Temporal Variations in Plankton Communities and Environmental Factors in the Shipra, a Central Himalayan Tributary of the Kosi River in Uttarakhand, India.

The essential role of smaller streams and tributaries indigenous to the area is crucial in revitalizing and restoring the main river system. The present study unraveled the relationship between plankton communities and environmental variables in the Shipra River, a Central Himalayan tributary of the Kosi River in Uttarakhand, India. Plankton distribution, abundance, and presence were investigated at four locations: upstream (S1 and S2) and downstream (S3 and S4). Forty-eight genera of phytoplankton and zooplankton have been identified belonging to ten classes (Bacillariophyceae, Chlorophyceae, Zygnematophyceae, Cyanophyceae, Euglenopyceae, Protozoa, Rotifers, Copepoda, Cladocera, and Insecta) based on the findings. Winter was dominated by phytoplankton (Navicula spp., Nitzchia spp., Diatom spp.); summer and monsoon by zooplankton (Daphnia spp., Cyclops spp., Keratella spp., Brachionus spp.). Plankton communities of the tributary were assessed using diversity indices (Shannon-Weiner's index (H), Simpson's diversity index (1-D), and Evenness Index (E)). Seasonal variations in water temperature, specific conductivity, total dissolved solids, dissolved oxygen, nitrate, and ammonium ions were found to be statistically significant (p<0.05). Canonical Correspondence Analysis, K-dominance plots, cluster analysis, and NMDS analysis showed the dynamic nature of the plankton communities with seasonal physiochemical variations in the unexplored Himalayan tributary. The plankton communities exhibited significant temporal fluctuations with physicochemical factors.

Anatomy of Major Duodenal Papilla Influences ERCP Outcomes and Complication Rates: A Single Center Prospective Study.

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) has been one of the most intensely studied endoscopic procedures due to its overall high complication rates when compared to other digestive endoscopy procedures. The safety and outcome of such procedures have been linked to multiple procedure- or patient-related risk factors. The aim of our study is to evaluate whether the morphology of the major duodenal papilla influences the ERCP outcomes and complication rates. METHODS: A total of 322 patients with a native papilla have been included in the study over an eight month period. Morphology of the papilla has been classified into normal papilla and four anatomical variations (Type I-IV). All patients have been prospectively monitored over a 15 day period after ERCP. Procedural outcomes and complication rates have been registered. RESULTS: Morphology of the papilla influences both overall complication rates (95%CI, p = 0.0066) and post-ERCP pancreatitis rates (95%CI, p = 0.01001) in univariate analysis. Type IV papillae have proven to be independent risk factors for post-ERCP pancreatitis in multivariate analysis (OR = 12.176, 95%CI, p = 0.005). Type I papillae have been significantly linked to difficult cannulation (AUC = 0.591, 95%CI, p = 0.008); Conclusions: In the monitored cohort morphology of the major duodenal papilla has significantly influenced both ERCP outcomes and post-procedural complication rates.

Comparative outcomes of endoscopic ultrasound-guided cystogastrostomy for peripancreatic fluid collections: a systematic review and meta-analysis.

BACKGROUND: Endoscopic ultrasound-guided cystogastrostomy has become the first-line treatment for symptomatic peripancreatic fluid collections. The aim of this study is to analyze the efficacy and safety of cystogastrostomy via a meta-analysis of the literature. METHODS: We performed a systematic search of PubMed and Medline databases for studies published from January 2005 to May 2018. We included randomized controlled trials along with retrospective and prospective observational studies reporting endoscopic ultrasound-guided cystogastrostomy stent placement for peripancreatic fluid collections. The primary outcome for our meta-analysis was complete peripancreatic fluid collection resolution on imaging. Our secondary outcomes included comparative efficacy and safety of the procedure for pseudocysts and walled-off pancreatic necrosis using metal and plastic stents. RESULTS: Seventeen articles involving 1708 patients met our inclusion criteria for meta-analysis. Based upon the random effects model, the pooled technical success rate of cystogastrostomy was 88% (95% confidence interval = 83-92 with I 2 = 85%). There was no difference in the technical success rate between pancreatic pseudocysts and walled-off pancreatic necrosis (91% and 86%, respectively p = nonsignificant). The adverse event rates for metal and plastic stents were equivalent (14% and 18%, respectively, p = nonsignificant). CONCLUSION: Endoscopic ultrasound-guided cystogastrostomy stents are effective in the treatment of pancreatic pseudocysts and walled-off pancreatic necrosis. We found no difference in technical success or adverse event rates of drainage based on peripancreatic fluid collection type or stent used.

The unusual case of dyspnea: a pancreaticopleural fistula.

Dyspnea secondary to a pleural effusion is a common presentation all clinicians observe, however, usually leads to anchoring the diagnosis to cardiopulmonary etiologies. The formulation of a differential diagnosis encompassing the history of a patient cannot be emphasized enough and is paramount for accurate diagnosis, as described in this case.

Spontaneous splenic rupture: a rare complication of acute pancreatitis in a patient with Crohn's disease.

Crohn's disease (CD) is an idiopathic inflammatory bowel disease which can involve any part of the gastrointestinal tract. It frequently involves the ileum, colon and the anorectum. Although rare, acute pancreatitis as a complication of CD involving the duodenum has been described in the literature. We describe a 37-year-old male with CD presenting with acute pancreatitis and spontaneous splenic rupture. The potential mechanisms associated with acute pancreatitis along with spontaneous rupture of the spleen in this patient population and its treatment will be discussed. Common complaints such as upper abdominal pain in a patient with CD should undergo workup to exclude less commonly involved sites such as the pancreas and spleen. Close monitoring in the critical care setting is recommended in carefully selected and hemodynamically stable patients with splenic rupture. Surgical treatment is considered as the standard of care in hemodynamically unstable patients.

Diagnosis of marginal cell lymphoma of small intestine by double balloon enteroscopy.

A 65-year-old woman with a medical history of diabetes mellitus type 2, hypertension, an old cerebrovascular accident, and seizure disorder presented to the emergency room with lower abdominal pain of 4 weeks duration. Upon physical examination, her abdomen was soft and bowel sounds were present, but there was diffuse tenderness in her lower abdomen with some guarding. A computed tomography scan of her abdomen with oral and intravenous contrast showed significantly thickened small bowel loops with subjacent lymphadenopathy. Biopsies obtained during esophagogastroduodenoscopy and colonoscopy showed acute and chronic inflammation. A double balloon enteroscopy (DBE) was then performed, which showed stricture in the jejunum from which the biopsy was obtained. The biopsy showed marginal cell lymphoma. The patient is presently undergoing chemotherapy. Double balloon enteroscopy is a new elegant endoscopical technique that seems promising, as the endoscopist can reach undiscovered small bowel segments. It seems to be well tolerated and safe. For the first time, it provides the means to endoscopically investigate and treat disorders of the small intestine that have previously been inaccessible to conventional endoscopy.

Gastric adenocarcinoma with features of endodermal sinus tumor.

Extragonadal germ cell tumors are rare. The most common sites for EGGCTs are in midline locations such as the mediastinum, retroperitoneum and pineal gland. These tumors rarely present in the stomach. We describe here a case where a middle aged man presented with typical symptoms of gastric cancer. After extensive workup, which included blood work, CT abdomen scan, upper endoscopy, and endoscopic ultrasound, the patient was diagnosed with gastric cancer. However, due to very high blood levels of alpha-fetoprotein, the specimen was sent for special histochemical staining, which demonstrated that the tumor had features of both adenocarcinoma and endodermal sinus tumor. This is a very aggressive tumor with a very poor prognosis.