Cholecystoduodenal fistula: a rare cause of gastric outlet obstruction-case report and imaging findings

Cholecystoduodenal fistula (CDF) is a rare complication of chronic gallstone disease, characterized by an abnormal communication between the gallbladder and duodenum. It is often asymptomatic but may present with complications such as gastric outlet obstruction (GOO), gallstone ileus, or cholangitis. Due to its nonspecific clinical presentation, CDF is often diagnosed incidentally on imaging or during surgery. In rare cases, it can lead to GOO, usually due to chronic inflammation-induced duodenal stenosis. Early recognition is crucial to prevent complications and guide appropriate management. We present the case of a 66-year-old male with a history of gallstone disease who developed progressive nausea, vomiting, and weight loss over two months. Abdominal examination revealed mild epigastric tenderness. Routine blood investigations were unremarkable. Contrast-enhanced CT abdomen showed pneumobilia, a contracted gallbladder with a direct fistulous communication to the duodenum, and significant enhancing thickening of the pyloroduodenal region, suggesting chronic inflammation-induced GOO. Upper gastrointestinal endoscopy confirmed pyloric stenosis without an obstructing gallstone. The patient underwent laparoscopic cholecystectomy with fistula closure and gastrojejunostomy, with significant symptomatic improvement postoperatively. This case highlights the suspicion of CDF in cases of unexplained GOO with pneumobilia

Encrypting Messages for Incomplete Chains of Certificates

A public key infrastructure (PKI) binds public keys to the identities of their respective owners. It employs certificate authorities or a web of trust over social links to transitively build cryptographic trust across parties in the form of chains of certificates. In existing PKIs, Alice cannot send a message to Bob confidentially until a complete chain of trust from Alice to Bob exists. We observe that this temporal restriction---which may be severely limiting in some contexts like whistleblowing---can be eliminated by combining webs of trust with concepts from hierarchical identity-based encryption. Specifically, we present a novel protocol that allows Alice to securely send a message to Bob, binding to any chain of social links, with the property that Bob can decrypt the message only after trust has been established on all links in the chain. This trust may be established either before or after Alice has sent the message, and it may be established in any order on the links. We prove the protocol\u27s security relative to an ideal functionality, develop a prototypical implementation and evaluate the implementation\u27s performance for a realistic environment obtained by harvesting data from an existing web of trust. We observe that our protocol is fast enough to be used in practice

Developing Standard Treatment Workflows—way to universal healthcare in India

Primary healthcare caters to nearly 70% of the population in India and provides treatment for approximately 80–90% of common conditions. To achieve universal health coverage (UHC), the Indian healthcare system is gearing up by initiating several schemes such as National Health Protection Scheme, Ayushman Bharat, Nutrition Supplementation Schemes, and Inderdhanush Schemes. The healthcare delivery system is facing challenges such as irrational use of medicines, over- and under-diagnosis, high out-of-pocket expenditure, lack of targeted attention to preventive and promotive health services, and poor referral mechanisms. Healthcare providers are unable to keep pace with the volume of growing new scientific evidence and rising healthcare costs as the literature is not published at the same pace. In addition, there is a lack of common standard treatment guidelines, workflows, and reference manuals from the Government of India. Indian Council of Medical Research in collaboration with the National Health Authority, Govt. of India, and the WHO India country office has developed Standard Treatment Workflows (STWs) with the objective to be utilized at various levels of healthcare starting from primary to tertiary level care. A systematic approach was adopted to formulate the STWs. An advisory committee was constituted for planning and oversight of the process. Specialty experts' group for each specialty comprised of clinicians working at government and private medical colleges and hospitals. The expert groups prioritized the topics through extensive literature searches and meeting with different stakeholders. Then, the contents of each STW were finalized in the form of single-pager infographics. These STWs were further reviewed by an editorial committee before publication. Presently, 125 STWs pertaining to 23 specialties have been developed. It needs to be ensured that STWs are implemented effectively at all levels and ensure quality healthcare at an affordable cost as part of UHC

Report of rotifer-ciliate-gastropod hyperepibiosis found on snail (Mollusca) from Goa, India

Here we report a rotifer-ciliate-gastropod hyperepibiosis in freshwater canal, Goa, India. A rotifer Philodina cf. megalotrocha Ehrenberg, 1832 was found attached on the colony of Epistylis plicatilis Ehrenberg, 1838 which was epibiont on gastropod Pomacea bridgesi (Reeve, 1856). This is first report of a member of Epistylis as an epibiont on Pomacea bridgesi.Artykuł dotyczy doniesienia o hiperepibiozie wrotków, orzęsków i ślimaków w kanale słodkowodnym w Goa w Indiach. Wrotek Philodina cf. megalotrocha Ehrenberg, 1832 został znaleziony w kolonii Epistylis plicatilis Ehrenberg, 1838, która była epibiontem na ślimaku Pomacea bridgesi (Reeve, 1856). Jest to pierwsze stwierdzenie Epistylis plicatilis jako epibionta na Pomacea bridgesi