A gap in nitrous oxide emission reporting complicates long-term climate mitigation.

Nitrous oxide (N2O) is an important greenhouse gas (GHG) that also contributes to depletion of ozone in the stratosphere. Agricultural soils account for about 60% of anthropogenic N2O emissions. Most national GHG reporting to the United Nations Framework Convention on Climate Change assumes nitrogen (N) additions drive emissions during the growing season, but soil freezing and thawing during spring is also an important driver in cold climates. We show that both atmospheric inversions and newly implemented bottom-up modeling approaches exhibit large N2O pulses in the northcentral region of the United States during early spring and this increases annual N2O emissions from croplands and grasslands reported in the national GHG inventory by 6 to 16%. Considering this, emission accounting in cold climate regions is very likely underestimated in most national reporting frameworks. Current commitments related to the Paris Agreement and COP26 emphasize reductions of carbon compounds. Assuming these targets are met, the importance of accurately accounting and mitigating N2O increases once CO2 and CH4 are phased out. Hence, the N2O emission underestimate introduces additional risks into meeting long-term climate goals.

Impacts assessment of nitrification inhibitors on U.S. agricultural emissions of reactive nitrogen gases.

Fertilizer-intensive agriculture leads to emissions of reactive nitrogen (Nr), posing threats to climate via nitrous oxide (N2O) and to air quality and human health via nitric oxide (NO) and ammonia (NH3) that form ozone and particulate matter (PM) downwind. Adding nitrification inhibitors (NIs) to fertilizers can mitigate N2O and NO emissions but may stimulate NH3 emissions. Quantifying the net effects of these trade-offs requires spatially resolving changes in emissions and associated impacts. We introduce an assessment framework to quantify such trade-off effects. It deploys an agroecosystem model with enhanced capabilities to predict emissions of Nr with or without the use of NIs, and a social cost of greenhouse gas to monetize the impacts of N2O on climate. The framework also incorporates reduced-complexity air quality and health models to monetize associated impacts of NO and NH3 emissions on human health downwind via ozone and PM. Evaluation of our model against available field measurements showed that it captured the direction of emission changes but underestimated reductions in N2O and overestimated increases in NH3 emissions. The model estimated that, averaged over applicable U.S. agricultural soils, NIs could reduce N2O and NO emissions by an average of 11% and 16%, respectively, while stimulating NH3 emissions by 87%. Impacts are largest in regions with moderate soil temperatures and occur mostly within two to three months of N fertilizer and NI application. An alternative estimate of NI-induced emission changes was obtained by multiplying the baseline emissions from the agroecosystem model by the reported relative changes in Nr emissions suggested from a global meta-analysis: -44% for N2O, -24% for NO and +20% for NH3. Monetized assessments indicate that on an annual scale, NI-induced harms from increased NH3 emissions outweigh (8.5-33.8 times) the benefits of reducing NO and N2O emissions in all agricultural regions, according to model-based estimates. Even under meta-analysis-based estimates, NI-induced damages exceed benefits by a factor of 1.1-4. Our study highlights the importance of considering multiple pollutants when assessing NIs, and underscores the need to mitigate NH3 emissions. Further field studies are needed to evaluate the robustness of multi-pollutant assessments.

Endoscopic Drainage of Pancreatic Pseudocysts: Clinical Profile and Outcome Analysis.

BACKGROUND: Pancreatic pseudocyst is a complication of acute and chronic pancreatitis. Although surgery considered the gold standard, there is a rapid shift towards endoscopic treatment owing to its therapeutic outcome and minimal invasive involvement. This study aims to present the clinical profile and outcome analysis of the endoscopic drainage of pancreatic pseudocysts in Dhulikhel Hospital. METHODS: This is a retrospective review of all patients who were diagnosed with pancreatic pseudocyst between January 2015 and December 2018 in Dhulikhel Hospital. The retrospective data were on patient characteristics, etiology, location of the cyst, other clinical characteristics. RESULTS: The study included 51 patients and the average age of the patients in this study was 39 years and among them 62.7% were female. The mean size of pseudocyst was 7.89 cm, and the average days of hospital stay was 13.64. The most common etiology was idiopathic and more than half of the patient's cyst was in head and/or body, 15 and 36 underwent conservative and therapeutic management respectively. The technical success rate was at 94% and reported increased pancreatic pseudocyst in Dhulikhel Hospital from 2015-18. CONCLUSIONS: The study findings highlight the increased trend of pancreatitis pseudocyst as a complication of acute or chronic pancreatitis. Endoscopic drainage of pseudocyst with plastic stent is an established method of managing it. However, pancreatic pseudocyst even larger than 6 cm can undergo spontaneous resolution.Hence, conservative management should be considered first.

Demographic and clinical profile of patients undergoing colonoscopy at a tertiary care center in Nepal: a retrospective cross-sectional study.

Background: Colonoscopy is widely used as a tool for diagnosis, screening and treatment of various pathologies in the rectum, colon, and terminal ileum. The aim of this study is to evaluate the demographic, clinical, and histological parameters of the records of patients undergoing colonoscopy at a tertiary care hospital in Nepal. Materials and methods: This retrospective cross-sectional study included the hospital records of all patients who underwent colonoscopy from 2015 to 2019 in a tertiary care centre in Nepal. Results: A total of 1255 records were included in the study. The mean and standard deviation of age were 43.8 and 19 years, respectively. Among the total study population, 61.9% were males and 38.1% were females. Common indications for colonoscopy included lower gastrointestinal bleeding (27.7%), altered bowel habit (26.9%) and persistent or recurrent abdominal pain (17.3%). Only 3% of the patients who underwent colonoscopy had inadequate bowel preparation. The overall diagnostic yield of colonoscopy was 57.5%. Findings during colonoscopy included colorectal polyp (19.4%), internal haemorrhoids (8.2%) and colitis (6.5%). Having an age of 50 or more years was significantly associated with the presence of colorectal adenocarcinoma (P=0.017, χ2 test) with an odds ratio of 2.35 (95% CI: 1.14, 4.89). Furthermore, having a female sex was found to be significantly associated with the presence of colorectal adenocarcinoma (P=0.012, χ2 test) with an odds ratio of 2.43 (95% CI: 1.19, 4.97). Conclusion: In the authors' study, a smaller proportion of the colonoscopies was aimed at screening for colorectal carcinoma (CRC), when compared to studies in developed countries. The sex predisposition of CRC in the authors' study is in contrast to the global trend. The authors recommend conducting studies to determine the risk factors and need for CRC screening in the Nepalese population.

Nonhealing oesophageal ulcer: a case report.

Esophageal tuberculosis is a rare presentation of a common infectious disease. It may occur as a primary infection of the esophagus or as a secondary spread mostly from caseating mediastinal lymph nodes. The clinical diagnosis of the condition is presumed to be complex, owing to nonspecific biopsy findings, failure of isolation of bacilli, and a lack of predisposing conditions in patients. This study aims to present a rare condition of esophageal tuberculosis secondary to mediastinal lymphadenitis and highlights a unique modality of diagnosis of the condition, especially in a resource strained setting. Case presentation: This case report presents the case of a 50-year-old male with dysphagia and a burning sensation at the epigastrium. Endoscopy and histopathological examination showed ulceration at the esophagus and granulomatous inflammation, respectively. Computed tomography showed enlargement of the prevascular and paratracheal group of lymph nodes. However, the acid-fast bacilli stain at the ulcer site was negative. The diagnosis could be confirmed only after 2 months of the antitubercular treatment trial, which significantly potentiated ulcer healing. Clinical discussion: Esophageal tuberculosis may result from a secondary infection caused by systemic dissemination following a pulmonary disease or as a primary infection. In this case, it likely resulted from lymphatic dissemination via prevascular and paratracheal lymph nodes manifested mainly as dysphagia. Conclusion: Tuberculosis should be considered as one of the differential diagnoses in areas of limited resources. Clinicians may have to rely on clinical judgement and/or the patient's response to standard antitubercular treatment to make a definitive diagnosis.

Counterfactual scenarios reveal historical impact of cropland management on soil organic carbon stocks in the United States.

Natural climate solutions provide opportunities to reduce greenhouse gas emissions and the United States is among a growing number of countries promoting storage of carbon in agricultural soils as part of the climate solution. Historical patterns of soil organic carbon (SOC) stock changes provide context about mitigation potential. Therefore, our objective was to quantify the influence of climate-smart soil practices on SOC stock changes in the top 30 cm of mineral soils for croplands in the United States using the DayCent Ecosystem Model. We estimated that SOC stocks increased annually in US croplands from 1995 to 2015, with the largest increase in 1996 of 16.6 Mt C (95% confidence interval ranging from 6.1 to 28.2 Mt CO2 eq.) and the lowest increase in 2015 of 10.6 Mt C (95% confidence interval ranging from - 1.8 to 22.2 Mt C). Most climate-smart soil practices contributed to increases in SOC stocks except for winter cover crops, which had a negligible impact due to a relatively small area with cover crop adoption. Our study suggests that there is potential for enhancing C sinks in cropland soils of the United States although some of the potential has been realized due to past adoption of climate-smart soil practices.

Cronkhite-Canada Syndrome: A Case Report.

Cronkhite-Canada Syndrome is a rare disease characterised by diffuse gastrointestinal polyposis, abdominal pain, diarrhoea, cutaneous and mucosal hyperpigmentation, alopecia, and onychodystrophy. Here we report a case of a 40-year-old female with Cronkhite-Canada Syndrome, who presented with the complaints of diffuse abdominal pain, blood mixed stools, and diarrhoea associated with tenesmus. She had nausea and reduced appetite and lost 10 kgs in 3 months. She had hair fall (alopecia), atrophic changes of nails (onychodystrophy), and hyperpigmentation of the skin in fingers, tongues, and lips. Histopathological biopsy of the gastric and colonic biopsy revealed polypoid edematous mucosa and the colonic biopsies showed scattered dilated glands with inflammatory exudate and mucin. She got Entamoeba histolytica and COVID-19. She received respective antibiotics and protein diets that helped relieve the symptoms. After 4 weeks of steroids, her symptoms improved drastically. Corticosteroids, treating co-infection along with nutritional counselling can be helpful to relieve the symptoms. Keywords: alopecia; case reports; cronkhite-canada syndrome; hyperpigmentation.

Hepatitis C Virus Infection in Pregnancy and Children: Its Implications and Treatment Considerations with Directly Acting Antivirals: A Review.

Hepatitis C virus infection (HCV) is a global health problem affecting >71 million people worldwide with chronic hepatitis C, 40% reproductive age group, and 8% pregnant women. Intravenous drug abuse, multi-transfusions are major risk factors in adults, while vertical transmission in pediatric population. It commonly presents as a chronic liver disease, has higher risk of liver cirrhosis and even progression to hepatocellular carcinoma. Therefore, proper screening of high-risk populations including pregnancy is recommended. All diagnosed chronic hepatitis C cases should be treated with directly acting anti-virals (DAAs) including pre-conception which has a cure rate of >95%. This would reduce the disease burden, vertical transmission, and disability associated. However, no DAAs regimens recommendation till date due to lack of evidence on adverse fetal outcomes and are concerned about the pharmacokinetic effect regarding physiological changes during pregnancy. Therefore, in this review, we have tried to explore the possible use of DAAs regimens and their safety issues during pregnancy, and possible consideration of few pan-genotypic regimens in the late 2nd and early 3rd trimester. This would not only prevent vertical transmission and decrease disease burden but also help to meet the WHO 2030 target of HCV elimination as a major public health problem.

Epidemiology of Inflammatory Bowel Diseases in Nepal.

Introduction Inflammatory bowel diseases (IBD) comprise ulcerative colitis (UC) and Crohn's disease (CD). These are diseases of the gastrointestinal tract without a clear etiology but have strong relationships with underlying factors like genetic susceptibility, environmental factors, and intestinal bacteria. In the east, inflammatory bowel diseases predominantly affect the younger population and have an almost equal gender distribution. With urbanization and the adoption of the western lifestyle, the incidence and prevalence of IBD are increasing in Asia. In this study, we describe the epidemiology of IBD in Nepal. Methods This was an observational study conducted in nine endoscopy centers within Nepal. Two years of data of colonoscopies in these centers were collected retrospectively. IBD was diagnosed by endoscopic examination. The incidence of IBD was calculated as the number of patients with IBD per 1000 colonoscopies per year. The demographic profiles of the patients were also collected. Results A total of 7526 colonoscopies were done in nine centers within the two years study period. IBD was seen in 479 patients (6.3%). The incidence of UC was 23.7 per 1000 colonoscopies per year and the incidence of CD was 1.6 per 1000 colonoscopies per year. UC (87%) was more common than CD (13%). Both UC and CD were mostly seen in the 30 to 40 years age group. In patients with UC, the rectum was the most commonly affected site. Discussion IBD in Nepal affects young males in their thirties. Younger age of affliction with a chronic disease and lack of awareness regarding the symptoms and diagnostic modalities of IBD may result in a delayed diagnosis. The target population must be made aware of the presenting symptoms of IBD and a need for colonoscopic examination for diagnosis. There is also a need for creating a national IBD registry for Nepal.

Modeling nitrous oxide mitigation potential of enhanced efficiency nitrogen fertilizers from agricultural systems.

Agriculture soils are responsible for a large proportion of global nitrous oxide (N2O) emissions-a potent greenhouse gas and ozone depleting substance. Enhanced-efficiency nitrogen (N) fertilizers (EENFs) can reduce N2O emission from N-fertilized soils, but their effect varies considerably due to a combination of factors, including climatic conditions, edaphic characteristics and management practices. In this study, we further developed the DayCent ecosystem model to simulate two EENFs: controlled-release N fertilizers (CRNFs) and nitrification inhibitors (NIs) and evaluated their N2O mitigation potentials. We implemented a Bayesian calibration method using the sampling importance resampling (SIR) algorithm to derive a joint posterior distribution of model parameters that was informed by N2O flux measurements from corn production systems a network of experimental sites within the GRACEnet program. The joint posterior distribution can be applied to estimate predictions of N2O reduction factors when EENFs are adopted in place of conventional urea-based N fertilizer. The resulting median reduction factors were - 11.9% for CRNFs (ranging from -51.7% and 0.58%) and - 26.7% for NIs (ranging from -61.8% to 3.1%), which is comparable to the measured reduction factors in the dataset. By incorporating EENFs, the DayCent ecosystem model is able to simulate a broader suite of options to identify best management practices for reducing N2O emissions.

Adaptation in U.S. Corn Belt increases resistance to soil carbon loss with climate change.

Increasing the amount of soil organic carbon (SOC) has agronomic benefits and the potential to mitigate climate change. Previous regional predictions of SOC trends under climate change often ignore or do not explicitly consider the effect of crop adaptation (i.e., changing planting dates and varieties). We used the DayCent biogeochemical model to examine the effect of adaptation on SOC for corn and soybean production in the U.S. Corn Belt using climate data from three models. Without adaptation, yields of both corn and soybean tended to decrease and the decomposition of SOC tended to increase leading to a loss of SOC with climate change compared to a baseline scenario with no climate change. With adaptation, the model predicted a substantially higher crop yield. The increase in yields and associated carbon input to the SOC pool counteracted the increased decomposition in the adaptation scenarios, leading to similar SOC stocks under different climate change scenarios. Consequently, we found that crop management adaptation to changing climatic conditions strengthen agroecosystem resistance to SOC loss. However, there are differences spatially in SOC trends. The northern part of the region is likely to gain SOC while the southern part of the region is predicted to lose SOC.

An Unwanted Guest in the Biliary Tract: A Case Report.

Ascariasis is a frequent human gastrointestinal tract helminthic disease caused by Ascaris lumbricoide. It usually stays in the intestinal lumen and occasionally migrates into the biliary tract through ampulla of Vater .Biliary ascariasis is a critical complication of intestinal ascariasis with life-threatening manifestations .We report a case of a-38 year-old lady who presented with colicky type epigastric pain radiating to back with diffuse tenderness over abdomen on examination. Ultrasonography abdomen showed linear echogenic structure in common bile duct .Biliary ascariasis was noted on Endoscopic Retrograde CholangioPancreaticography following which extraction was done .Our report highlights the varied clinical features of biliary ascariasis. Keywords: ascariasis; ascaris lumbricoides; cholangiopancreatography endoscopic retrograde; common bile duct.