Goals: No established methods exist to predict who will require a higher number of endoscopic necrosectomy sessions for walled-off necrosis (WON). We aim to identify radiologic predictors for requiring a greater number of necrosectomy sessions. This may help to identify patients who benefit from aggressive endoscopic management. Materials and Methods: This is a multicenter retrospective study of patients with WON at 3 tertiary care centers. WON characteristics on preintervention computed tomography imaging were evaluated to determine if they were predictive of requiring more endoscopic necrosectomy. Results: A total of 104 patients were included. Seventy patients (67.3%) underwent endoscopic necrosectomy, with median of 2 necrosectomies. WON largest transverse diameters (P=0.02), largest coronal diameters (P=0.01), necrosis pattern [likelihood ratio (LR)=17.85, P<0.001], spread (LR=11.02, P=0.01), hemorrhage (LR=8.64, P=0.003), and presence of disconnected pancreatic duct (LR=6.80, P=0.01) were associated with undergoing ≥2 necrosectomies. Patients with septations/loculations were significantly less likely to undergo ≥2 necrosectomies (LR=4.86, P=0.03). Conclusions: Several computed tomography radiologic features were significantly associated with undergoing ≥2 necrosectomies. These could help identify patients who will undergo a higher number of endoscopic necrosectomy sessions.

Background  Gall  stone  diseases and  alcohol  are  the  two  most  common causes  of  acute  pancreatitis. The  present  work  was undertaken  to  identify the  various etiological  factors  in  acute  pancreatitis  after  excluding  alcoholism  and  gall  stone  diseases. The etiology of an attack of non alcohol non gall stone acute pancreatitis is highly variable. The main objective was to identify the causing factor, because it can have an effect on the specific treatment of acute pancreatitis. . This is a rare cross- sectional study of its kind which is the first one to be reported from India. Materials and Methods A cross-sectional community based study was designed and conducted in Medical College and Hospital, Kolkata, West Bengal, India from July 2009 to June 2011. Z test and Chi square test were used to observe the variation between different variables and strength of the relationship with logistic regression.  Odd ratios were calculated and their 95% confidence intervals (95% CI). p < 0.05 was considered as statistically significant. Results CMV was the commonest etiology of non alcohol and non gallstone acute pancreatitis 26.7% followed by HEV 6.7% and Pancreas Divisum 6.7%%, SOD 3.3%, EBV 3.3%, Mumps 3.3%, Hepatitis 3.3%, Tumour 3.3%, Choledochal cyst 3.3%,Drugs 3.3% and Gallstone 3.3%. Logistic regression analysis finding indicates that acute pancreatitis was found more prevalent in < 40 yrs [OR 2.076,95%(CI 0.339, 12.716)] and among patients  having monthly income of <5000 rs/month yrs [OR 1.4,95%(CI 0.224, 8.768)] . According to the severity of CT grading, Patients had Grade D severity  [OR 2.667,95%(CI 0.158, 45.141)], Grade C[OR 1.333,95%(CI 0.104, 17.098)] and Grade E [OR 1.333,95%(CI 0.88, 20.108)]as compared to Grade B severity of CT.  Conclusion In the  study  an  etiological  factor  was  evident  among  almost 3/4th   of the patients  of  non-alcoholic  and  non-gallstone  pancreatitis. The most common etiological factors were CMV followed by HEV.  These  results  rather  suggests  that the most diligent  workup  including  a  biliary  microcrystal  analysis,  a  sphincter  of  Oddi  manometry  and  possible  gene  analysis  for  hereditary  disorders  may  further  reduce   the  apparently  idiopathic  group in  the  analysis  of  such  patients. DOI: http://dx.doi.org/10.3126/nje.v4i3.10663 Nepal Journal of Epidemiology 2014; 4(3): 351-62

Background and objectives: A progressive accumulation of body iron easily occurs as a result of long-term transfusions in patients with anaemia of genetic disorders such as thalassaemia. Iron deposit in liver biopsy sections was studied in beta-thalassaemia major patients to assess the grade of liver siderosis and to correlate the grade with amount of blood transfused. Materials and methods: Beta-thalassaemia major patients having splenomegaly and selected for splenectomy were enrolled. Liver biopsy was taken from every patient during the splenectomy. Liver tissue was sectioned and stained with Perls’ prussian blue method for the presence of iron deposition. The degree of iron deposition was expressed as grades of siderosis from 0 to 4. Results: A total of 30 beta-thalassemia patients were enrolled in the study. Out of 30 patients, 7 were males (23.3%) and 23 females (76.7%). The mean age of patients was 15.2 ± 1.4 years. The mean serum iron and ferritin levels of the study cases were above the normal range. Blood received by all patients was 51.5 ± 11.6 units (range 31 to 88 units). Out of 30 patients, grade 1, 2, 3 and 4 liver siderosis was present in 1, 3, 9 and 17 patients respectively. Serum ferritin level of patients with grade 4 siderosis was significantly higher (p = 0.03) compared to grade 3 cases. Pearson’s correlation coefficient test revealed significant positive correlation between grades of liver siderosis and amount of blood transfusion received (0.626, p < 0.01). Conclusion: Grade of liver siderosis is associated with increased units of blood transfusion and is a good indicator for transfusional iron overload in beta-thalassaemia major patients. IMC J Med Sci. 2023. 17(1): 004. DOI: https://doi.org/10.55010/imcjms.17.004 *Correspondence: Dr. Souvik Basak, Department of General Surgery, Medical College, Kolkata, West Bengal, India. Email: sb009cmc@gmail.com

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