Ultrastructure of the anterior adhesive apparatus of the gill parasite Macrogyrodactylus clarii and skin parasite M. congolensis (Monogenea; Gyrodactylidae) from the catfish Clarias gariepinus

Transmission electron microscopy (TEM) was used for the first time to study the anterior adhesive apparatus of the monogeneans Macrogyrodactylus clarii Gussev, 1961 and M. congolensis (Prudhoe, 1957) Yamaguti, 1963 inhabiting gills and skin respectively of the same catfish Clarias gariepinus. Despite the different microhabitats occupied by these parasites, the present study revealed that they have a similar anterior adhesive system. In both parasites, the anterior adhesive apparatus consists of three types of gland cells: G1 cells that produce rod-shaped bodies (S1), G2 cells manufacture irregularly shaped bodies (S2) and G3 cells form mucoid-like secretions (S3). In the cytoplasm of G1 cells, a single layer of microtubules encloses each developing rod-shaped body. A unique feature of S1 secretory bodies is that some fully developed S1 bodies are attached to each other, forming large condensed globules in the cytoplasm of G1 gland cells and terminal portion of the G1 ducts, but none were detected in the adhesive sacs outside the ducts. In the adhesive sacs, G1 ducts open with multiple apertures whereas each of the G2 and G3 ducts have a single opening. The adhesive sacs are lined with two types of tegument (st1 and st2). A third tegument type (st3) connects the st2 tegument with the general body tegument. Only st1 has microvilli. Each adhesive sac is provided with a spike-like sensillum and single uniciliated sense organ. The possible functions of microvilli in increasing the surface area and assistance in spreading and mixing of the adhesive secretion, and the role of sense organs associated with the adhesive sacs are discussed

Management of the Rectal Stump after Subtotal Colectomy Operations for Inflammatory Bowel Disease in the Era of Immunologic Therapy : A Two-Centre Cohort Study

Funding Sources The authors received no financial support for the research, authorship, and/or publication of this article.Non peer reviewedPublisher PD

PANC Study (Pancreatitis: A National Cohort Study): national cohort study examining the first 30 days from presentation of acute pancreatitis in the UK

Abstract Background Acute pancreatitis is a common, yet complex, emergency surgical presentation. Multiple guidelines exist and management can vary significantly. The aim of this first UK, multicentre, prospective cohort study was to assess the variation in management of acute pancreatitis to guide resource planning and optimize treatment. Methods All patients aged greater than or equal to 18 years presenting with acute pancreatitis, as per the Atlanta criteria, from March to April 2021 were eligible for inclusion and followed up for 30 days. Anonymized data were uploaded to a secure electronic database in line with local governance approvals. Results A total of 113 hospitals contributed data on 2580 patients, with an equal sex distribution and a mean age of 57 years. The aetiology was gallstones in 50.6 per cent, with idiopathic the next most common (22.4 per cent). In addition to the 7.6 per cent with a diagnosis of chronic pancreatitis, 20.1 per cent of patients had a previous episode of acute pancreatitis. One in 20 patients were classed as having severe pancreatitis, as per the Atlanta criteria. The overall mortality rate was 2.3 per cent at 30 days, but rose to one in three in the severe group. Predictors of death included male sex, increased age, and frailty; previous acute pancreatitis and gallstones as aetiologies were protective. Smoking status and body mass index did not affect death. Conclusion Most patients presenting with acute pancreatitis have a mild, self-limiting disease. Rates of patients with idiopathic pancreatitis are high. Recurrent attacks of pancreatitis are common, but are likely to have reduced risk of death on subsequent admissions. </jats:sec

Applying Agile Approach in ERP Implementation

Enterprise Resource Planning (ERP) systems are enterprise wide systems which, integrate and automate all of company’s business processes. It has been widely reported that a large number of ERP implementations fail to meet expectations, over time and over budget. Implementation approach is the important factor that affects the success of ERP implementation. This paper summarized the most two common ERP implementation approach (Agile implementation approach and Big bang implementation approach), differentiate between them and reporting a hybrid approach to avoid the disadvantages for these approaches

Financial Burden Secondary to Delay in Cholecystectomy Following Mild Biliary Pancreatitis

Aim of the study: The guidelines recommend that patients with mild gallstones pancreatitis should undergo a definitive management for gallstones during the same admission or within the next two weeks. The aim of this study was to estimate the financial cost resulting from a delay in surgical management following mild gallstones pancreatitis. This includes the costs of readmissions with biliary events and the subsequent investigations required during these admissions. Materials and methods: A retrospective analysis included patients with gallstone pancreatitis who were admitted to a district general hospital in the United Kingdom over one year. Patients with severe pancreatitis and those unfit for surgery were excluded. Results: Forty patients were included in the study, 27 females (67%) and 13 males (33%). Mean age was 50.2 years. Twenty-two patients of the total presented with a single admission with gallstone pancreatitis prior to an elective surgery; however, 18 patients (45%) required recurrent admissions. The duration between the first admission and surgery ranged from 14 to 389 days (median of 99 days). Only one patient (2.5%) had cholecystectomy within two weeks of admission as per guidelines. Twenty-two ultrasound scans, four computed tomography scans, 15 magnetic resonance cholangiopancreatography, and two endoscopic retrograde cholangiopancreatography were the total of the extra-investigations required during readmissions. Estimated costs of extra admissions and extra investigations exceeded £33,000. Conclusions: The delay in cholecystectomy for patients admitted with mild gallstone pancreatitis and fit for surgery has resulted in high readmission rate with biliary events, and subsequently high extrax costs