Acute oral poisoning due to pretilachlor herbicide - a rare case report from Nepal.

Introduction: Acute oral intoxication of pretilachlor, a synthetic chloroacetanilide herbicide, can present similar clinical manifestations of organophosphorus toxicity in humans. Case presentation: A 15-year-old male was admitted after suicidal ingestion of pretilachlor poison, with decreased consciousness and blood-mixed vomiting. Discussion: Pretilachlor is a colorless and odorless liquid that can cause neurotoxicity and carcinogenicity due to its prolonged exposure. The effects of acute oral exposure are mild and may differ from chronic exposure. Individuals exposed to chloroacetanilides may not show symptoms or experience vomiting and neurological issues. Clinical manifestations such as vomiting, excessive lacrimation, bowel and bladder incontinence, bradycardia, and hypotension can be observed in both organophosphate poisoning and pretilachlor poisoning, making accurate diagnosis challenging, particularly in resource-limited settings like ours. There is no specific antidote for pretilachlor poisoning. Treatment focuses on symptomatic care and monitoring the patient's hemodynamics as per standard protocol. Conclusion: This case underscores the need for prompt stabilization, vigilant monitoring, and supportive care to ensure timely recovery in pretilachlor poisoning cases despite similarities with organophosphate poisoning. It emphasizes the importance of educating and raising awareness among physicians about potential mimickers like organophosphates.

Diagnostic challenges in tuberculous meningitis: a case report with negative genexpert result.

Introduction: Tuberculous meningitis (TBM) is a severe form of tuberculosis affecting the meninges, primarily caused by Mycobacterium tuberculosis. Diagnosis of TBM poses numerous challenges due to its nonspecific clinical presentation and the limitations of diagnostic tests like GeneXpert. Case presentation: The authors report a case of a 22-year-old female from Eastern Nepal presenting with acute-onset fever, headache, vomiting, and neck pain. Cerebrospinal fluid (CSF) analysis showed lymphocytic pleocytosis, elevated protein, low glucose levels, and cobweb coagulum indicative of TBM. However, the GeneXpert test revealed negative results. Discussion: In resource-limited settings like Nepal, where access to GeneXpert MTB/Rif is limited, CSF analysis and clinical algorithms play a crucial role in diagnosing TBM. Relying solely on GeneXpert results may lead to false negatives, so a high level of suspicion based on patient risk factors is essential. Prompt initiation of empirical antitubercular therapy is vital for a favorable outcome in TBM cases. Conclusion: Negative MTB PCR results from CSF can be misleading in diagnosis of tubercular meningitis. Therefore, comprehensive evaluations, including detailed patient history, physical examination, and CSF fluid analysis, are crucial in high tuberculous prevalence countries to ensure accurate and timely diagnosis.

Serial estimations of serum albumin levels as a prognostic marker in critically ill patients admitted in ICU in tertiary center: An observational study.

Critical illness is a severe condition that poses a significant threat to multiple organ systems and can lead to substantial morbidity and mortality. Serum albumin concentration can serve as an independent predictor of mortality risk in critically ill patients. This study aimed to determine the role of serial monitoring of serum albumin (SA) levels as a prognostic marker of mortality and morbidity. This observational prospective study was conducted at a tertiary hospital over a period from January 1, 2020, to December 31, 2020, among critically ill patients admitted to the intensive care unit. Data collection was performed using a prestructured proforma. Statistical analysis was carried out using Statistical Package for the Social Sciences software version 23, employing appropriate tests. The P-value <.05 was considered statistically significant. The study included 78 patients with 59 (75.6%) were survivors, and 19 (24.4%) were non-survivors. Mean SA levels did not significantly differ between non-survivors (3.30 ±â€…0.40 g/dL) and survivors (3.42 ±â€…0.35 g/dL) on admission (day 1) (P = .234). However, on day 3, non-survivors had significantly lower levels (3.02 ±â€…0.46 g/dL) compared to survivors (3.31 ±â€…0.29 g/dL) (P = .001). This trend continued on day 5, with non-survivors having significantly lower levels (2.92 ±â€…0.30 g/dL) compared to survivors (3.31 ±â€…0.33 g/dL) (P = .003). The decline in SA levels from day 1 to day 3 and from day 1 to day 5 was statistically significant in non-survivors (P = .001). In survivors, a significant decline was observed from day 1 to day 3 (P = .019), while the decline from day 1 to day 5 was not statistically significant (P = .074). Serial estimation of SA levels in critically ill patients can serve as a valuable prognostic marker, aiding in the identification of individuals at a higher risk of mortality and morbidity.

Coexistence of cerebral venous thrombosis and dural arteriovenous fistula in an adolescent: A case report.

Key Clinical Message: Clinicians should consider central venous thrombosis (CVT) as a differential diagnosis in young adolescents with persistent headaches. It is essential to assess for concurrent CVT and dural arteriovenous fistula (DAVF), particularly in those with a history of CVT. Abstract: Cerebral venous thrombosis (CVT) and dural arteriovenous fistula (DAVF) are uncommon vascular disorders with diverse clinical presentations. The coexistence of CVT and DAVF is a rare but important association that may impact the management and prognosis of affected patients. Prothrombotic conditions generally ranging from acquired to genetic, oral contraceptives, malignancy, puerperium, infection, and head injury are the common risk factors for cerebral venous thrombosis. Here, we present a case of 18 years males who developed recurrent cerebral thrombosis on the background of the presence of an arteriovenous fistula.

Scrub Typhus Presenting as Unilateral Abducens Nerve Palsy: A Case Report.

Abducens nerve palsies associated with infectious diseases are rare. Scrub typhus is an acute, febrile, infectious illness caused by Orientia tsutsugamushi carried out by vector mite zoonosis and is highly endemic in the so-called "tsutsugamushi triangle". The organism has been reported to be capable of entering the nervous system, causing meningitis and focal neurologic abnormalities. We report a 23 years old previously healthy girl who presented with fever, pain abdomen, vomiting and classical pathognomic black eschar mark on the right proximal medial calf region. After exclusion of other common infectious causes, scrub typhus serology immunoglobulin M was positive and was diagnosed with scrub typhus associated with unilateral abducens nerve palsy which responded to doxycycline therapy. On the background of strong clinical suspicion, we underline its significance in the interpretation of the serologic testing and its role in guiding the further treatment respectively. Keywords: abducens nerve palsy; case report; Orientia tsutsugamushi; scrub typhus; zoonoses.

A global trait-based approach to estimate leaf nitrogen functional allocation from observations.

Nitrogen is one of the most important nutrients for plant growth and a major constituent of proteins that regulate photosynthetic and respiratory processes. However, a comprehensive global analysis of nitrogen allocation in leaves for major processes with respect to different plant functional types (PFTs) is currently lacking. This study integrated observations from global databases with photosynthesis and respiration models to determine plant-functional-type-specific allocation patterns of leaf nitrogen for photosynthesis (Rubisco, electron transport, light absorption) and respiration (growth and maintenance), and by difference from observed total leaf nitrogen, an unexplained "residual" nitrogen pool. Based on our analysis, crops partition the largest fraction of nitrogen to photosynthesis (57%) and respiration (5%) followed by herbaceous plants (44% and 4%). Tropical broadleaf evergreen trees partition the least to photosynthesis (25%) and respiration (2%) followed by needle-leaved evergreen trees (28% and 3%). In trees (especially needle-leaved evergreen and tropical broadleaf evergreen trees) a large fraction (70% and 73%, respectively) of nitrogen was not explained by photosynthetic or respiratory functions. Compared to crops and herbaceous plants, this large residual pool is hypothesized to emerge from larger investments in cell wall proteins, lipids, amino acids, nucleic acid, CO2 fixation proteins (other than Rubisco), secondary compounds, and other proteins. Our estimates are different from previous studies due to differences in methodology and assumptions used in deriving nitrogen allocation estimates. Unlike previous studies, we integrate and infer nitrogen allocation estimates across multiple PFTs, and report substantial differences in nitrogen allocation across different PFTs. The resulting pattern of nitrogen allocation provides insights on mechanisms that operate at a cellular scale within leaves, and can be integrated with ecosystem models to derive emergent properties of ecosystem productivity at local, regional, and global scales.

Large carbon release legacy from bark beetle outbreaks across Western United States.

Warmer conditions over the past two decades have contributed to rapid expansion of bark beetle outbreaks killing millions of trees over a large fraction of western United States (US) forests. These outbreaks reduce plant productivity by killing trees and transfer carbon from live to dead pools where carbon is slowly emitted to the atmosphere via heterotrophic respiration which subsequently feeds back to climate change. Recent studies have begun to examine the local impacts of bark beetle outbreaks in individual stands, but the full regional carbon consequences remain undocumented for the western US. In this study, we quantify the regional carbon impacts of the bark beetle outbreaks taking place in western US forests. The work relies on a combination of postdisturbance forest regrowth trajectories derived from forest inventory data and a process-based carbon cycle model tracking decomposition, as well as aerial detection survey (ADS) data documenting the regional extent and severity of recent outbreaks. We find that biomass killed by bark beetle attacks across beetle-affected areas in western US forests from 2000 to 2009 ranges from 5 to 15 Tg C yr(-1) and caused a reduction of net ecosystem productivity (NEP) of about 6.1-9.3 Tg C y(-1) by 2009. Uncertainties result largely from a lack of detailed surveys of the extent and severity of outbreaks, calling out a need for improved characterization across western US forests. The carbon flux legacy of 2000-2009 outbreaks will continue decades into the future (e.g., 2040-2060) as committed emissions from heterotrophic respiration of beetle-killed biomass are balanced by forest regrowth and accumulation.

Post-clearcut dynamics of carbon, water and energy exchanges in a midlatitude temperate, deciduous broadleaf forest environment.

Clearcutting and other forest disturbances perturb carbon, water, and energy balances in significant ways, with corresponding influences on Earth's climate system through biogeochemical and biogeophysical effects. Observations are needed to quantify the precise changes in these balances as they vary across diverse disturbances of different types, severities, and in various climate and ecosystem type settings. This study combines eddy covariance and micrometeorological measurements of surface-atmosphere exchanges with vegetation inventories and chamber-based estimates of soil respiration to quantify how carbon, water, and energy fluxes changed during the first 3 years following forest clearing in a temperate forest environment of the northeastern US. We observed rapid recovery with sustained increases in gross ecosystem productivity (GEP) over the first three growing seasons post-clearing, coincident with large and relatively stable net emission of CO2 because of overwhelmingly large ecosystem respiration. The rise in GEP was attributed to vegetation changes not environmental conditions (e.g., weather), but attribution to the expansion of leaf area vs. changes in vegetation composition remains unclear. Soil respiration was estimated to contribute 44% of total ecosystem respiration during summer months and coarse woody debris accounted for another 18%. Evapotranspiration also recovered rapidly and continued to rise across years with a corresponding decrease in sensible heat flux. Gross short-wave and long-wave radiative fluxes were stable across years except for strong wintertime dependence on snow covered conditions and corresponding variation in albedo. Overall, these findings underscore the highly dynamic nature of carbon and water exchanges and vegetation composition during the regrowth following a severe forest disturbance, and sheds light on both the magnitude of such changes and the underlying mechanisms with a unique example from a temperate, deciduous broadleaf forest.