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The RAC and DBC both signify an advance in the description and differentiation of AP patients. Herein, we describe the complications of the disease independently associated to morbidity and mortality. Our findings are valuable not only when designing future studies on AP but also for the improvement of current classifications.

of stones. Traditionally, it was considered a fatal disease almost exclusively of critical ill patients; however, there are recent reports of cases of AAC affecting less severe patients with good prognosis treated with antibiotics, in the absence of cholecystectomy.We herein report a case of a young man who developed AAC after a Salmonella enteritidis gastrointestinal infection. CASE REPORTA 27-year-old man was admitted to hospital with abdominal pain, diarrhoea, persistent vomiting and 38℃ temperature. On physical examination, he was febrile, but in a good state of health. His abdomen was mildly tender to palpation with guarding in his lower right area. Laboratory tests disclosed a white cell count of 5300 × 1000/μL with 50% neutrophils and 32% lymphocytes, and haemoglobin and platelets were nor mal. The biochemical studies including liver and renal tests, electrolyte panel and coagulation profile, were normal. An abdominal X-ray film showed gas in several loops of a moderately dilated small bowel, and an abdominal sonography disclosed marked mucosal thickening in the right quadrant affecting ileon loops, cecum and ascending colon with small lymph node enlargement; the remainder of the abdominal contents, including the gallbladder were normal. Serology for Salmonella typhi H and O, Yersinia and Shigella were negative, as were blood cultures. The coproculture obtained on admission was positive for Salmonella enteritidis.The patient was treated with intravenous fluids, analgesics and antipyretics and became afebrile on the second day; in a week time, the abdominal pain subsided and he was able to restart oral diet so he was discharged from hospital.The following day he returned to the Emergency Department due to epigastric and right hypochondria pain, nausea and fever. He had no diarrhoea. On physical examination, he presented a temperature of 38℃, a tender upper abdomen, and Murphy's sign. The laboratory tests showed mild normocytic-normochromic anaemia with 7900 × 1000/μL white cells. The biochemical tests were normal. A new abdominal sonography disclosed normal intestinal loops, but his gallbladder was distended and presented a markedly thick wall (7 mm) with no stones, and was surrounded by a little fluid collection.He was then administered intravenous antibiotics AbstractAcute acalculous cholecystitis (AAC) is defined as an acute inflammation of the gallbladder in the absence of stones. We herein report a case of a young man who developed AAC after a Salmonella enteritidis gastrointestinal infection.

ObjectiveThis study aimed to develop and validate a patient-reported outcome measure (PROM) in acute pancreatitis (AP) as an endpoint centred on the patient.DesignA PROM instrument (PAtieNt-rePoRted OutcoMe scale in acute pancreatItis, an international proSpEctive cohort study, PAN-PROMISE scale) was designed based on the opinion of patients, professionals and an expert panel. The scale was validated in an international multicentre prospective cohort study, describing the severity of AP and quality of life at 15 days after discharge as the main variables for validation. The COSMIN (COnsensus-based Standards for the selection of health status Measurement INstruments) methodology was applied. Both the design and validation stages considered the content and face validity of this new instrument; the metric properties of the different items, reliability (reproducibility and internal consistence), the construct, structural and criterion validity, responsiveness and interpretability of this scale.ResultsPAN-PROMISE consists of a seven-item scale based on the symptoms that cause the most discomfort and concern to patients with AP. The validation cohort involved 15 countries, 524 patients. The intensity of symptoms changed from higher values during the first 24 hours to lower values at discharge and 15 days thereafter. Items converged into a unidimensional ordinal scale with good fit indices. Internal consistency and split-half reliability at discharge were adequate. Reproducibility was confirmed using test–retest reliability and comparing the PAN-PROMISE score at discharge and 15 days after discharge. Evidence is also provided for the convergent-discriminant and empirical validity of the scale.ConclusionThe PAN-PROMISE scale is a useful tool to be used as an endpoint in clinical trials, and to quantify patient well-being during the hospital admission and follow-up.Trial registration numberNCT03650062

Eosinophilic esophagitis (EE) is a rarely diagnosed condition involving eosinophilic infiltration of the esophageal mucosa The hallmark of this condition is intermittent and often painful dysphagia that may become constant as the disease progresses. It was initially included within the more general condition known as eosinophilic gastroenteritis but it is now considered an independent entity. Attwood et al. called attention to eosinophilic esophagitis as a distinct clinical condition in 1993. Although eosinophilic esophagitis was thought to occur primarily in children, a significant body of evidence suggests that it affects adults as well. We describe a clinical case of a young woman with a long-standing history of dysphagia affected of this rare entity.