Objective: Acute pancreatitis (AP) is not consistent in terms of its clinical presentation and severity. Various biochemical parameters, computerized tomography and certain scoring systems are used for this purpose and to determine the need for intensive care. Methods:In this study patients of AP, who presented with the onset of symptoms by or before 48 hours were included. Blood samples were collected for the estimation of procalcitonin (PCT) on day of admission. Chemiluminescent immunoassay (Elecsy Brahms PCT Roche Diagnostic) was used for measuring serum PCT concentration. In this study Revised Atlanta classification was used as the gold standard to stratify severity of acute pancreatitis. Results:Of the 115 patients of AP, 58.3% were male; mean age of presentation was 47 (ranged 18-90) years, 14.8% had severe pancreatitis with organ failure, 16.5% had moderately severe pancreatitis and 68.7% were acute mild pancreatitis. Death occurred in 7%. Commonest risk factor for AP was gall stone disease (53.9%) followed by alcohol (21.7%). In 14.8% of the patients, cause was idiopathic. Mean ± SD value of serum PCT for mild, moderately severe and severe pancreatitis on day of admission were 0.46 ± 1.35 ng/ml, 1.45 ± 1.21ng/ml and 2.58 ± 3.2 ng/ml respectively. Best cut off value of serum PCT was 0.42 ng/ml between mild and moderately severe pancreatitis (ROC curve (AUC):0.785 95% CI (0.691 to 0.861) p 0.0001 with 65% sensitivity and 89.9% specificity. While best cut off value of serum PCT was 0.53 ng/ml between moderately severe and acute severe pancreatitis (ROC curve (AUC):0.70% CI (0.528 to 0.842) P 0.025 with 81.3% sensitivity and 55% specificity. Conclusion:Serum PCT is potentially a simple and a reliable early biomarker in predicting the severity of AP; however require further research to confirm its accuracy. We have best cut off values that stratify AP into mild, moderately severe and severe pancreatitis with sensitivity ranges between 65% to 81.3% at day of admission.

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Clostridium difficile is a signicant cause of morbidity and mortality among hospitalized patients, and the incidence of C. difficile infection (CDI) has dramatically increased due to frequent usage of broadspectrum antibiotics in these patients. The wide variation in the spectrum of clinical manifestations of CDI makes the diagnosis difcult. Further, the wide range of variability in the sensitivity and specicity of the various diagnostic methods and the high cost of these methods add to the difculty. It is a spore-forming gram-positive anaerobic organism. Until the 1970s, it was considered as a microorganism that is rarely present in normal intestinal microbiota. But it was not until 1978 that C. difcile was identied as a cause of [1] pseudomembranous colitis . Since then, C. difcile has been recognized as a common cause of antibiotic associated diarrhoea and nosocomial diarrhoea. The incidence of C. difcile infection (CDI) varies from place to place. In India, it is known to infect up to 25 % of [2] people taking antibiotics

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All the three Indian gastroenterology societies (Society of Gastrointestinal Endoscopy of India, Indian Society of Gastroenterology, and Indian National Association for the Study of the Liver) jointly recommend to consider only emergency and urgent endoscopy procedures for the next 1 month or till the current threat due to coronavirus disease 2019 (COVID-19) is over.Two laws that are penal in nature are now applicable in the current pandemic, namely the Epidemics Diseases Act 1897 and the Indian Penal Code 1860. No act of an endoscopist should be seen to be in contravention of any of the aforementioned laws, and the sections thereunder as provisions of the Indian Penal Code can be attracted in the current scenario for spreading an infectious disease either knowingly (Section 270) or unknowingly or negligently (Section 269).Section 4 of the Epidemics Disease Act 1897 gives legal protection to every person who has acted under this Act or the directions issued under this Act subject to only one condition, that is, the act must have been done in good faith.Though the hospitals are obliged to ensure personal safety of its staff legally, morally and ethically, because of the huge gap in demand and supply of personal protective equipment (PPE), it is advisable to arrange PPE on one’s own to first protect oneself and then, by extension, to prevent the spread to others. The dictum is “take care of yourself.” Self-preservation is a supreme law.In the current COVID-19 pandemic conditions, certain additional information, to be agreed upon by the patient, needs to be incorporated in the consent. It should be incorporated in the consent that:• While all the necessary precautions are being taken, there is a finite though small risk that the patient may contract the infection from the hospital.• He/she indemnifies the hospital and the endoscopist against any such liability arising out of any action taken while doing the procedure.• Furthermore, to protect the patient him/herself, he/she agrees to get the preprocedural test for COVID-19 as well as bear the additional cost of the PPE used by the endoscopist and support staff.Several of those who have undergone an endoscopy would require a follow-up consultation. As it is difficult to have physical interaction, teleconsultation may be done as per the telemedicine practice guidelines issued by the Medical Council of India (MCI).