Severe acute pancreatitis in the early postoperative period due to afferent loop syndrome following gastrectomy for gastric cancer.

Afferent loop syndrome (ALS) is an uncommon complication of gastrojejunostomy. It may be acute or chronic depending on whether symptoms manifest within 7 days of surgery. Rarely acute ALS may give rise to acute pancreatitis. It may present early in the postoperative course and, if diagnosed late, may result in organ failure within 48h. We report a middle-aged woman with carcinoma of the stomach managed by subtotal gastrectomy with Billroth II gastrojejunostomy and Braun jejunojejunostomy. The patient developed vomiting and abdominal pain in the first postoperative day with acute renal shutdown and about 500ml drain output of dirty fluid. On investigation, a diagnosis of acute pancreatitis due to afferent loop syndrome was made, and the patient was resuscitated in the intensive care unit. However, she showed early signs of organ failure and succumbed to her condition within 6 days of surgery. Since the complication is rare following gastrojejunostomy and often mimics ALS, an early diagnosis becomes difficult. If delay in management happens, premature organ failure may lead to high morbidity and mortality.

Declining Use of Corticosteroids for Crohn's Disease Has Implications for Study Recruitment: Results of a Pilot Randomized Controlled Trial.

BACKGROUND: Corticosteroids (CS) have been used extensively to induce remission in Crohn's disease (CD); however, they are associated with severe side effects. We hypothesized that the administration of an exclusive enteral nutrition (EEN) formula to CS would lead to increased CD remission rates and to decreased CS-related adverse events. We proposed to undertake a pilot study comparing EEN and CS therapy to CS alone to assess decrease symptoms and inflammatory markers over 6 weeks. AIM: The overall aim was to assess study feasibility based on recruitment rates and acceptability of treatment in arms involving EEN. METHODS: The pilot study intended to recruit 100 adult patients with active CD who had been prescribed CS to induce remission as part of their care. The patients were randomized to one of three arms: (i) standard-dose CS; (ii) standard-dose CS plus EEN (Modulen 1.5 kcal); or (iii) short-course CS plus EEN. RESULTS: A total of 2009 CD patients attending gastroenterology clinics were screened from October 2018 to November 2019. Prednisone was prescribed to only 6.8% (27/399) of patients with active CD attending outpatient clinics. Of the remaining 372 patients with active CD, 34.8% (139/399) started or escalated immunosuppressant or biologics, 49.6% (198/399) underwent further investigation and 8.8% (35/399) were offered an alternative treatment (e.g., antibiotics, surgery or investigational agents in clinical trials). Only three patients were enrolled in the study (recruitment rate 11%; 3/27), and the study was terminated for poor recruitment. CONCLUSION: The apparent decline in use of CS for treatment of CD has implications for CS use as an entry criterion for clinical trials.

Eating well, living well and weight management: A co-produced semi-qualitative study of barriers and facilitators experienced by adults with intellectual disabilities.

Adults with intellectual disabilities in England experience health inequalities. They are more likely than their non-disabled peers to be obese and at risk of serious medical conditions such as heart disease, stroke and type 2 diabetes. This semi-qualitative study engaged adults with intellectual disabilities in a co-production process to explore their perceived barriers and facilitators to eating well, living well and weight management. Nineteen participants with intellectual disabilities took part in four focus groups and one wider group discussion. They were supported by eight of their carers or support workers. Several barriers were identified including personal income restrictions, carers' and support workers' unmet training needs, a lack of accessible information, inaccessible services and societal barriers such as the widespread advertising of less healthy foodstuffs. A key theme of frustration with barriers emerged from analysis of participants' responses. Practical solutions suggested by participants included provision of clear and accessible healthy lifestyle information, reasonable adjustments to services, training, 'buddying' support systems or schemes and collaborative working to improve policy and practice.

Canadian association of gastroenterology clinical practice guideline for the management of Luminal Crohn's Disease

Crohn's disease (CD) is a lifelong illness with substantial morbidity, although new therapies and treatment paradigms have been developed. We provide guidance for treatment of ambulatory patients with mild to severe active luminal CD. We performed a systematic review to identify published studies of the management of CD. The quality of evidence and strength of recommendations were rated according to the Grading of Recommendation Assessment, Development and Evaluation (GRADE) approach. Statements were developed through an iterative online platform and then finalized and voted on by a group of specialists. The consensus includes 41 statements focused on 6 main drug classes: antibiotics, 5-aminosalicylate, corticosteroids, immunosuppressants, biologic therapies, and other therapies. The group suggested against the use of antibiotics or 5-aminosalicylate as induction or maintenance therapies. Corticosteroid therapies (including budesonide) can be used as induction, but not maintenance therapies. Among immunosuppressants, thiopurines should not be used for induction, but can be used for maintenance therapy for selected low-risk patients. Parenteral methotrexate was proposed for induction and maintenance therapy in patients with corticosteroid-dependent CD. Biologic agents, including tumor necrosis factor antagonists, vedolizumab, and ustekinumab, were recommended for patients failed by conventional induction therapies and as maintenance therapy. The consensus group was unable to clearly define the role of concomitant immunosuppressant therapies in initiation of treatment with a biologic agent. Optimal management of CD requires careful patient assessment, acknowledgement of patient preferences, evidence-based use of existing therapies, and thorough assessment to define treatment success.

Description of new myxozoan parasite Myxobolus awadhii sp. nov from the gills of freshwater catfish Clarias batrachus Linn.

Parasitic infestations are one of the major problems in freshwater fish production. Clarias batrachus Linnaeus, 1758 (Clariidae) is a commercially important native catfish mainly used for food as it has very high iron content and other minerals. Unfortunately, it is difficult to breed in captivity and is highly prone to parasitic infections particularly the Myxobolus sp. The present article discusses a new species of Myxobolus identified as Myxobolus awadhii from the gills of C. batrachus. Plasmodia were found on the gill filaments with the intensity of infection to be moderate as indicated by gill plasmodial index (GPI = 6). The mature myxospores were oval to ellipsoidal in shape measuring 8.82-11.68 (10.57 ± 0.50) × 5.76-7.37 (6.70 ± 0.36) µm in size. The present species was compared with species found from the same host and other resembling species as M. acanthorhodi, M. bhadurius, M. bilineatum, M. chrysichthyi. Present article deals with morphological and morphometric description of M. awadhii sp. nov. Morphological comparisons of the mature myxospores were done with the similar myxospores and species reported earlier from C. batrachus.

Inter and intraspecific genetic diversity (RAPD) among three most frequent species of macrofungi (Ganoderma lucidum, Leucoagricus sp. and Lentinus sp.) of Tropical forest of Central India.

In present study seven RAPD primers were used to access the diversity within and among twelve populations of three mushroom species Ganoderma lucidum, leucoagaricus sp. and Lentinus sp. Total of 111 bands were scored by 7 RAPD primers in 30 accessions of three mushroom species collected from different sampling sites of central India. Total 111 bands were generated using seven primers which were F-1, OPG-06, OPC-07, OPD-08, OPA-02, OPD-02, OPB-10. All 111 bands were polymorphic in nature (100%). Therefore, it revealed that the used primers had sufficient potency for population studies and 30 accessions had higher genetic differences among each other. In best of the knowledge, this is the first report, which accesses the genetic diversity between three mushroom species (Gd Ganoderma lucidum, Lg Leucoagaricus sp., Ls Lentinus). The polymorphic percentage ranged from 3.60 to 23% within twelve populations, while polymorphic percentage among group was 40.56, among population within groups was 41.12 and within population was 18.32. This indicated that the genetic diversity within the population was very low, but slightly higher in the populations of three species. Among three groups representing Gd., Lg and Ls, Among populations within groups shown highest percentage of variation (Pv = 41.12) while within populations, the lowest percentage of variation (18.32) was observed. This result also support that the highest genetic variation was present among groups in comparison to among the population within a species and lowest genetic variation was observed within the population.

Innate immune response against an oomycete pathogen Aphanomyces invadans in common carp (Cyprinus carpio), a fish resistant to epizootic ulcerative syndrome.

Infection with Aphanomyces invadans, also known as epizootic ulcerative syndrome, is a destructive disease of freshwater and brackishwater fishes. Although more than 130 species of fish have been confirmed to be susceptible to this disease, some of the commercially important fish species like common carp, milk fish and tilapia are reported to be resistant. Species that are naturally resistant to a particular disease, provide a potential model to study the mechanisms of resistance against that disease. In the present study, following experimental infection with A. invadans in common carp Cyprinus carpio, sequential changes in various innate immune parameters and histopathological alterations were monitored. Some of the studied innate immunity parameters viz. respiratory burst, alternative complement and total antiproteases activities of the infected common carp were higher compared to control fish, particularly at early stages of infection. On the other hand, some parameters such as myeloperoxidase, lysozyme and alpha-2 macroglobulin activities were not altered. Histopathological examination of the muscle at the site of injection revealed well developed granulomas at 12 days post infection, with subsequent regeneration of muscle fibers. From the results, it could be inferred that innate defense mechanisms of common carp are able to neutralize the virulence factors secreted by A. invadans, thereby, preventing its invasive spread and containing the infection. The results obtained here will help to better understand the mechanisms underlying resistance against A. invadans infection.

Authentication of five Barilius species from Indian waters using DNA barcoding.

Authentic identification of fish species is essential for conserving them as a valuable genetic resource in our environment. DNA barcoding of living beings has become an important and ultimate tool for establishing their molecular identity. Among cyprinids, Barilius is an important genus having nearly 23 species in Indian region whose morphological identification is often difficult due to minute differences in their features. Five species collected from Indian waters and primarily identified as Opsarius bakeri (syn. Barilius bakeri), B. gatensis, B. vagra, B. bendelisis and B. ngawa were authenticated by their DNA barcoding based on mitochondrial COI gene sequences. Five individuals of each species were taken for barcode preparation by COI gene sequencing which yielded one barcode for B. ngawa, two barcodes each for O. bakeri, B. gatensis, B. bendelisis and three barcodes for B. vagra. The order of inter and intra-specific variation was estimated to know a preliminary status of variation prevailing in these cold stream fish species significant for evolution and conservation of these valued species of our ichthyofauna. Average variation within genera was found to be 13.6% with intra-specific variation ranging from 0.0% (B. ngawa) to 0.6% (B. gatensis). These distance data are in the same order found by various researchers globally using COI barcode sequences in different fish species. Phylogenetic relatedness among Barilius species and some other cyprinids validate their status of individual species as established by conventional taxonomy.

Isolation and characterization of Pseudomonas stutzeri and its potential application in biological nitrification.

Ammonia-oxidizing bacteria (AOB) were isolated from sediment samples of fishponds with an aim to use them for application in biological nitrification of water. Isolation of AOB was done in an inorganic medium and nitrite-producing bacterial isolates were selected. These isolates were further screened by polymerase chain reaction using specific primers forAOB. Out of 119 nitrate positive isolates, only 12 showed positive amplification and yielded a PCR product of ~465 bp. Treatment of aquaculture pond and riverwaterwith one of the bacterial isolate (HC-5) resulted in lowering of soluble ammonia level from 3.50 to 0.05 mgl(-1) and 7.5 to 0.01 mgl(-1), respectively. Partial 16S rRNA gene sequencing of isolate HC-5 identified the microorganism as Pseudomonasstutzeri.

ATPase 8/6 GENE BASED GENETIC DIVERSITY ASSESSMENT OF SNAKEHEAD MURREL, Channa striata (Perciformes, Channidae).

The mitochondrial DNA (mtDNA) ATPase 8/6 gene has been used in phylogenetic as well as in phylogeographic studies along with other mtDNA markers. In this study, ATPase gene sequences were used to assess the genetic structuring and phylogeographic patterns in Channa striata. Out of 884 nucleotide positions generated in ATPase 8/6 genes, 76 were polymorphic. The study suggested 23 unique haplotypes from 67 individuals of nine populations collected from different riverine systems of India. The ATPase 8/6 sequence revealed highest haplotype as well as nucleotide diversities in Imphal River population and lowest diversities in Tapti River population. The pattern of genetic diversity and haplotype network indicated distinct mitochondrial lineages for Chaliyar population, whereas mismatch distribution strongly suggested a population expansion in mid pleistocene epoch (0.4 Mya) with distinct genetic structuring in C. striata. The baseline information on genetic variation and the population sub-structuring would facilitate conservation and management of this important snakehead murrel.

Mitochondrial 16S rRNA gene-based evolutionary divergence and molecular phylogeny of Barilius spp.

Barilius is an important genus of fish family Cyprinidae, which comprises 22 species from Indian region. This study aimed to characterize five commonly occurring Bariline species, for example, Barilius bakeri. Barilius gatensis. Barilius vagra. Barilius bendelisis and Barilius tileo, across the country using partial mitochondrial 16 S rRNA gene, to estimate the order of inter- and intra-species divergence among these species and to establish phylogenetic and evolutionary relationships. The average inter-specific divergence was estimated as 7.10%. Intra-specific divergence of 0.20% and 0.10% was observed in B. gatensis and B. bendelisis that exhibited three and two haplotypes with 0.70 and 0.60 haplotype diversities, respectively. The NJ and MP phylogenetic trees were constructed using 16 S rRNA sequences along with sequences of the other five Indian cyprinid species retrieved from NCBI. Phylogenetic trees revealed five discrete branches each as a distinct species of the genus and exhibited identical phylogenetic relationship with other cyprinids. The study provided adequate information to distinguish the five Barilius species and indicated the suitability of 16S rRNA gene sequences in genetic divergence and phylogenetic studies.

Innate immune response of Indian major carp, Labeo rohita infected with oomycete pathogen Aphanomyces invadans.

The fish pathogenic oomycete Aphanomyces invadans is the causative agent of epizootic ulcerative syndrome (EUS), a fish disease of international significance and reportable to the World Organisation for Animal Health. In spite of the current and potential impact of A. invadans infection on fisheries and aquaculture sectors of the world, very little is known about the host-A. invadans interactions. In the present study, following experimental infection with A. invadans in one of the Indian major carps, Labeo rohita, sequential changes in various innate immune parameters were monitored. The results indicated that at early stages of infection, no significant changes in any of the studied innate immune parameters were observed. However, at the advanced stages of infection from 6 to 12 days post infection (dpi), the respiratory burst and alternate complement activity were significantly higher whereas lysozyme, antiproteases and α-2 macroglobulin values were significantly lower than the control group and also from the infected group at earlier stages of infection. Since, the possibility of vaccination of fish against A. invadans appears remote due to difficulties in eliciting a specific antibody response, the information generated in the present study could be useful for developing strategies for improving resistance to A. invadans infection by stimulating the innate immunity through immunomodulation.

Cross-priming of microsatellite loci in subfamily cyprininae (family Cyprinidae): their utility in finding markers for population genetic analysis in three Indian major carps.

This study is aimed to identify polymorphic microsatellite markers and establish their potential for population genetics studies in three carp (family cyprinidae; subfamily cyprininae) species, Labeo rohita, Catla catla and Cirrhinus mrigala through use of cyprinid primers. These species have high commercial value and knowledge of genetic variation is important for management of farmed and wild populations. We tested 108 microsatellite primers from 11 species belonging to three different cyprinid subfamilies, Cyprininae, Barbinae and Leuciscinae out of which 63 primers (58.33%) successfully amplified orthologous loci in three focal species. Forty-two loci generated from 29 primers were polymorphic in these three carp species. Sequencing of amplified product confirmed the presence of SSRs in these 42 loci and orthologous nature of the loci. To validate potential of these 42 polymorphic loci in determining the genetic variation, we analyzed 486 samples of three focal species collected from Indus, Ganges and Brahmaputra river systems. Results indicated significant genetic variation, with mean number of alleles per locus ranging from 6.80 to 14.40 and observed heterozygosity ranging from 0.50 to 0.74 in the three focal species. Highly significant (P < 0.00001) allelic homogeneity values revealed that the identified loci can be efficiently used in population genetics analysis of these carp species. Further, thirty-two loci from 19 primers were useful for genotyping in more than one species. The data from the present study was compiled with cross-species amplification data from previous results on eight species of subfamily cyprininae to compare cross-transferability of microsatellite loci. It was revealed that out of 226 heterologous loci amplified, 152 loci that originated from 77 loci exhibited polymorphism and 45 primers were of multispecies utility, common for 2-7 species.

EST-based identification of immune-relevant genes from spleen of Indian catfish, Clarias batrachus (Linnaeus, 1758).

A normalized cDNA library from spleen of Indian catfish, Clarias batrachus, was constructed with a redundancy factor of 2.29. A total of 2045 clones from the library were single-pass sequenced, which generated 1937 high quality ESTs with an average read length of approximately 700 bp. Based on sequence similarities, 65 ESTs were found to be associated with immune functions, which were mainly associated with response to stress, response to chemical stimulus, cellular response to stimulus, response to external stimulus, immune response and regulation of response to stimulus. The immune-relevant gene for CD141, thrombomodulin, has been identified in Teleosts for the first time. Six EST-SSRs and three SNPs were found associated with eight immune-relevant genes. These markers associated with important immune genes would be useful for the identification of trait associated alleles for marker-assisted selection. The identification of the putative immune-related genes provides a meaningful framework to understand the Indian catfish immune system and defense mechanisms.

Genetic divergence in wild population of Labeo rohita (Hamilton, 1822) from nine Indian rivers, analyzed through MtDNA cytochrome b region.

The present study examined partial cytochrome b gene sequence of mitochondrial DNA for polymorphism and its suitability to determine the genetic differentiation in wild Labeo rohita. The 146 samples of L. rohita were collected from nine distant rivers; Satluj, Brahmaputra, Son, Chambal Mahanadi, Rapti, Chauka, Bhagirathi and Tons were analyzed. Sequencing of 307 bp of Cyto b gene revealed 35 haplotypes with haplotype diversity 0.751 and nucleotide diversity (π) 0.005. The within population variation accounted for 84.21% of total variation and 15.79% was found to among population. The total Fst value, 0.158 (P < 0.05) was found to be significant. The results concluded that the partial cyto b is polymorphic and can be a potential marker to determining genetic stock structure of L. rohita wild population.

Seasonal variations in abundance of nitrifying bacteria in fish pond ecosystem.

Seasonal changes in abundance of nitrifiers (ammonia-oxidizing and nitrite-oxidizing bacteria) in surface and bottom water of freshwater ponds were examined with respect to temperature, DO, pH as well as concentration of ammonia and nitrite. The most probable number (MPN) of ammonia-oxidizers in different ponds varied from 1297 +/- 3.6 to 1673.23 +/- 0.36 ml(-1) in bottom and 720.5 +/- 8.1 to 955.3 +/- 10.8 ml(-1) in surface water during the rainy season while the MPN ranged from 1074 +/- 1.07 to 1372.17 +/- 4.6 ml(-1) in bottom and 515 +/- 10.1 to 678 +/- 11.8 ml(-1) in surface water in winter. However, the MPN were greatly reduced in summer and ranged from 435.05 +/- 15.7 to 547.54 +/- 2.12 ml(-1) in bottom and 218.7 +/- 7.3 to 368.4 +/- 9.32 ml(-1) in surface water. Similar seasonal trends were also observed in MPN of nitrite-oxidizers. Among all the physico-chemical parameters, abundance of nitrifiers was more positively correlated with ammonia and nitrite concentration in all the seasons. The abundance of nitrifiers in surface and bottom water was highest in rainy season followed by winter and modest in summer. The potential nitrification activities and oxidation rates were shown to be linear and activity of ammonia-oxidizing and nitrite-oxidizing bacteria was highest during rainy season.

Health checks in primary care for adults with intellectual disabilities: how extensive should they be?

BACKGROUND: Routine health checks have gained prominence as a way of detecting unmet need in primary care for adults with intellectual disabilities (ID) and general practitioners are being incentivised in the UK to carry out health checks for many conditions through an incentivisation scheme known as the Quality and Outcomes Framework (QOF). However, little is known about the data being routinely recorded in such health checks in relation to people with ID as practices are currently only incentivised to keep a register of people with ID. The aim of this study was to explore the additional value of a health check for people with ID compared with standard care provided through the current QOF structure. METHODS: Representative practices were recruited using a stratified sampling approach in four primary care trusts to carry out health checks over a 6-month period. The extracted data were divided into two aggregated informational domains for the purpose of multilevel regression analysis: 'ID-specific' (containing data on visual assessment, hearing assessment, behaviour assessment, bladder function, bowel function and feeding assessment) and financially incentivised QOF targets (blood pressure, smoking status, ethnicity, body mass index, urine analysis and carer details) which are incentivised processes. RESULTS: A total of 651 patients with ID were identified in 27 practices. Only nine practices undertook a health check on 92 of their patients with ID. Significant differences were found in the recorded information, between those who underwent a health check and those who did not (P < 0.001, chi(2) = 56.3). In the group that had health check, recorded information was on average higher for the 'QOF targets' domain, compared with the 'ID-specific' domain, by 58.7% (95% CI: 54.1, 63.3, P < 0.001). CONCLUSIONS: If incentives are to be used as a method for improving care for people with ID through health checks a more targeted approach focused on ID-specific health issues might be more appropriate than an extensive health check.

The NQO1 allelic frequency in hindu population of central India varies from that of other Asian populations.

CONTEXT: THE ENZYMES ENCODED BY THE POLYMORPHIC GENES NAD (P) H: quinone oxidoreductase 1 (NQO1) play an important role in the activation and inactivation of xenobiotics. This enzyme has been associated with xenobiotic related diseases, such as cancer, therapeutic failure and abnormal effects of drugs. AIM: The aim of the present study was to determine the allelic and genotypic frequencies of NQO Hinf I polymorphisms in a Hindu population of Central India. SETTINGS AND DESIGN: Polymorphisms of NQO1 were determined in 311 unrelated Hindu individuals. MATERIALS AND METHODS: Polymerase chain reaction- Restriction Fragment Length Polymorphism (PCR-RFLP) analysis in peripheral blood DNA for NQO1 Hinf I polymorphism was used in 311 unrelated Hindu individuals. STATISTICAL ANALYSIS: Allele frequencies were calculated by direct counting. Hardy Weinberg Equilibrium was evaluated using a Chi-square goodness of fit test. RESULTS: The observed allelic frequency was 81% for C (wild) and 19% for T (mutant) in the total sample. CONCLUSIONS: The allelic frequency of "C" was higher than in other Asians (57%), but similar to Caucasians (81%). The genotype distributions for Hinf I polymorphisms were in Hardy-Weinberg equilibrium.

Evaluation of genetic variation in the clown Knifefish, Chitala chitala, using allozymes, RAPD, and microsatellites.

Twenty-seven enzyme systems, six random amplified polymorphic DNA (RAPD) primers, and two microsatellite loci were tested to determine intraspecific divergence in the natural population of the endangered Indian featherback fish, Chitala chitala, for the first time. The 262 samples of C. chitala were collected from six riverine locations in India: the Satluj, Ganga (Ghagra, Bhagirathi, and Brahmaputra), Mahanadi, and Narmada river systems. The analysis revealed population subdivisions, with an F(ST) value from 0.1235 (95% confidence 0.0868-0.1621) for RAPD and a combined F(ST) of 0.0344 (95% confidence 0.0340-0.0350) for microsatellite loci. An analysis of 38 allozyme loci did not reveal any polymorphism in the samples from any of the riverine localities; a possible explanation for this could be that the ancestors of Chitala could have faced a population reduction in prehistoric periods, as low allozyme variation is also reported for other species of Chitala from south Asia.