The effects of invertebrates on wood decomposition across the world.

Invertebrates and microorganisms are important but climate-dependent agents of wood decomposition globally. In this meta-analysis, we investigated what drives the invertebrate effect on wood decomposition worldwide. Globally, we found wood decomposition rates were on average approximately 40% higher when invertebrates were present compared to when they were excluded. This effect was most pronounced in the tropics, owing mainly to the activities of termites. The invertebrate effect was stronger for woody debris without bark as well as for that of larger diameter, possibly reflecting bark- and diameter-mediated differences in fungal colonisation or activity rates relative to those of invertebrates. Our meta-analysis shows similar overall invertebrate effect sizes on decomposition of woody debris derived from angiosperms and gymnosperms globally. Our results suggest the existence of critical interactions between microorganism colonisation and the invertebrate contribution to wood decomposition. To improve biogeochemical models, a better quantification of invertebrate contributions to wood decomposition is needed.

Assessment and genomic analysis of Salmonella and Campylobacter from different stages of an integrated no-antibiotics-ever (NAE) broiler complex: a longitudinal study.

The objective of this study was to determine prevalence and perform genomic analysis of Salmonella spp. and Campylobacter spp. isolated from different stages of an integrated NAE broiler complex. Environmental samples were screened with 3M-Molecular Detection System (MDS) and MDS positive samples were further processed for confirmation of results and identification. Core genome-based phylogenies were built for both bacteria isolated from this study along with selected NCBI genomes. The odds ratios and 95% confidence limits were compared among stages and sample types (α < 0.05) using multivariable model. Based on MDS results, 4% and 18% of total samples were positive for Salmonella spp. and Campylobacter spp. respectively. The odds of Salmonella detection in hatchery samples were 2.58 times as likely as compared to its detection in production farms' samples (P = 0.151) while the odds of Campylobacter detection in production farms' samples were 32.19 times as likely as its detection in hatchery (P = 0.0015). Similarly, the odds of Campylobacter detection in boot swabs, soil, water, and miscellaneous samples were statistically significant (P < 0.05) as compared with fly paper as reference group. The serovars identified for Salmonella were Typhimurium, Barranquilla, Liverpool, Kentucky, Enteritidis, Luciana, and Rough_O:r:1,5. For Campylobacter, the species identified were Campylobacter jejuni and Campylobacter coli. Phylogeny results show close genetic relatedness among bacterial strains isolated from different locations within the same stage and between different stages. The results show possibility of multiple entry points of such bacteria entering broiler complex and can potentially contaminate the final raw product in the processing plant. It suggests the need for a comprehensive control strategy with strict biosecurity measures and best management practices to minimize or eliminate such pathogens from the poultry food chain.

Evaluating the impact of gypsum as a novel bedding material on broiler performance, foot pad health, and fear response.

Flue Gas Desulfurization (FGD) gypsum is a byproduct of the coal-fired power plant process commonly used to remove sulfur dioxide emissions from the flue gas. FGD gypsum has numerous industrial, agricultural, and environmental applications. This study aimed to explore a novel approach involving the use of FGD gypsum combined with different litter treatments as bedding for broiler production. It focused on performance metrics, including adjusted feed conversion ratio (AFCR) and average body weight (BW), foot pad dermatitis (FPD), and fear response over 5 consecutive flocks. A total of 1,800 one-day-old Ross 708 chicks were randomly assigned to 24 pens (75 birds/pen), divided into 6 treatment groups (4 pens/treatment), with 5 replications and raised until 42 d old (d). Treatments were gypsum that was decaked (D), rotovated (E), and rotovated then windrowed (F) between flocks. Control treatments using pine shavings were decaked (A), rotovated (B), and windrowed postrotovating (C). AFCR, average BW, and mortality were used as a measure of production. Foot pad dermatitis scores were taken on d42 using a scale of 0 (absence), 1 (mild), and 2 (severe). Response to observer and human approach test were used to measure fear response. Data were analyzed as a 2-way ANOVA (Proc Glimmix) for the main effects of bedding type and litter treatment. Means were identified using Tukey's HSD. No effect of bedding type or litter treatment was found for AFCR, BW, or mortality. FPD scores 2 and 1, were higher with pine shavings than gypsum (P = 0.01 and P = 0.01, respectively). While FPD scores 0 were higher for gypsum than the pine shaving (P = 0.01). No difference in fear response was found among birds raised on any of the gypsum litter treatments and any of the pine shaving litter treatments. Overall, the use of gypsum as bedding results in equivalent production and fear response to pine shavings, while increasing FPD quality when compared to pine shaving.

Citrobacter freundii-associated osteomyelitis and thromboembolic events following Moderna COVID-19 vaccination: a rare case report from Nepal.

Introduction: Vaccination against coronavirus disease 2019 (COVID-19) is essential for controlling the ongoing cases of this disease. Citrobacter infections of the bones and joints are extremely uncommon. Thromboembolism and deep vein thrombosis (DVT) are very rare complications. Case presentation: The authors present a rare case of osteomyelitis, septic arthritis, deep venous thrombosis, and pulmonary embolism in a 15-year-old previously healthy boy occurring shortly after receiving the second dose of the Moderna COVID-19 vaccine. He experienced pain, swelling in the right leg, shortness of breath, and fever, followed by chest pain and leg edema. Treatment included anticoagulation, ketorolac for pain management, antipyretics, and intravenous antibiotics (Tazobactam/Piperacillin, Linezolid, Clindamycin) for osteomyelitis. Discussion: The risk of COVID-19 vaccine-related thrombotic events is minimal. Thrombotic events reported among mRNA is very rare. Citrobacter freundii bone and joint infections are very rare, accounting for a small percentage of cases. Some documented cases include cefotaxime-resistant strains causing necrotizing fascitis and osteomyelitis, including postarthroplasty infections. Due to the diverse range of susceptibility patterns and the widespread occurrence of drug resistance, personalized treatment based on culture and sensitivity testing is recommended. However, in rare cases, severe complications like DVT and joint infections associated with Citrobacter infection may occur and should be reported to the vaccine adverse events reporting system. Conclusion: Administering the COVID-19 vaccine to enhance natural antibodies is crucial, despite the low risk of infection, thromboembolism, and DVT. Healthcare providers should stay vigilant about adverse effects postvaccination and promptly report those cases.

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.

Association of vaccination status with the clinicobiochemical profile, hospital stay, and mortality in COVID-19: A case-control study.

Background and Aims: The effectiveness of coronavirus disease 2019 (COVID-19) vaccines in reducing symptoms, disease advancement, complications, and mortality in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been well-established. This case-control study aimed to compare different blood parameters, and prognostic and survival outcomes of COVID-19 patients based on vaccination status. Methods: We performed a case-control study that included hospitalized patients with COVID-19 at Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Individuals who received vaccination were designated as cases and unvaccinated individuals as controls. Demographics, co-morbidity, clinical data, laboratory data, and disease outcomes were recorded for both groups. Multivariate, Cox, and linear regression were used for analysing blood parameters, hospital admission, survival, and hospital stay, respectively, between cases and controls. Results: Out of 100 participants enrolled, 46 were vaccinated, and 54 weren't. At admission, ferritin and erythrocyte sedimentation rate (ESR) were significantly lower in cases. At discharge, cases showed a higher monocyte than controls. Ferritin, ESR, and d-imer showed excellent performance in determining the severity of symptoms. Significant correlation and regression of ferritin and ESR with the length of hospital stay was observed. Length of hospital stay was significantly lower in cases than in controls. No significant differences between cases and controls were observed in mortality. Conclusion: COVID-19 vaccines effectively reduced hospitalization duration. Ferritin and ESR were significantly lower in vaccinated individuals and showed the best utility in monitoring the disease.

Drug reaction with eosinophilia and systemic symptoms syndrome secondary to isoniazid and ethambutol: a case report and literature review.

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe, potentially life-threatening condition precipitated by reaction of therapeutic drugs. The prevalence of potential antitubercular therapy (ATT)-induced DRESS is 1.2%. Case presentation: A 71-year-old female patient after 5 weeks of starting ATT complaints of fever, vomiting, dizziness, and generalized itchy maculopapular rash over the body. It was associated with marked eosinophilia (absolute eosinophil count 3094 cell/mm3, 36% in peripheral blood smear). Discussion: Fever, rash, lymphadenopathy, and internal organ involvement with marked eosinophilia constitute the major clinical manifestations of DRESS. RegiSCAR scoring system is usually used to diagnose DRESS. Identification of the culprit drug is based on the temporal correlation of symptoms with drug exposure and rechallenge test, patch test and lymphocytic transformation tests may be valuable adjunctive tools. Treatment includes withdrawal of offending agent and use of topical or systemic corticosteroids, antihistamines, cyclosporin or JAK inhibitor with clinical judgement. Conclusion: Clinicians from the tuberculosis burden region must be aware of DRESS associated with ATT and they must counsel the patient properly before prescription and manage them without delay if DRESS ensues.

The Role of Dietary Supplementation of Yeast Cell Walls in Response to a Campylobacter jejuni Inoculation in Broiler Chickens.

Controlling Campylobacter jejuni during broiler production is a topic of interest from a public health standpoint, as colonized birds can contaminate poultry products during processing and sicken humans if not properly cooked or handled before consumption. The aim of this study was to evaluate dietary yeast cell wall (YCW) as a potential alternative to antibiotic growth promoters with or without a C. jejuni challenge. A total of 2240 day-old Ross 708 males were randomly assigned within 8 experimental groups with a 4 × 2 factorial design, with 4 diets (negative control [CTL-], positive control [CTL+, bacitracin, 50 g/ ton], YCW constant dose [400 g/ton], and YCW step-down dose [SD, 800, 400, and 200 g/ton in the starter, grower, and finisher periods, respectively]) and with or without a Day-16 C. jejuni oral gavage challenge at a 103-colony-forming-units (CFU)/ml dose. Body weights and feed consumption were measured on Days 0, 14, 28, and 41 to determine broiler performance. Ileum tissue samples were collected from 24 birds per treatment on Days 17 and 24 (1 and 8 days postinoculation [PI]) for relative gene expression (RGE) analysis. Cecal content samples were collected from 24 birds per treatment on Days 24, 34, and 42 for C. jejuni enumeration and prevalence calculation. A total of 80 birds per treatment were processed to determine carcass yield on Day 44, and on Day 45, 16 carcass rinsates per treatment were collected for C. jejuni enumeration and prevalence calculation. The interaction between diet and inoculation did not influence growth performance (P > 0.05). However, a diet effect was observed in the starter period where birds fed SD diet had a lower feed conversion ratio than birds fed CTL- diet (P = 0.0165). Additionally, the treatment of birds inoculated with C. jejuni fed with SD had a trend to a lower feed conversion ratio during the grower period (P = 0.0550). The RGE of interleukin 1ß and interleukin 10 was similar in all treatments 1 and 8 days PI. The RGE of avian beta defensin 10 was similar in all treatments on Day 1 PI, but different on Day 8 PI (P = 0.0476). All birds inoculated with C. jejuni had similar CFU per milliliter counts in the cecal contents at Days 24, 34, and 42 (P > 0.05), and all birds inoculated with phosphate-buffered saline were negative for C. jejuni after prevalence testing. After processing 1) carcass yield was similar in all treatments (P > 0.05); 2) C. jejuni-inoculated birds fed CTL- had lower CFU per milliliter counts than birds provided CTL+ and constant-dose diets (P = 0.0383); and 3) all birds inoculated with PBS were negative for Campylobacter. Overall, under the conditions of this study, the addition of YCW during a C. jejuni challenge did not have an impact on growth performance, innate immune response, cecal colonization, carcass yield, or carcass colonization after processing.

El papel de la suplementación dietética de paredes celulares de levadura en la respuesta a la inoculación de Campylobacter jejuni en pollos de engorde. El control de Campylobacter jejuni durante la producción de pollos de engorde es un tema de interés desde el punto de vista de la salud pública, ya que las aves colonizadas pueden contaminar los productos avícolas durante el procesamiento y enfermar a los humanos si no se cocinan o manipulan adecuadamente antes del consumo. El objetivo de este estudio fue evaluar la pared celular de levadura dietética (YCW) como una alternativa potencial a los antibióticos promotores del crecimiento con o sin desafío por C. jejuni. Un total de 2240 machos Ross 708 de un día de edad fueron asignados aleatoriamente dentro de ocho grupos experimentales con un diseño factorial 4 × 2, que incluye cuatro dietas (control negativo [CTL­], control positivo [CTL+, bacitracina, 50 g/ton], YCW a dosis constante [400 g/ton] y dosis progresivamente reducida de YCW [SD, 800, 400 y 200 g/ton en los períodos de inicio, crecimiento y finalización, respectivamente]) y con o sin un desafío al día 16 con C. jejuni por sonda oral a una dosis de 103 unidades formadoras de colonias (UFC)/ml. Se midieron los pesos corporales y el consumo de alimento los días 0, 14, 28 y 41 para determinar el rendimiento de los pollos de engorde. Se recolectaron muestras de tejido del íleon de 24 aves por tratamiento en los días 17 y 24 (1 y 8 días después de la inoculación [PI]) para el análisis de la expresión génica relativa (RGE). Se recolectaron muestras de contenido cecal de 24 aves por tratamiento en los días 24, 34 y 42 para la enumeración de C. jejuni y para el cálculo de la prevalencia. Se procesó un total de 80 aves por tratamiento para determinar el rendimiento de la canal en el día 44. En el día 45 se recolectaron 16 enjuagues de la canal por tratamiento para el recuento de C. jejuni y el cálculo de la prevalencia. La interacción entre la dieta y la inoculación no influyó en el rendimiento del crecimiento (P > 0.05). Sin embargo, se observó un efecto de la dieta en el período de iniciación, donde las aves alimentadas con la dieta progresivamente reducida tuvieron una tasa de conversión alimenticia más baja que las aves alimentadas con la dieta control negativa (P = 0.0165). Además, el tratamiento de aves inoculadas con C. jejuni alimentadas con la dieta progresivamente reducida tuvo una tendencia a una tasa de conversión alimenticia más baja durante el período de crecimiento (P = 0.0550). El análisis de expresión génica relativa de la interleucina 1ß y la interleucina 10 fue similar en todos los tratamientos a los días uno y ocho después de la inoculación. El análisis de expresión génica relativa de la beta defensina 10 aviar fue similar en todos los tratamientos en el día uno después del desafío, pero diferente en el día ocho después de la inoculación (P = 0.0476). Todas las aves inoculadas con C. jejuni tuvieron recuentos similares de UFC por mililitro en el contenido cecal en los días 24, 34 y 42 (P > 0.05), y todas las aves inoculadas con solución salina amortiguada de fosfatos fueron negativas para C. jejuni después de la prueba de prevalencia. Después del procesamiento 1) el rendimiento de la canal fue similar en todos los tratamientos (P > 0.05); 2) las aves inoculadas con C. jejuni y alimentadas con la dieta control negativa tuvieron recuentos de CFU por mililitro más bajos que las aves que recibieron la dieta control positiva y dietas de dosis constante (P = 0.0383); y 3) todas las aves inoculadas con la solución amortiguada de fosfatos fueron negativas para Campylobacter. En general, bajo las condiciones de este estudio, la adición de la pared celular de levadura dietética durante un desafío con C. jejuni no tuvo un impacto en el rendimiento del crecimiento, en la respuesta inmune innata, en la colonización cecal, en el rendimiento de la canal o la colonización de la canal después del procesamiento.

Managing Chronic Neuropathic Pain: Recent Advances and New Challenges.

Aim: Neuropathic pain affects 7-10% of the population, with most of the patients receiving inadequate and incomplete treatment. Owing to the high financial burden and the poor quality of life of the patients and their caretakers, there is a dire need to address the challenges in diagnosing and treating chronic neuropathic pain. Methods: This literature review was conducted to review novel treatments and related challenges through a systematic search from sources such as PubMed, Google Scholar with the combination of MESH words such as neuropathic pain, management of neuropathic pain. Articles from non-English literature, reports without human subjects, animal studies, and abstracts/posters were excluded. However, human studies and studies published in English were included. Result: This review article discusses novel treatment modalities while acknowledging the challenges medical workers face while encountering neuropathic pain. Despite the recent advances in diagnosis and treatment modalities, several challenges still exist. Hence, there is still a need to explore the various treatment modalities, emphasizing the cause and underlying pathophysiology of neuropathic pain. Conclusion: We recommend integrated multimodal treatment with the current treatment facility, including various medical disciplines. However, a personalized approach would work the best depending on the 'patient's medical history. Therefore, this article recommends an integrated, cause-specific, cost-effective approach to address this problem of chronic neuropathic pain.

Post-COVID syndrome: A prospective study in a tertiary hospital of Nepal.

INTRODUCTION: The post-coronavirus disease 2019 (COVID-19) syndrome is defined as the persistence of symptoms after viral clearance and the emergence of new symptoms after a few months following recovery from COVID-19. This study aimed to assess the prevalence of post-COVID-19 syndrome and the risk factors that contribute to its development. METHODS: This study was conducted prospectively in Tribhuvan University Teaching Hospital (TUTH), located in Maharajgunj, Kathmandu. The patients were followed up for three months. RESULTS: The post-COVID status of 300 patients admitted to the COVID emergency of TUTH was studied. The mean age of the patients was 46.6±15.7 years, and the proportion of male (56%) was slightly higher than female (44%). Most of the patients (81.7%) had fever on their presentation to the emergency which was followed by fatigue (81.3%) and cough (78.3%). During the post-COVID phase, fatigue was the most common persistent symptom, with 34% experiencing fatigue after 60 days and 28.3% even after 90 days from the onset of symptoms. Univariate logistic regression showed sore throat (OR 4.6; 95% CI (2.8-7.6)), rhinitis (OR 3.6; 95% CI (2.1-5.9)), fatigue (OR 3.7; 95% CI (1.8-7.6)), diarrhea (OR 4.1; 95% CI (2.4-6.9)), anosmia (OR 6.7; 95% CI (3.9-11.3)), ageusia (OR 7.8; 95% CI (4.5-13.4)) and shortness of breath (OR 14.9; 95% CI (1.8-119.6)) at admission were all predictors of post-COVID syndrome after three months. CONCLUSION: Even after recovering from COVID-19, people with COVID-19 may develop symptoms. As a result, COVID-19's long-term consequences should not be neglected, as they may lead to increased morbidity among patients, consumption of financial resources, and added burden on the health system.

Pattern of Tuberculosis, Trend and Outcome of Patients Registered at DOTS Centre of a Tertiary Care Hospital.

BACKGROUND: Tuberculosis is a common respiratory disease imposing significant health burden. Directly observed treatment short course strategy ensures patient compliance in tuberculosis treatment. The aim of this study was to assess pattern of tuberculosis, trend and outcome of patients registered at Directly observed treatment short course centre of Tribhuvan University Teaching Hospital. METHODS: A retrospective observational study was conducted at Tribhuvan University Teaching Hospital. Tuberculosis patients of all age groups registered from July 2017 to June 2020 at Tribhuvan University Teaching Hospital Directly observed treatment short course centre were included. Data entry and analysis was done in SPSS version 20.0. Descriptive statistics was performed and results were interpreted in mean, frequency and percentage. RESULTS: A total of 2790 tuberculosis patients were included for final analysis. There were 1736 (62.2%) males. Mean age of patients was 37.94±20.28 years. Pulmonary tuberculosis was the most common type of tuberculosis seen in 948 (34%) patients. Fifty percent of total tuberculosis cases were confined to thorax. Tubercular pleural effusion and pleurisy (14.6%), central nervous system (13.2%), bone and joint (12.2%) were common forms of extrapulmonary tuberculosis. The mean incident tuberculosis cases registered annually was 697.5±95.63. Nearly half (49.1%) of the patients completed tuberculosis treatment regimen while 43.3% were referred to other Directly observed treatment short course centre as per their convenience. CONCLUSIONS: This study reflects the trend and pattern of tuberculosis epidemiology at tertiary care hospital of Nepal. There is a huge burden of both pulmonary and extrapulmonary tuberculosis at Tribhuvan University Teaching Hospital with slight annual variation in incident tuberculosis cases. Despite implementation of Directly observed treatment short course, the problem of non-compliance persists among the tuberculosis patients.

Pegcetacoplan in paroxysmal nocturnal hemoglobinuria: A systematic review on efficacy and safety.

Introduction: Pegcetacoplan, a pegylated penta-decapeptide, targets complement C3 to control both intravascular and extravascular hemolysis. This systematic review aims to study the efficacy and safety of pegcetacoplan in paroxysmal nocturnal hemoglobinuria (PNH). Methods: We performed a comprehensive and systematic literature search for all studies on PubMed, Google Scholar, Cochrane Library, and clinicaltrials.gov. The studies were searched using keywords "paroxysmal nocturnal hemoglobinuria" or "PNH," "Pegcetacoplan" or "Empaveli." The primary outcomes included change in hemoglobin level, transfusion independence, absolute reticulocyte count, and lactate dehydrogenase (LDH) level after pegcetacoplan therapy. The safety outcomes included the proportion of deaths and adverse effects. Results: We included a total of three studies. The total number of patients with PNH was112. 59.83% were female. In the PADDOCK study and study by Hillmen et al., the average increase in hemoglobin was 3.68 g/L and 2.37 g/L, respectively. In the study by de Castro et al., the hemoglobin level increased from below the lower limit of normal and stayed in the normal range (11.1-15.9 g/L). Absolute reticulocyte count and LDH levels decreased in all patients receiving pegcetacoplan. In the study by de Castro et al., LDH level remained stable, and within <1.5× upper limit of normal, whereas in the study by Hillman, the mean change of LDH from baseline was -15 ± 43 U/L. Two of six, seven of 23, and seven of 41 patients reported adverse events in the study by de Castro et al., PADDOCK, and Hillmen et al., respectively. Conclusion: Pegcetacoplan effectively improves hemoglobin level and transfusion requirements in patients with PNH, including those unresponsive to eculizumab.

Anchored fallopian tube through the drain tube: A rare case report.

Anchored fallopian tube through the drain tube is rare. We present a case of a 27-year-old female patient who underwent right salpingectomy with the fenestrated drain tube in the pelvic cavity. Postoperatively, the drain could not be removed. Laparotomy revealed the left fallopian tube entering through the fenestration of the drain tube.

Optic neuropathy induced by ethambutol: A rare case from Nepal.

Introduction: Ethambutol is a drug used against tuberculosis and causes side effects like problems with vision, which may lead to optic neuropathy. It has a low prevalence of 1% and typically develops after 4-12 months of its medications. Case presentation: Here, we report a case of a 42-year-old male with ethambutol-induced optic neuropathy after six weeks of initiations of ethambutol. Discussion: Nutritional and tobacco/alcohol, ischemia, compressive, demyelinating, and genetic optic neuropathies were all ruled out as differential diagnosis for toxic optic neuropathy. Because our patient did not have vasculopathy and his vision loss was progressive on follow up and bilateral, rather than acute and unilateral, as is more usual with an ischemic disease, ischemic optic neuropathy was ruled out. Finally, because hereditary optic neuropathy usually manifests at a younger age and is expressed in many generations which was not the case in our patient, it was effectively ruled out as the cause of optic neuropathy. Conclusion: This case highlights that ethambutol toxicity is rare in cases of new onset pulmonary tuberculosis where ethambutol has been administered for only 2 months.

Ethnomedicinal landscape: distribution of used medicinal plant species in Nepal.

BACKGROUND: The risk of losing traditional knowledge of medicinal plants and their use and conservation is very high. Documenting knowledge on distribution and use of medicinal plants by different ethnic groups and at spatial scale on a single platform is important from a conservation planning and management perspective. The sustainable use, continuous practice, and safeguarding of traditional knowledge are essential. Communication of such knowledge among scientists and policy makers at local and global level is equally important, as the available information at present is limited and scattered in Nepal. METHODS: In this paper, we aimed to address these shortcomings by cataloguing medicinal plants used by indigenous ethnic groups in Nepal through a systematic review of over 275 pertinent publications published between 1975 and July 2021. The review was complemented by field visits made in 21 districts. We determined the ethnomedicinal plants hotspots across the country and depicted them in heatmaps. RESULTS: The heatmaps show spatial hotspots and sites of poor ethnomedicinal plant use documentation, which is useful for evaluating the interaction of geographical and ethnobotanical variables. Mid-hills and mountainous areas of Nepal hold the highest number of medicinal plant species in use, which could be possibly associated with the presence of higher human population and diverse ethnic groups in these areas. CONCLUSION: Given the increasing concern about losing medicinal plants due to changing ecological, social, and climatic conditions, the results of this paper may be important for better understanding of how medicinal plants in use are distributed across the country and often linked to specific ethnic groups.

Bioactive secondary metabolites in Paris polyphylla Sm. and their biological activities: A review.

Paris polyphylla Sm. is an important medicinal plant used to treat a variety of diseases through traditional medicine systems such as Ayurveda, Tibetan traditional medicines, Chinese traditional medicines, and others around the world. The IUCN red list has designated it as "vulnerable" due to a decline in wild population by over-exploitation, habitat degradation, illegal collection for trade and traditional use. This review paper aims to summarize the bioactive secondary metabolites in Paris polyphylla. Paris saponins or steroidal saponins are the main bioactive chemical constituents from this plant that account for more than 80% of the total compounds. For instance, polyphyllin D, diosgenin, paris saponins I, II, VI, VII, and H are steroidal saponins having anticancer activity comparable to synthetic anticancer medicines. Antioxidant, anticancer, anti-leishmaniasis, antibacterial, antifungal, anthelmintic, antityrosinase, and antiviral effects of extracts and pure compounds were also demonstrated in vivo and in vitro. In conclusion, this review summarizes the bioactive components from the P. polyphylla which will be useful to researchers and scientists, and for the development of potential drugs.

Acute Lower Limb Ischemia in COVID-19 Patient with Delayed Presentation.

Thromboembolism is a common complication of SARS-CoV-2, which generally involves venous thromboembolism, although there have been reported cases of arterial thrombosis affecting cerebral, coronary, and visceral arteries, as well as arteries in the extremities. We discuss a case of a 45-year-old diabetic man with COVID-19 who developed late-onset acute lower limb ischemia.

Reactivation of herpes zoster after vaccination with an inactivated vaccine: A case report from Nepal.

COVID-19 has been linked to a number of cutaneous symptoms in COVID-19 patients. Although herpes zoster (HZ) was the first sign of COVID-19 infection in several patients, cases of HZ after COVID-19 vaccination are rare. Here, we report a case of 51-year-old male patient with herpes zoster after Sinopharm (Vero cell) vaccination.

Case report of a spontaneous pneumothorax after the recovery from COVID-19 pneumonia: A delayed complication.

This case demonstrates pneumothorax as a consequence of COVID-19 and emphasizes the significance of follow-up of the COVID-19 patients.