الفهرس 
Introduction
Acute PancreatitisOnly 14 pages are availabe for public view
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Abstract
Acute pancreatitis (AP) is an acute inflammatory disease of the pancreas characterized by sudden onset of epigastric pain, elevated serum amylase, and characteristic changes in contrast enhanced C.T. scan79 . Revised Atlanta classification system 2012 classified acute pancreatitis in the whole disease course into mild, moderately severe, and severe acute pancreatitis according to several clinical and radiological parameters2. The clinical course of AP is generally mild but about 25% of patients will suffer from pancreatic necrosis with subsequent persistence of local or systemic complications and multi-organ failure, and this is the definition of severe AP (SAP)80. Although contrast enhanced C.T. scan is the gold standard diagnostic technique for pancreatic necrosis81, it has many pitfalls. The emerging need for early predictors of necrosis with easy and simple bedside tests. Multiple biomarkers are evaluated in many researches trying to predict the course of acute pancreatitis in the first 48h of disease onset 82 Mitochondria DNA is considered a damage-associated molecular pattern (DAMPs), if released in the circulation from necrotic tissue, it stimulates the release of different cytokines especially IL-6. The release of cellular contents in pancreatic necrosis is supposed to elevate the levels of plasma mitochondrial DNA, this may be used as a marker for the prediction for severity 83 Interleukin 6 (IL-6) is secreted by immune cells like monocytes/macrophages, in response to several acute conditions such as burns, major surgery, and sepsis84 .It stimulates the synthesis of acute-phase proteins, including CRP, from hepatocytes 85. IL-6 binds to the IL-6R on target cells, this complex binds the gp130, stimulates its dimerization and the subsequent phosphorylation of the JAK-STAT3 pathway. This classical signaling pathway is activated during early immune responses. At the genomic level, STAT3 positively regulates the expression of anti-apoptotic (Bcl-2 and Bcl-xl) and anti-oxidative proteins. It reduces the expression of the pro-apoptotic factor and regulates the expression of some growth factors, such as vascular endothelial growth factor. 86 As regard study group demographics, our study showed the predominance of male gender in the SAP group and female gender in MAP and MSAP. Male gender is well-recognized risk factor for many infectious and inflammatory diseases, either for epidemiology or severity of the disease. Vahidy et al. 2021 documented strong male susceptibility for the severe outcomes of coronavirus disease 87 . Although systemic lupus erythematosus is more predominant in females, Crosslin et al. 2011 reported that affected males have more severe course, cardiovascular and renal complications 88 . Hsiu et al. 2013 reported that Gender is an important predictor of severity in patients with acute biliary pancreatitis 89. this contrasts with Paul George et al. who reported that gender is not an independent risk factor for the severity and outcome of acute pancreatitis90. Although there is no clear data, why males are more susceptible to complications, male patients need more meticulous observation and management plans.