Hematological profile and gametocyte carriage in malaria patients from southern Pakistan

Background: Malarial infection is a major cause of concern, both worldwide and in Pakistan. Gametocytes are the sexual forms of the parasite that are essential for transmission. They fuse inside the mosquito to develop sporozoites. Gametocytes of the plasmodium parasites, which cause the infection, differentiate into male and female gametocytes. These gametocytes constitute the sexual stage of the malaria parasite and are essential in transmission of the disease from human to vector Anopheles. Gametocytes are affected by factors such as host immunity, drug treatment, reticulocytemia, anemia, low levels of asexual parasitemia and stress to the parasite. The aim of this study was to observe the hematological parameters, age and gametocyte carriage in an area of seasonal malaria transmission.Methods: The study was conducted at Aga Khan University Hospital (AKUH) Laboratory over the period of one year and 294 patients with uncomplicated malaria were recruited. Patients infected with Plasmodium falciparum (P. falciparum) or Plasmodium vivax (P. vivax) malaria and no co-morbidities were included in the study.Results: Gametocytemia was highest during the period of July to November, with P. vivax, 267 (90.8%), predominating compared to P. falciparum, 27 (9.2%). P. vivax gametocytes were observed from May to October and P. falciparum gametocytes were observed from July to December. Low hemoglobin in females and low platelet levels were observed. The mean platelet count was significantly lower in cases of P. vivax having gametocytes compared to P. falciparum with gametocytes. Higher parasitic index was associated with lower platelet count. The most significantly altered parameters were hemoglobin, hematocrit, white blood cell (WBC), and platelet count. Hemoglobin and platelets were significantly lower during the malaria season in study participants, both male and female.Conclusion: In conclusion, infection with P. falciparum and P. vivax modulates significant changes in hematological parameters in populations living in malaria endemic regions. In the malaria season males were more frequently affected by malaria with thrombocytopenia. Gametocyte carriage remains unaffected by seasonal changes thus ensuring parasite transmission during the dry season

SpHincterotomy for Acute Recurrent Pancreatitis Randomized Trial: Rationale, Methodology, and Potential Implications

Objectives: In patients with acute recurrent pancreatitis (ARP), pancreas divisum, and no other etiologic factors, endoscopic retrograde cholangiopancreatography (ERCP) with minor papilla endoscopic sphincterotomy (miES) is often performed to enlarge the minor papillary orifice, based on limited data. The aims of this study are to describe the rationale and methodology of a sham-controlled clinical trial designed to test the hypothesis that miES reduces the risk of acute pancreatitis. Methods: The SpHincterotomy for Acute Recurrent Pancreatitis (SHARP) trial is a multicenter, international, sham-controlled, randomized trial comparing endoscopic ultrasound + ERCP with miES vs. endoscopic ultrasound + sham for the management of ARP. A total of 234 consented patients having two or more discrete episodes of acute pancreatitis, pancreas divisum confirmed by magnetic resonance cholangiopancreatography, and no other clear etiology for acute pancreatitis will be randomized. Both cohorts will be followed for a minimum of 6 months and maximum of 48 months. Results: The trial is powered to detect a 33% risk reduction of acute pancreatitis frequency. Conclusions: The SHARP trial will determine whether ERCP with miES benefits patients with idiopathic ARP and pancreas divisum. Trial planning has informed the importance of blinded outcome assessors and long-term follow-up

Novel dual-action tissue through-the-scope clip for endoscopic closure.

Video 1Use of a novel Dual Action Tissue through-the-scope clip for endoscopic closure

Rare solitary giant hamartomatous polyp of the stomach removed by endoscopic submucosal dissection

Video 1Endoscopic submucosal dissection of a large solitary gastric hamartomatous polyp

Successful management of a duodenal perforation using a through-the-scope suturing device after failed attempt at closure with an over-the-scope clip

Video 1Endoscopic closure of a duodenal perforation using a through-the-scope helix tacking suture-based system

Helix tack for lumen-apposing metal stent fixation in single-session EUS-directed transgastric ERCP

Video 1Helix tack for lumen-apposing metal stent fixation in single-session EUS-directed transgastric ERCP

The use of fully-covered self-expanding metallic stents for intraprocedural management of post-sphincterotomy perforations: a single-center study (with video).

Background and study aims :Management of post-sphincterotomy perforations is variable, with some patients managed conservatively and other requiring surgery. Fully-covered self-expanding metal stents (FCSEMs) have been used in the past, but data is limited. The aim of this study was to report the clinical characteristics and outcomes following placement of anchored FCSEMSs for the immediate management of post-sphincterotomy perforation. Patients and methods :All patients undergoing an ERCP procedure between June 2011 and December 2015 at our institution were reviewed for post-sphincterotomy perforation. All intra-procedurally recognized perforations underwent placement of FCSEMs with flexible anchoring fins and were included in this study. Data extracted included patient demographics, indication, peri-procedural details, clinical course and long-term outcome following anchored FCSEMS placement. Results :A total of 15 patients (12 females, median age-66 years) with post-sphincterotomy perforation were included. Major indications included choledocholithiasis in 9 (60 %), and 5 (33.3 %) patients had intra-ampullary or periampullary diverticula. All patients underwent placement of FCSEMS without any complication and had immediate resolution of perforation as evidenced by decrease in fluoroscopic gas and lack of contrast extravasation. None of the patients became symptomatic or needed surgery with a median 2 days of hospitalization following the procedure. Stents were removed after a median of 30.5 days and no complications were noted during follow-up after stent removal. Conclusions :Anchored FCSEMs are safe and effective for management of intra-procedurally recognized post-sphincterotomy perforations and obviates need for surgery

The use of fully-covered self-expanding metallic stents for intraprocedural management of post-sphincterotomy perforations: a single-center study (with video).

Background and study aimsManagement of post-sphincterotomy perforations is variable, with some patients managed conservatively and other requiring surgery. Fully-covered self-expanding metal stents (FCSEMs) have been used in the past, but data is limited. The aim of this study was to report the clinical characteristics and outcomes following placement of anchored FCSEMSs for the immediate management of post-sphincterotomy perforation.Patients and methodsAll patients undergoing an ERCP procedure between June 2011 and December 2015 at our institution were reviewed for post-sphincterotomy perforation. All intra-procedurally recognized perforations underwent placement of FCSEMs with flexible anchoring fins and were included in this study. Data extracted included patient demographics, indication, peri-procedural details, clinical course and long-term outcome following anchored FCSEMS placement.ResultsA total of 15 patients (12 females, median age-66 years) with post-sphincterotomy perforation were included. Major indications included choledocholithiasis in 9 (60 %), and 5 (33.3 %) patients had intra-ampullary or periampullary diverticula. All patients underwent placement of FCSEMS without any complication and had immediate resolution of perforation as evidenced by decrease in fluoroscopic gas and lack of contrast extravasation. None of the patients became symptomatic or needed surgery with a median 2 days of hospitalization following the procedure. Stents were removed after a median of 30.5 days and no complications were noted during follow-up after stent removal.ConclusionsAnchored FCSEMs are safe and effective for management of intra-procedurally recognized post-sphincterotomy perforations and obviates need for surgery

The use of fully-covered self-expanding metallic stents for intraprocedural management of post-sphincterotomy perforations: a single-center study (with video)

Background and study aims :Management of post-sphincterotomy perforations is variable, with some patients managed conservatively and other requiring surgery. Fully-covered self-expanding metal stents (FCSEMs) have been used in the past, but data is limited. The aim of this study was to report the clinical characteristics and outcomes following placement of anchored FCSEMSs for the immediate management of post-sphincterotomy perforation. Patients and methods :All patients undergoing an ERCP procedure between June 2011 and December 2015 at our institution were reviewed for post-sphincterotomy perforation. All intra-procedurally recognized perforations underwent placement of FCSEMs with flexible anchoring fins and were included in this study. Data extracted included patient demographics, indication, peri-procedural details, clinical course and long-term outcome following anchored FCSEMS placement. Results :A total of 15 patients (12 females, median age-66 years) with post-sphincterotomy perforation were included. Major indications included choledocholithiasis in 9 (60 %), and 5 (33.3 %) patients had intra-ampullary or periampullary diverticula. All patients underwent placement of FCSEMS without any complication and had immediate resolution of perforation as evidenced by decrease in fluoroscopic gas and lack of contrast extravasation. None of the patients became symptomatic or needed surgery with a median 2 days of hospitalization following the procedure. Stents were removed after a median of 30.5 days and no complications were noted during follow-up after stent removal. Conclusions :Anchored FCSEMs are safe and effective for management of intra-procedurally recognized post-sphincterotomy perforations and obviates need for surgery