Systemic sclerosis with interstitial lung disease and myocardial infarction: a case report.

Systemic sclerosis (SSc) is a rare autoimmune connective tissue disorder that causes fibrosis due to an accelerated inflammatory response. One of the most frequent co-morbidities with SSc is interstitial lung disease (ILD), which is also one of the biggest killers among SSc patients. Case presentation: The authors present a rare case of diffuse SSc with ILD and myocardial infarction having a history of Raynaud phenomenon, skin thickening, and shortness of breath. Antinuclear antibody and antitopoisomerase antibody tests were positive. The patient was managed medically and the condition of patient is improving. Clinical discussion: SSC can affect the skin as well as other organs, with the lungs being the most frequently involved and seriously impacted. SSc patients can have multiple organ involvement like the skin, lungs, heart, kidneys, and gastrointestinal tract. Because ILD is the leading cause of death among people with SSC, early diagnosis and high suspicion of lung involvement can reduce mortality. Conclusion: The mortality rate for SSC associated with ILD is extremely high. Even though ILD is common in SSc, it might be difficult to identify and detect early for which a high-resolution CT scan can be used. In SSc patients, heart involvement can coexist with ILD.

The use of PI 277012-derived Fusarium head blight resistance QTL in winter wheat breeding.

Fusarium head blight (FHB) caused by Fusarium graminearum results in substantial grain yield and quality losses in common wheat (Triticum aestivum L.). Genetic resistance is partial but crucial for effective, integrated management of the disease. Host resistance is conditioned by numerous small effect quantitative trait loci (QTL) that are strongly affected by the environment and genetic background. Qfhb.rwg-5A.1 and Qfhb.rwg-5A.2 (PI 277012 is the source for both genes) are two recently discovered FHB resistance QTL that also occur in spring wheat GP80 (PI 277012 derivative). To transfer the PI 277012 resistance from GP80 to hard winter wheat (HWW), GP80 was first crossed with Novus-4. The F1 hybrid was crossed with SY Monument, following which marker-selected progeny were crossed with, and backcrossed to, ND Noreen. To potential carriers of FHB resistance QTL among the 22 F1 of the ND Noreen cross, simple sequence repeat (SSR) markers, Illumina 90 K single nucleotide polymorphism (SNP) haplotypes and greenhouse FHB Type II resistance tests were done. Likely homozygotes for Qfhb.rwg.5A.1 and Qfhb.rwg.5A.2, were selected and backcrossed to ND Noreen. In the B1F1, 131 plants were evaluated for SNP haplotypes, SSR markers and FHB resistance. Nine B1F2:3 lines were derived, and their resistance confirmed in a third greenhouse FHB trial. The results suggested that eight lines had higher resistance and were comparable to GP80 with the Qfhb.rwg-5A.2 markers occurring in all eight and the Qfhb.rwg-5A.1 markers occurring in four lines. The eight selections constitute a valuable HWW resistance breeding resource.

Fissured Tongue among Patients Visiting the Department of Oral Medicine and Radiology in a Tertiary Care Centre.

Introduction: Examination of the tongue and knowledge of its variation can aid clinicians in correctly assessing the cause of a patient's complaint. Despite World Health Organization recommendations to encourage more epidemiological assessment of oral mucosal variations and lesions, the volume of literature in this area is limited. This study aimed to find out the prevalence of fissured tongues among patients visiting the Department of Oral Medicine and Radiology in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among patients visiting the Department of Oral Medicine and Radiology in a tertiary care centre. Data was collected from 12 March 2023 to 10 May 2023 after obtaining ethical approval from the same institute. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results: Out of 540 patients, the prevalence of fissured tongue was 73 (13.51%) (10.63-16.40, 95% Confidence Interval). A total of 34 (46.57%) were males and 39 (53.42%) were females. Conclusions: The prevalence of fissured tongue among patients visiting the Department of Oral Medicine and Radiology was higher than other studies done in similar settings. Keywords: anatomic variation; fissured tongue; Nepal; oral mucosa; prevalence.

Successful thrombolysis with low dose thrombolytic agent in a patient with acute life-threatening massive pulmonary thromboembolism: A case report.

Introduction: and importance: Acute massive pulmonary thromboembolism is a potentially life-threatening condition requiring urgent management to decrease mortality. Although the standard dose of systemic thrombolysis with alteplase is 100 mg, half the dose of alteplase can be used to break up clots successfully, especially if bleeding is a concern. Case presentation: We report a case of massive pulmonary thromboembolism presenting with cardiopulmonary arrest, successfully managed with advanced cardiac life support, anticoagulants, and low-dose thrombolytics. Clinical discussion: Management of massive pulmonary thromboembolism includes medical thrombolysis along with maintenance of hemodynamic stability. Our patient was successfully managed with low-dose thrombolytics and was continued with standard oral anticoagulants for 6 months. Conclusion: In patients of acute massive pulmonary thromboembolism, a low dose of the thrombolytic agent can achieve complete resolution of the thrombus with less bleeding risk.

Efficacy of Curcumin in Combination with Intralesional Dexamethasone with Hyaluronidase in the Treatment of Oral Submucous Fibrosis: A Randomized Controlled Trial.

OBJECTIVE: The objective of this study was to determine the efficacy of curcumin in combination with  intralesional dexamethasone with hyaluronidase in the treatment of oral submucous fibrosis (OSF). METHODS: This randomized, double blind, parallel design, clinical trial was conducted at B.P. Koirala Institute of Health Sciences, Nepal. Thirty-four patients with clinically diagnosed OSF were randomized into two groups (17 participants in each) with baseline treatment of intralesional dexamethasone with hyaluronidase for 6 weeks for the both. Curcumin (2gm/day) was provided to Group A (Test) and Group B (Control) received placebo. Interincisal mouth opening, tongue protrusion, cheek flexibility and visual analogue scale (VAS) scoring of burning sensation of oral mucosa was recorded at baseline, 6, 8 and 12 weeks follow-up and independent t-test was used to compare the improvements in two groups. RESULTS: On comparing the 6 weeks and baseline values, in Group A and B the mean difference in mouth opening was 8.82±1.33 mm and 5.53±1.17 mm respectively (p<0.001), in cheek flexibility was 2.94±1.02 mm and 1.94±1.24 mm respectively (p=0.02) and in tongue protrusion was 6.23±1.48 and 3.65±1.37 mm respectively (p<0.001). The findings were consistent in the 8 weeks follow-up. In 12 weeks follow-up, on comparing with the baseline values, in Group A and B, the mean difference in mouth opening was 8.71±1.16 mm and 5.35±1.22 mm respectively (<0.001), ), in cheek flexibility was 2.81±1.01 mm and 1.76±1.35 mm respectively (p=0.02) and in tongue protrusion was 6.06±1.48 and 3.35±1.50 mm respectively (p<0.001). Both the arms showed 100% improvement in burning sensation in 6, 8 and 12 weeks follow-up. CONCLUSION: Curcumin in combination with intralesional dexamethasone with hyaluronidase is efficacious in the treatment of OSF.

Drinking Water Quality and Public Health in the Kathmandu Valley, Nepal: Coliform Bacteria, Chemical Contaminants, and Health Status of Consumers.

Residents of Nepal's Kathmandu Valley draw drinking water from tube wells, dug wells, and stone spouts, all of which have been reported to have serious water quality issues. In this study, we analyzed drinking water samples from 35 tube wells, dug wells, stone spouts, and municipal tap water for bacterial and chemical contaminants, including total and fecal coliform, aluminum, arsenic, barium, beryllium, boron, cadmium, cobalt, chromium, copper, fluoride, iron, mercury, manganese, molybdenum, nickel, lead, antimony, selenium, thallium, uranium, vanadium, and zinc. We also asked a sampling of households who used these specific water sources to rate the taste of their water, list any waterborne diseases they were aware of, and share basic health information about household members. This survey provided us with information from 146 households and 603 individuals. We found widespread bacterial contamination of water sources, with 94% of sources having detectable total or fecal coliform. Nepal Drinking Water Quality Standards and World Health Organization (WHO) Drinking-Water Guidelines or health-based values were exceeded for aluminum (max = 0.53 mg/L), arsenic (max = 0.071 mg/L), iron (max = 7.22 mg/L), and manganese (max = 3.229 mg/L). The distribution of water sources with high arsenic, iron, and manganese appeared to be associated with floodplain deposits. Mixed effects logistic regression models were used to examine the interactions between social factors and water contaminants and their effects on household members' health. Consumers of water sources with both high and low concentrations of manganese were less likely to have a positive attitude towards school than those whose water sources had moderate concentrations of manganese. Social factors, especially education, played a large role in predicting individual health outcomes. Household taste ratings of drinking water were not correlated with iron or manganese concentrations, suggesting that WHO's reliance on aesthetic criteria for these contaminants instead of formal drinking-water guidelines may not be sufficient to protect public health.

Emission factors and emission inventory of diesel vehicles in Nepal.

A comprehensive emission inventory of the transport sector through fuel-based emission factors (EFs) was developed for the first time in Nepal. This study estimates air pollutants emission from diesel vehicles between the years 1989 and 2018 based on national statistical data, average vehicle kilometers travelled, fuel mileage, and measurement-based EFs for each vehicle category during idle and moving conditions. The consumption of diesel by vehicle category was also estimated and total consumption was compared with national sales data. The Monte Carlo was used to estimate uncertainties. Nationally, total diesel consumption was estimated as 892,770 kL (85-115%) in 2017/18, 13.4 times higher than 1989/90. Ratnoze1 and Microaeth were used to conduct the tail pipe emission measurements. The fuel-based EFs of CO2, CO, BC, and PM2.5 were calculated through the carbon mass balance method. Of all diesel vehicles measured (n = 29) during idling, the average EFs were estimated as CO2 2600 (99-101%), CO 33.3 (44-156%), BC 0.6 (25-101%), and PM2.5 5.2 (0-235%) in unit of g L-1. For moving conditions (n = 5), the average EFs were estimated to be CO2 2476 (90-110%), CO 97.3 (0-232%), BC 1.7 (46-110%), and PM2.5 20.7 (0-255%), all in g L-1. Multiplying fuel consumption by EFs, national air pollutant emissions were estimated as 2214 (90-110%) to 2781(85-115%) for CO2, 27.7 (42-158%) to 88.8 (0-232%) for CO, 0.51 (23-177%) to 3.55 (46-110%) for BC and 3.42 (0-236%) to 23.47 (0-255%) for PM2.5 in 2017/18 in unit of Gg. This paper recommends revising national vehicle mass emission standards based on the findings of this study and including and enhancing sustainable low-carbon transport through amendment of transport policy.

Cookstove Smoke Impact on Ambient Air Quality and Probable Consequences for Human Health in Rural Locations of Southern Nepal.

Residential emission from traditional biomass cookstoves is a major source of indoor and outdoor air pollution in developing countries. However, exact quantification of the contribution of biomass cookstove emissions to outdoor air is still lacking. In order to address this gap, we designed a field study to estimate the emission factors of PM2.5 (particulate matter of less than 2.5 µ diameter) and BC (black carbon) indoors, from cookstove smoke using biomass fuel and with smoke escaping outdoors from the roof of the house. The field study was conducted in four randomly selected households in two rural locations of southern Nepal during April 2017. In addition, real-time measurement of ambient PM2.5 was performed for 20 days during the campaign in those two rural sites and one background location to quantify the contribution of cooking-related emissions to the ambient PM2.5. Emission factor estimates indicate that 66% of PM2.5 and 80% of BC emissions from biomass cookstoves directly escape into ambient air. During the cooking period, ambient PM2.5 concentrations in the rural sites were observed to be 37% higher than in the nearby background location. Based on the World Health Organization (WHO)'s AirQ+ model simulation, this 37% rise in ambient PM2.5 during cooking hours can lead to approximately 82 cases of annual premature deaths among the rural population of Chitwan district.