67 my)) indicates the most primitive record of date palm. Present discovery of biocompounds from fossil wood of Phoenix collected from Deccan Intertrappean having affinity with the biocompounds known from modern plant further exemplify the earliest documentation of Phoenix in Indian peninsula.

An experimental study of the effect of strontium pre-treatment on calcium release from carious and non-carious teeth.

The administration of strontium salt is known to be beneficial for bones in preventing calcium loss and osteoporosis. Therefore, we decided to study if strontium treatment affects calcium release from teeth in vitro. Extracted carious as well as non-carious teeth were washed, cleaned, and dried. These were individually immersed in 25 ml of 1% lactic acid at 37 degrees C for 24 h, and the amount of calcium released was measured. The rate of calcium release from these teeth was again determined after their exposure to M/4 strontium chloride for 1 month at 37 degrees C. It was found that: (1) the rate of calcium release from non-carious teeth was significantly higher than carious teeth, possibly because there was more calcium present, (2) the rate of calcium release was almost halved after strontium treatment in both groups of teeth, (3) the Vicker's microhardness of non-carious teeth was higher than those of carious teeth, and (4) strontium treatment did not affect hardness. Strontium treatment may be beneficial in reducing loss of calcium from intact teeth-non-carious as well as carious-and this beneficial effect of strontium is unrelated to change in teeth hardness.

Significance of trace element profile of blood of persons with multiple caries versus sound teeth.

In order to determine any possible relation between chemical composition of a person's blood to formation of dental caries, whole blood was analyzed for 35 inorganic elements (Si, Al, Fe, Ca, Mg, K, Mn, Ti, P, Li, Be, B, V, Cr, Co, Ni, Cu, Zn, As, Sr, Y, Nb, Mo, Ag, Cd, Sn, Sb, Ba, La, Ce, W, Pb, Bi, Zr, and F) in the 15 people having sound teeth as well as an equal number of those having multiple caries. The results showed the absence of 13 elements (Si, Al, Mn, Ti, Be, Co, As, Y, Cd, Ba, La, Ce, and Zr) in the blood of both groups. Of the remaining 22 elements, the results of only seven elements (Fe, P, B, V, Sr, Sn, and F) were significantly different between the two groups. The most remarkable finding of this study was significantly decreased amount of phosphorus, strontium, and fluorine and perhaps increased boron in the blood of persons with caries.