SARS-CoV-2 leading to acute pancreatitis: an unusual presentation.

During SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2) pandemic, the etiologic agent of COVID-19, several studies described the involvement of other tissues besides the respiratory tract, such as the gastrointestinal tract. Angiotensin-converting enzyme-2, the functional virus host cell receptor expressed by organs and tissues, seems to have an important role in the pathophysiology and presentation of this disease. In pancreas, this receptor is expressed in both exocrine glands and islets, being a potential target for the virus and subsequent pancreatic injury. There are few articles reporting pancreatic injury in COVID-19 patients but most of them do not report acute pancreatitis. Diagnosing acute pancreatitis secondary to SARS-CoV-2 infection is challenging due to the need to rule out other etiologies as well the notable heterogeneous presentations. Herein we report the case of a patient with COVID-19 who developed severe acute pancreatitis.

CFTR polymorphisms in patients with alcoholic chronic pancreatitis.

INTRODUCTION: Pancreas susceptibility to alcohol is variable and only 5-10% of chronic alcohol abusers develop chronic pancreatitis; the role of genetic factors in this process is unknown. The CFTR gene encodes a protein that acts on epithelial cells and plays a key role in normal exocrine pancreatic function. METHODS: This study investigated the frequency of polymorphisms in intron 8 of the CFTR gene in patients with alcoholic chronic pancreatitis. Three groups of patients were studied: group A - 68 adult alcoholics with a diagnosis of chronic pancreatitis; group B - 68 adult alcoholics without pancreatic disease or liver cirrhosis and group C - 104 healthy nonalcoholic adults. RESULTS: T5/T7 genotype was more frequent in group A (11.8%) than in group B (2.9%) (p = 0.0481), and there was no statistical difference when groups A and C (5.8%) were compared (p = 0.1317). The haplotype combination (TG)10-T7/(TG)11-T7 was more frequent in groups B (23.5%) and C (20.2%) than in group A (7.3%) (p = 0.0080 and 0.0162). CONCLUSION: There are differences when these three groups are compared and individuals with T5/T7 genotype might have a greater risk of developing chronic pancreatitis when they become chronic alcoholics.

Frequency of Tabagism and N34S and P55S Mutations of Serine Peptidase Inhibitor, Kazal Type 1 (SPINK1) and R254W Mutation of Chymotrypsin C (CTRC) in Patients With Chronic Pancreatitis and Controls.

OBJECTIVE: This study aimed to investigate the association between chronic pancreatitis and smoking or genetic mutations. METHODS: The study sample comprised 148 patients with chronic pancreatitis, 110 chronic alcoholic subjects without pancreatic disease, and 297 volunteer blood donors. RESULTS: Of the patients with chronic pancreatitis, 74% had alcoholic etiology and 26% had idiopathic pancreatitis. The frequency of smoking was 91.4% in patients with alcoholic pancreatitis, higher than 73.3% in alcoholic subjects without pancreatitis (P < 0.01). The difference in smoking frequency was not significant between the patients with idiopathic pancreatitis and blood donors. The N34S mutation of serine peptidase inhibitor, Kazal type 1 (SPINK1) was found in 2.7% of patients with chronic alcoholic pancreatitis, in 5.3% of patients with idiopathic pancreatitis, and in 0.4% of blood donors (P = 0.02). The P55S mutation of SPINK1 was found in 2.7% of patients with alcoholic pancreatitis and in 0.7% of blood donors (P = 0.12). The R254W mutation of chymotrypsin C was found in 0.9% of patients with alcoholic pancreatitis, in 0.9% of chronic alcoholic subjects without pancreatitis, and in 0.4% of blood donors (P = 0.75). In all cases, the mutations were heterozygous. CONCLUSIONS: Smoking and the N34S mutation of SPINK1 were positively correlated with chronic pancreatitis.

Tratamento da gastropatia congestiva hemorrágica através do implante do TIPS: estudo piloto / Treatment of hemorrhagic congestive gastropathy through TIPS implantation: pilot study

Procedimentos percutâneos minimamente invasivos ocupam lugar de destaque na medicina interna. Neste conceito inclui-se a anastomose portossistêmica intra-hepática transjugular (TIPS). Neste estudo piloto, descreve-se a realizaçäo desta modalidade terapêutica na conduçäo de três cirróticos com gastropatia congestiva hemorrágica, näo responsiva à administraçäo de drogas que promovem reduçäo do gradiente hepático-portal e coibem os sangramentos. Foram conduzidos pelo implante do TIPS, levando à interrupçäo de hemorragia em todos (100 por cento), sem requerimento posterior de hemotransfusäo, com ocasional melhora das provas bioquímicas que definem agressäo ao hepatócito e das condiçöes hemodinâmicas, com baixas respectivamente do gradiente hepático-portal com 50 por cento, 30 por cento e 75 por cento dos seus valores iniciais. Um dos pacientes evoluiu com reduçäo do calibre da prótese com necessidade de dilataçäo posterior, enquanto outro, com encefalopatia hepática, prontamente reversível com medidas terapêuticas habituais. Reforça-se a indicaçäo desta atitude, colocando os pacientes em melhores condiçöes hemodinâmicas para posterior transplante de fígado. Trata-se do primeiro relato desta evoluçäo na literatura nacional.

Uso da laparoscopia no diagnóstico da tuberculose peritoneal / Use the laparoscopy in dignosis of tugerculous perionitis

A laparoscopia é um método propedêutico utilizado para avaliar as moléstias que acometem a cavidade abdominal e näo está isenta de complicaçöes. Relata-se dois casos de tuberculose peritoneal diagnosticadas por meio de laparoscopia, comenta-se suas formas de apresentaçäo e discute-se os métodos de diagnóstico desta doença de sintomas inespecíficos.