Himalayan watersheds in Nepal record high soil erosion rates estimated using the RUSLE model and experimental erosion plots.

The rising unpredictability in the food supply chain in many parts of the world is related to soil loss and poor agricultural output. The Revised Universal Soil Loss Equation (RUSLE), widely used for estimating soil loss, was applied in the western mid-hills in Nepal, with steep slopes and fragile geology. This region is at high risk for rapid soil erosion and mass wasting. To estimate soil loss, this study utilized the RUSLE model with experimental erosion plots in the Aadhikhola and Tinahukhola watersheds, capturing real-time erosion in the field. The annual soil loss for the Aadhikhola watershed is estimated at ∼41.4 tons ha-1 yr-1. In contrast, in the Tinahukhola watershed, soil loss is low (∼24.1 tons ha-1 yr-1). Although annual rainfall showed an increasing trend in both watersheds, the change in soil loss was statistically insignificant. The high erosion rates from the experimental plots in both watersheds support the model outputs. Results from the experimental plots recorded the rate of soil erosion for different land use as: irrigated agricultural land > rainfed agricultural land > forests. The trends highlight the role of human activities in enhancing soil erosion in these mountainous terrains in terms of medium to long-term perspectives. Therefore, sustainable agriculture practices in these terrains must investigate alternate ways to decrease soil erosion to support people's livelihoods.

The effect of physiographic and hydrologic complexities and their alterations on the distribution of obligate freshwater dolphins.

Physiographic and hydrologic complexities play major role in determining the habitat suitability for river dolphins. However, dams and other water development structures alter hydrologic regimes that degrade habitat conditions. For the three extant species of obligate freshwater dolphins, namely: Amazon dolphin (Inia geoffrensis), Ganges dolphin (Platanista gangetica), and Indus dolphin (Platanista minor), the threat is high as dams and water-based infrastructure dotted throughout their distribution range impact dolphin populations by restricting their movement. But there is also evidence of localized increase in dolphin population in certain segments of habitats affected by such hydrologic alterations. Hence, the impacts of hydrologic alterations on dolphin distribution are not as binary as it seems. We aimed to ascertain the role of hydrologic and physiographic complexities in determining the distribution of the dolphins in their geographic ranges using density plot analysis and also to understand how hydrologic alterations in the rivers affect their distribution using a combination of density plot analysis and review of literature. The influence of some of the study variables such as distance to confluence and sinuosity was similar across species-for instance, all three dolphin species preferred slightly sinuous river segments and habitats near confluences. However, varying influences across species were observed for some other variables such as river order and river discharge. We assessed 147 cases of impacts of hydrological alterations on dolphin distribution by categorizing the reported impacts in nine broad types out of which habitat fragmentation accounted for the majority of the impacts (35%) followed by habitat reduction (24%). These endangered species of freshwater megafauna will experience further intensified pressures as more large-scale hydrologic modifications such as damming and diversion of rivers are underway. In this context, basin-scale water-based infrastructural development planning should take into consideration the salient ecological requirements of these species to ensure their long-term survival.

Giant ovarian mucinous cystadenocarcinoma: A case report.

Giant ovarian tumors are rare in the present day due to the early diagnosis and treatment. However, owing to the large size, it can often compress the inferior vena cava and sudden decompression of it during the removal can lead to hemodynamic instability with disastrous outcomes.

Esophageal Perforation following Accidental Ingestion of a Razor Blade.

Background: Ingestion of sharp foreign bodies is uncommon and often underreported. It can present with esophageal perforation which is a life-threatening complication requiring prompt diagnosis and management. Case Presentation. We report a case of accidental ingestion of a razor blade in a chronic alcoholic who presented with hematemesis after an esophageal perforation, the diagnosis of which was confirmed by radiology. Conclusion: Early recognition of esophageal perforation is crucial for early intervention. Proper history taking and radiological investigations are a key to reaching a diagnosis.

Massive Middle Cerebral Artery Ischemic Stroke Associated with Severe Acute Respiratory Distress Syndrome in H1N1 Influenza: A Case Report.

Influenza has a common occurrence during its peak seasons. It usually causes disease of the respiratory tract including severe acute respiratory distress syndrome. However, it may also cause disease and complication of other organ systems. We present a rare complication of influenza in which a patient secondary to influenza developed massive middle cerebral artery ischemic stroke. The patient however survived following recovery of both severe acute respiratory distress syndrome and ischemic stroke after decompressive craniectomy and a prolonged intensive care unit stay. This case report is to highlight the importance of influenza related complications besides the pulmonary infliction which can lead to morbidity and even mortality if not managed on time.

Severe conservation risks of roads on apex predators.

The global expansion of road networks threatens apex predator conservation and ecosystem functioning. This occurs through wildlife-vehicle collisions, habitat loss and fragmentation, reduced genetic connectivity and increased poaching. We reviewed road impacts on 36 apex predator species and assessed their risk from current roads based on road exposure and species vulnerability. Our findings reveal all apex predators are exposed to road impacts. Eight of the ten species with the highest risk occur in Asia, although other high-risk species are present in the Americas, Africa and Europe. The sloth bear suffers the highest risk of all apex predators, followed by the tiger and dhole. Based on species risk from roads, we propose a widely applicable method to assess the potential impact of future roads on apex predators. We applied this method to proposed road developments in three areas: the Brazilian Amazon, Africa, and Nepal, to locate high-impact road segments. Roughly 500 protected areas will be intersected by these roads, threatening core apex predator habitats. We advocate the need for rigorous road development planning to apply effective mitigation measures as an urgent priority and to avoid construction in wilderness areas and predator strongholds.

Transmesenteric hernia with closed-loop small bowel obstruction: A case report.

BACKGROUND: Transmesenteric hernia is a subtype of internal abdominal hernia (IAH) and a rare cause of small bowel obstruction in adults. Difficulty in reaching a definitive diagnosis due to non-specific clinical and imaging findings often cause life-threatening bowel ischemia. CASE REPORT: We report a case of a 37-year-old female who presented with clinical and imaging features of small bowel obstruction. She underwent an emergency laparotomy where the diagnosis of transmesenteric hernia causing closed-loop obstruction was made. The non-viable portion of the intestine was resected, anastomosis of the ileum along with the closure of the mesenteric defect was performed. DISCUSSION: IAH is the protrusion of abdominal viscera, most commonly small bowel loops through a peritoneal or mesenteric defect into the abdominal or pelvic cavity. Considered common in children, it is rare in adults and is most common after abdominal surgeries like Roux-en-Y gastric bypass surgery. Clinical features and imaging findings are non-specific causing delay in the diagnosis. CONCLUSION: A high index of suspicion is required while assessing the patient with symptoms suggestive of acute bowel obstruction as the preoperative diagnosis of a transmesenteric hernia is challenging.

Mature cystic teratoma of the temporal lobe: A rare tumor with an unusual location.

Intracranial mature cystic teratoma is rare. The temporal lobe is a very unusual location and can pose a considerable diagnostic challenge. Proper histological diagnosis and long-term follow-up are imperative.

Sinonasal mucosal melanoma presenting as a maxillary sinus mass: A case report.

Maxillary sinus melanoma is a rare mucosal melanoma difficult to diagnose in the absence of pigmentation. Intranasal masses presenting with the features of occult malignancy and rapid progression should always be investigated in the line of melanoma irrespective of pigmentation. The histopathological and immunohistochemical examination helps to confirm the diagnosis.

Role of Hyperbilirubinaemia as a Predictor of Complicated Appendicitis in Paediatric Population.

BACKGROUND: Acute appendicitis is a common surgical emergency amongst the paediatric population. Available diagnostic tools are focussed to make a diagnosis of acute appendicitis. A definitive predictive factor for the diagnosis of complicated appendicitis is lacking. Thus, this aims to analyse hyperbilirubinaemia as a predictor of complicated appendicitis amongst the paediatric population. MATERIALS AND METHODS: A prospective observational study was conducted in a tertiary hospital from November 2018 to October 2019. All children undergoing emergency appendectomy were included in the study. Preoperatively, patients were evaluated clinically, and routine investigations including total and direct serum bilirubin were sent. All patients were grouped as 'simple appendicitis' or 'complicated appendicitis' based on intra-operative and histological findings. Bilirubin level was compared between these groups and analysed. RESULTS: A total of 52 children fulfilling the inclusion criteria were included. The mean age was 13.2 ± 4.2 years, and the male: female ratio was 2.1:1. Thirty-four (65.4%) had simple appendicitis and 18 (34.6%) had complicated appendicitis. Total bilirubin was 23.83 ± 5.94 mmol/L in the complicated appendicitis group and 13.15 ± 3.29 mmol/L in the simple appendicitis group. Direct bilirubin was 5.28 ± 2.22 mmol/L in complicated appendicitis and 2.62 ± 0.83 mmol/L in simple one. Both total and direct bilirubin were significantly high in the complicated group (P < 0.001) compared to the simple appendicitis group. On the Receiver operating curve (ROC), the best cutoff value for total and direct bilirubin was 21 and 5.5 mmol/L, respectively. The sensitivity and specificity of total and direct bilirubin were 72.2%, 100%, and 61.1%, and 85.3%, respectively. CONCLUSION: It is concluded that hyperbilirubinaemia is a good predictor for paediatric complicated appendicitis.

Central Venous Catheter-related Thrombosis in a Dialysis Patient: A Case Report.

Hemodialysis is one of the treatment modalities for advanced kidney disease and can help an individual live an active life despite failing kidneys. Although it improves the quality of life, it is not completely risk-free. It has several complications, among which, thrombus formation is common. We report a case of a 63-year-old man who presented at our institution for regular hemodialysis with recurrent arteriovenous graft failure. Because doppler ultrasound is a non-invasive procedure that can identify a thrombus in a vein, it is the best initial option for patients with internal jugular vein thrombosis. The use of ultrasound not only can guide a catheter pathway but can also help in early diagnosis and prevent complications following catheterization in a vein with a thrombus. Keywords: central venous catheterization; chronic kidney disease; hemodialysis; thrombus.

Presacral dermoid cyst in a young female patient: A case report.

Presacral dermoid cysts are rare, benign tumors of developmental origin that primarily affect women. Surgical resection is the mainstay of treatment for these cysts, even if asymptomatic, with the laparoscopic approach being safer and more efficient.

Tubal abortion masquerading as an acute appendicitis with a negative urine pregnancy test: A case report.

INTRODUCTION AND IMPORTANCE: Spontaneous expulsion of product of conception through the fimbrial end to the peritoneal cavity is a rare mode of progression of tubal pregnancy. Thus, ectopic pregnancy can present with right-sided iliac fossa pain which can be preoperatively misdiagnosed as acute appendicitis. CASE HISTORY: A 30-year regularly menstruating woman presented with right iliac fossa pain which was diagnosed as acute appendicitis preoperatively with an ultrasound. However, intraoperatively, a product of conception-like material measuring 3 ∗ 3 cm was seen hanging from the right fimbrial end of the fallopian tube with a normal appendix. With an intraoperative diagnosis of spontaneous tubal abortion, histopathology of the resected mass showed chorionic villi lined by trophoblastic cells along with decidualized tissue, fibrinoid material, and blood clot. DISCUSSION: Ectopic pregnancy presenting as a right iliac fossa pain can mimic acute appendicitis. An abnormal ß-hCG pattern/level which doesn't correspond to the gestational age suggests the likely diagnosis of ectopic gestation. Transvaginal ultrasound is the preferred imaging modality for the evaluation of patients with suspected ectopic gestation. A urine pregnancy kit cannot always exclude an underlying ectopic pregnancy because of the associated false-negative results. CONCLUSION: Urgent laparotomy to prevent detrimental complications associated with ectopic gestation should be done. Surgeons should be aware of this suspicion as a false negative UPT can happen and misguide clinicians about the possible occurrence of ectopic pregnancy.

Ileal perforation as an initial manifestation of systemic lupus erythematosus: A case report.

INTRODUCTION AND IMPORTANCE: Lupus enteritis is uncommon in patients with SLE and usually presents with anorexia, vomiting, and abdominal pain. Intestinal perforation as an initial manifestation of SLE is rare and can have a grave prognosis if not timely diagnosed. CASE HISTORY: We report an unusual case of a 22-year-old regularly menstruating female who presented with features of perforation peritonitis as an initial manifestation of lupus enteritis. Intraoperatively, a gangrenous ileal segment with multiple perforations was present. Thus, with an intraoperative diagnosis of perforation peritonitis, a gangrenous segment of the small bowel was resected and a double-barrel jejuno-ileostomy was created. DISCUSSION: Lupus enteritis manifesting initially as bowel perforation can be an uncommon cause of acute abdomen. A plain chest X-ray can show gas under the diaphragm suggesting bowel perforation. A contrast-enhanced CT scan of the abdomen is the gold standard in diagnosing lupus enteritis with a good prognosis on steroids. CONCLUSION: Primary closure, resection, and anastomosis of small gut or diverting stoma are required for management of perforation. A high degree of clinical suspicion is required for early diagnosis thus preventing the grave prognosis of such an entity.

Prevalence of Functional Limitation in COVID-19 Recovered Patients Using the Post COVID-19 Functional Status Scale.

INTRODUCTION: COVID-19 is an emerging global health pandemic causing tremendous morbidity and mortality worldwide. Chronic symptoms progressing to poor functional status have been reported in a substantial proportion of COVID-19 patients worldwide. This study aimed to determine the prevalence of functional limitation in COVID-19 recovered patients using the post-COVID-19 functional status scale. METHODS: A descriptive cross-sectional study was conducted at Tribhuvan University Teaching Hospital. COVID-19 recovered patients with reverse transcription-polymerase chain reaction negative status were included and assessed using the post-COVID-19 functional status scale. Data entry and analysis was done in Statistical Package for the Social Sciences version 20.0. Descriptive statistics were performed. RESULTS: A total of 106 patients were included for the final analysis. More than half of the patients (56.6%) reported having no functional limitation (grade 0), while the prevalence of some degree of functional limitation was observed in 46 (43.4%) patients (grade 1 to 4). CONCLUSIONS: Some form of functional limitation should be anticipated after COVID-19 infection. Post-COVID-19 functional status scale can be a valuable tool in determining the prevalence of functional limitation in COVID-19 recovered patients in acute health care settings. It can potentially guide in planning rehabilitative measures in post-acute care management of COVID-19 survivors.

Incidental finding of jejunal diverticula during laparotomy for suspected adhesive small bowel obstruction: A case report.

INTRODUCTION AND IMPORTANCE: Jejunal diverticula are usually asymptomatic and are discovered incidentally. While rare, their complications may be life-threatening. They should be considered as differential diagnoses in undiagnosed complaints of chronic abdominal pain, malabsorption, anemia, gastrointestinal bleed and intestinal obstruction. CASE PRESENTATION: A 66-year lady, known hypertensive and hypothyroidism with history of hysterectomy presented with symptoms suggestive of small bowel obstruction. Intraoperatively adhesions between loops of the small intestine, multiple diverticula with two of them impending perforation were found. Resection of 10 cm of jejunum containing diverticula with end-to-end anastomosis was performed. She had uneventful recovery and on 2 months of follow-up she was doing well. CLINICAL DISCUSSION: Although diverticula can be found anywhere along the gastrointestinal tract, jejunal diverticula are rare. Most patients are asymptomatic, symptoms if present is non-specific that delay diagnosis causing patients to land up with complications. They are diagnosed incidentally on endoscopy or imaging rather than through clinical suspicion. Asymptomatic cases do not mandate treatment while symptomatic cases can be managed conservatively with surgery being reserved for those with complications. CONCLUSION: Small bowel obstruction due to jejunal diverticula is a rare entity, a diagnosis of which can be confirmed only intra-operatively. So it must be borne as a differential in small bowel obstruction. Timely diagnosis and management will prevent life-threatening complications of it.

Heterotaxy syndrome with complex congenital heart disease, facial palsy, and asplenia: A rare newborn finding.

Heterotaxy syndrome is associated with asplenia/polysplenia and complex congenital heart disease. Facial palsy in heterotaxy is very rare. The management is still challenging with a poor prognosis. Proper counseling to the family about the disease course, treatment modalities, and outcomes is essential.

Cyclopia with proboscis: A rare congenital anomaly.

Cyclopia with a proboscis, a rare congenital anomaly, and a severe form of holoprosencephaly occur as a result of incomplete separation of prosencephalon into two halves of hemispheres during organogenesis. A prenatal anomaly scan can help in the early detection of the condition and timely termination of the pregnancy.

Symptomatic familial adenomatous polyposis in an adolescent: A case report.

INTRODUCTION: Familial adenomatous polyposis (FAP) is an inherited colorectal cancer syndrome characterized by several adenomatous polyps of the gastrointestinal mucosa with a universal risk of colorectal cancer in a lifetime. FAP is usually asymptomatic in the first decade of life. CASE PRESENTATION: We report a case of a 13-year-old girl diagnosed with FAP who presented in our center with symptoms of hematochezia along with a positive history of the untimely demise of her father and elder sister with similar symptoms. DISCUSSION: FAP is an autosomal dominant disease affecting both male and female equally with variable penetrance. Diagnosis is made by finding hundreds to thousands of adenomatous polyps in the colon and rectum, and molecular analysis of the APC gene which forms the definitive diagnosis. Prophylactic laparoscopic total proctocolectomy with ileorectal anastomosis is a safe and feasible surgical option with a low risk of complications among adolescents. An endoscopic/colonoscopic procedure is recommended every 6 to 12 months after surgery to assess the anastomosis site, pouch, and residual rectum. CONCLUSION: FAP, a rare disease entity in adolescents should be managed by appropriate diagnostic procedures, early prophylactic surgery, and regular lifelong follow-up.

Cecal gastrointestinal stromal tumor causing ileocolic intussusception in an adult: A rare case report.

INTRODUCTION AND IMPORTANCE: Cecal gastrointestinal stromal tumors (GIST) constitute a rarer subtype of all GISTs. Rarely, it can present with ileocolic intussusception in adults making it a challenging diagnosis due to non-specific clinical features. CASE PRESENTATION: A 30-year previously healthy woman presented with lower abdominal pain and a distended abdomen who was subsequently diagnosed with ileocolic intussusception on a CT scan. Intraoperatively, a pedunculated polypoid hard mass was identified in the cecum and thus, a standard right hemicolectomy was performed with the suspicion of malignancy. Histopathology of the resected mass confirmed CD117 negative, spindle type GIST. DISCUSSION: Cecal GIST presenting in the form of ileocolic intussusception is rare. Contrast-enhanced CT scan is the preferred imaging modality for the evaluation of patients with suspected GIST to determine the extent of the tumor, the presence or absence of metastatic disease alongside evaluation of the possibility of complete resection. Adjuvant imatinib therapy following complete resection decreases the disease recurrence. CONCLUSION: Intussusception in an adult can be the first manifestation of underlying malignancy like GIST. Complete surgical resection of the tumor with a negative margin offers long-term survival.