Low-grade malignant peripheral nerve sheath tumour presenting as retroperitoneal spindle cell neoplasm.

Retroperitoneal spindle cell neoplasms are diagnostically challenging. Malignant peripheral nerve sheath tumours (MPNSTs) can sometimes present as sporadic primary retroperitoneal tumours. MPNSTs are usually high-grade and highly aggressive tumours and are associated with a poor prognosis. Low-grade MPNSTs are very rarely described. This current case report describes a case of sporadic primary low-grade MPNST presenting as retroperitoneal spindle cell neoplasm. The diagnosis, imaging and immunohistopathological findings, as well as its successful surgical management, are presented.

Determination of causes of adult deaths using minimally invasive tissue sampling in Gandaki province of Nepal: a multicenter hospital-based study.

BACKGROUND: Minimally Invasive Tissue Sampling (MITS) has been successfully used to establish the cause of death in low- and middle-income countries, mostly in stillbirths and neonates. The objective of this study was to determine the causes of death among adults using MITS in the Gandaki province of Nepal and to find out the contribution of MITS to identify the causes of death. METHODS: A multicentric hospital-based pilot study was conducted to enroll 100 cases of adult deaths. The specimens of cerebrospinal fluid, blood, brain, lungs, and liver tissue were collected utilizing MITS. These specimens underwent standard histopathological, serological, and microbiological analyses. The findings from MITS, and if available, clinical records and forensic autopsy findings were compiled and the cause of death panel identified the causes of death. The final cause of death allocated to each case was based on the WHO International Medical Certificate of Death. RESULTS: Among a total of 100 cases enrolled during the study period, infectious cause attributed to the immediate cause of death in 77 (77%), cardiovascular in 10 (10%), neurological in 8 (8%), malignancy in two (2%), and gastrointestinal and hepatobiliary cause in one (1%) case. The mean age of the cases was 50.8 ± 15.9 years and 76 (76%) were males. MITS established the cause of death in the causal chain of events in 81(81%) cases and identified the cause of death significantly more with infectious than non-infectious causes (p < 0.001). CONCLUSIONS: MITS was useful in establishing the cause of death in the majority of adult deaths and the most common cause was infectious disease. Our findings suggest that MITS can be a valuable and alternative tool for mortality surveillance in low-resource settings, where complete diagnostic autopsies are less accepted or less prioritized.

Microscopic assisted excision of a rare posterior triangle branchial cyst.

Branchial cyst is a painless mass commonly located in the anterior triangle of the neck. It is rarely found in the posterior triangle of the neck. A computed tomography scan of the neck is important to see the extent of the anomaly and its relationship with the major vessel.

Endoscopic management of huge pleomorphic adenoma of the nasal septum; a case report.

Introduction: and Importance: Pleomorphic adenoma (PA) is one of the most common benign tumors of the salivary glands. They can develop in all the salivary glands, but it most commonly occurs in the parotid gland, followed minor salivary gland. It may occurs at the hard and soft palate, lips, cheeks, gingiva, and nasal septum. PA of the nasal septum is a rare tumor. Case presentation: 72-year-old female was diagnosed with pleomorphic adenoma of the nasal septum which was successfully treated by endoscopic endonasal surgical excision. Clinical discussion: Pleomorphic adenoma of the nasal septum was rare tumor may mimic with hemangioma of nose. Diagnostic nasal endoscopy, Computerized tomography and Magnetic resonance imaging are diagnostic to see extent and vascularity of tumor. Endoscopic endonasal approach with microdebrider can help removal of tumor. Conclusion: Pleomorphic adenoma of nasal septum is a rare diagnosis may mimic hemangioma. Endoscopic endonasal approach with microdebrider can be performed in highly vascular masses of the nose in selected cases.

Burden of Serious Bacterial Infections and Multidrug-Resistant Organisms in an Adult Population of Nepal: A Comparative Analysis of Minimally Invasive Tissue Sampling Informed Mortality Surveillance of Community and Hospital Deaths.

BACKGROUND: Bacterial diseases are the leading cause of mortality globally, and due to haphazard use of antibiotics, antimicrobial resistance has become an emerging threat. METHODS: This cross-sectional observational study utilized a minimally invasive tissue sampling procedure to determine the cause of death among an adult population. Bacterial cultures (blood, cerebrospinal fluid, lung tissue) and antibiotic susceptibility were evaluated, and the results were compared between community and hospital deaths. RESULTS: Of 100 deceased persons studied, 76 (76%) deaths occurred in the community and 24 (24%) in the hospital. At least 1 bacterial agent was cultured from 86 (86%) cases; of these, 74 (86%) had a bacterial disease attributed as the primary cause of death, with pneumonia (35, 47.3%), sepsis (33, 44.6%), and meningitis (3, 4.1%) most common. Of 154 bacterial isolates (76.6% from the community and 23.4% from the hospital) detected from 86 culture-positive cases, 26 (16.8%) were multidrug-resistant (MDR). Klebsiella species were the most common (13 of 26) MDR organisms. The odds of getting an MDR Klebsiella infection was 6-fold higher among hospital deaths compared with community deaths (95% confidence interval [CI], 1.37-26.40; P = .017) and almost 23-fold higher (CI, 2.45-213.54; P = .006) among cases with prior antibiotic use compared to those without. CONCLUSIONS: High incidence of serious bacterial infections causing death of adults in the community, with most MDR organisms isolated from hospitalized cases, calls for robust surveillance mechanisms and infection prevention activities at the community level and evidence-driven antibiotic stewardship in healthcare settings.

Disseminated cryptococcosis in a deceased with HIV-1 diagnosed by minimally invasive tissue sampling technique.

Minimal invasive tissue sampling (MITS) technique detected HIV infection and disseminated cryptococcosis in an adult female with sudden death. A proper autopsy is essential to diagnose the exact cause of death and MITS can suffice in natural deaths.

Histopathological Spectrum of Oral Mucosal Lesions in a Tertiary Care Hospital.

BACKGROUND: Neoplastic as well as non-neoplastic lesions commonly involve oral mucosa. It had been observed that benign lesions were more common than malignant ones. The present study was done to evaluate the pattern of distribution of various oral mucosal lesions in a tertiary care hospital. METHODS: This retrospective cross-sectional study reviewed the archival records in the Department of Pathology, Gandaki Medical College, Nepal from January 2017 to December 2020. The records of patients with histopathologic diagnosis of oral mucosal lesions were obtained. The histopathological diagnosis, age, gender, and the site of involvement were collected using a prepared form. Descriptive statistics was applied using SPSS 20 software. RESULTS: Oral mucosal lesions included 3.7% (180 out of total 4895) of cases diagnosed histopathologically. The cases were common among females (101cases/56.1%). Most of the oral mucosal lesions were diagnosed in more than 45 years old patients (75cases/41.7%). The non-neoplastic oral lesions (106cases/58.9%) were the most common lesions followed by neoplastic oral lesions (52cases/28.9%). Among non-neoplastic oral lesions, reactive hyperplastic oral lesions were the most common (50cases/27.8%). Reactive hyperplastic oral lesions frequently affected gingiva (18cases/36%). Neoplastic lesions (Benign neoplasm: 12cases/44.4%; Malignant lesions; 10cases/40%) frequently affected the tongue. CONCLUSIONS: Oral lesions were mostly non-neoplastic and reactive hyperplasia being the most commonest presentation Keywords: Neoplastic; non-neoplastic; oral mucosal lesions; reactive.

Policy Coherence and Interplay between Climate Change Adaptation Policies and the Forestry Sector in Nepal.

Least Developed Countries are likely to be hit the hardest by climate change and need focused efforts towards adaptation. Nepal recognizes that it needs to integrate climate change adaptation into various policies, but limited understanding of how to make these policies coherent is among the factors that hinder effective adaptation action. This can lead to wasted resources and lost opportunities. This paper applies concepts from policy coherence for development frameworks and policy content analysis to examine coherence in Nepal's climate and forest policies-and discusses the factors hindering effective implementation. The policies are analyzed at the horizontal/external level at three layers-motivation, measures, and planned implementation process. The paper finds that policies are more consistent on motivation level and adaptation measures, but are less coherent on implementation. The National Adaptation Programme of Action (NAPA) is more explicit in identifying institutions, organizations, roles and responsibilities, resource allocation (financial), and a monitoring and evaluation plan for climate change adaptation while other policies such as Climate Change Policy 2011, National Biodiversity Strategy and Action Plan 2014-2020, Forest Policy 2015, and Forest Sector Strategy 2016 have critical gaps in this area. This paper conclude that formulation of a policy, articulating targets, and mobilizing financial resources are in themselves not sufficient to effectively address climate change adaptation. Policy-based legislation is required, together with development of a supportive collaborative multi-stakeholder approach at different levels of governance, backed up by effective, collaborative monitoring and enforcement.