Test Tube or Computed Tomography Gantry - The Better Diagnostic Indicator of Severe Pancreatitis: A Retrospective Cohort Study

Background: Various studies have been done to assess the use of serum amylase, serum lipase, and amylase/lipase (A/L) ratio to differentiate between the causes of pancreatitis. Scoring systems (Ranson’s, Glasgow, and APACHE II) have been developed to assess the severity of pancreatitis. Computed tomography (CT), a gold standard for prognosticating pancreatitis, is expensive and affordability is a concern in developing country like ours. Methodology: We did a retrospective study in a tertiary care hospital to assess the use of A/L ratio to predict the severity of acute pancreatitis and to correlate with the presence on necrosis in comparison to that given by CT. Results: The median A/L ratio was higher among those with severe and necrotizing pancreatitis, 0.19 (interquartile range [IQR] 0.124–0.304) and 0.183 (IQR 0.117–0.300), respectively. Cutoff of 0.14 was taken, based on the receiver operating characteristic curves, which could predict severity with 75% sensitivity and 53% specificity and necrosis with 73% sensitivity and 55% specificity. Higher A/L ratio correlated with a decrease in hematocrit (P = 0.08), blood glucose (P = 0.042), and aminotransferase (P = 0.03), which are indicators of clinical severity. Increase in A/L ratio had an increased trend to a longer duration of stay and a higher chance of detecting multiorgan dysfunction syndrome. Conclusions: A/L ratio of >0.14 can be used as a predictor of severity as it indicates the presence or absence of necrosis, which further aids in referral and the need for a CT scan in low-resource settings

Production of L-asparaginase by Serratia marcescens SB08: optimization by response surface methodology

This paper describes optimization method that combines the Plackett-Burman design, a factorial design and the response surface method, which were used to optimize the medium for the production of L-asparaginase by Serratia marcescens SB08. Four medium factors, from out of 11 medium factors, were screened by Plackett-Burman design experiments and subsequent optimization process to find out the optimum values of the selected parameters using central composite design was performed. Sucrose, peptone, KH2PO4 and incubation time were found to be the best medium factors for the optimization of L-asparaginase production and central composite design experiments indicated the optimal concentrations of sucrose 12.50 g/l, peptone 4.5 g/l, KH2PO4 4.0 g/l and incubation time 51h. The combined optimization method described here is the effective for screening medium factors as well as determining their optimum levels for the production of L-asparaginase by Serratia marcescens SB08