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ABSTRACT BRASH syndrome characterized by bradycardia, renal dysfunction, atrioventricular nodal blockade (AVNB), shock, and hyperkalemia presents diagnostic and management challenges due to its complex pathophysiology and varied clinical presentations. We describe a 90‐year‐old woman with a history of multiple comorbidities who was on beta blockers bisoprolol for heart failure, presented with shock, refractory hyperkalemia along with bradycardia that required intermittent hemodialysis. Initial management involved aggressive hyperkalemia medical therapy and fluid resuscitation, with subsequent consideration of renal replacement therapy hemodialysis following collaboration with a multidisciplinary team, including cardiology and nephrology specialists. Despite aggressive medical management for hyperkalemia, some cases of BRASH syndrome may remain challenging to treat, requiring intermittent hemodialysis highlighting the need for further research and understanding of this complex clinical entity to improve treatment outcomes.

ABSTRACT Mayer–Rokitansky–Küster–Hauser syndrome (MRKHS) is a rare congenital disorder characterized by agenesis of the uterus and upper two‐thirds of the vagina. It affects around 1 in 4000–5000 females and is of two types: type 1, also known as isolated Müllerian aplasia or Rokitansky, which involves only uterovaginal agenesis, and type 2, presents as uterovaginal agenesis along with renal, cardiac, and other organ anomalies. Despite the absence of vaginal and uterine structures, individuals with MRKHS typically present with normal secondary sexual characteristics and ovarian functions. A 26‐year‐old female presented with primary amenorrhea. Despite this, she had typical secondary sexual characteristics. Physical examination revealed normal pubic hair distribution and external genitalia, consistent with Tanner's stage 5 development. Further evaluation via magnetic resonance imaging (MRI) confirmed diagnosis of MRKHS type II, revealing the absence of the uterus and upper two‐thirds of the vagina, with normal ovaries and absent left kidney. A multidisciplinary team performed McIndoe vaginoplasty creating a successful neovagina, measuring 7 cm in length, using split‐thickness skin graft. MRKHS, a rare congenital anomaly involving Müllerian duct abnormalities, poses diagnostic and therapeutic challenges. The etiology remains unknown, but it likely stems from defective Müllerian fusion during embryologic development. Differential diagnosis from conditions like androgen insensitivity syndrome (AIS) is crucial. MRI is important in diagnosis, revealing associated anomalies. Treatment aims to restore sexual function. This case presents that MRKHS can occur with normal hormonal function and typical secondary sexual characteristics. Neovagina creation is an effective surgical intervention for young females seeking to restore sexual function.

Abstract The integration of high‐throughput technologies such as near‐infrared spectroscopy (NIRS) for phenomic‐assisted selection in plant breeding has gained relevance in recent years. In blueberry, the use of phenomic selection could enable selection in the early stages, where thousands of seedlings are visually selected, and the use of genomic selection (GS) is cost‐prohibitive. In this study, we compared phenomic and GS in 372 genotypes, which were phenotyped for multiple fruit quality traits across 2 years. Our contribution is fourfold: (i) phenomic and GS methods have comparable predictive performances for multiple traits; (ii) leaves can achieve the highest genetic gains in the long term among NIRS of different biological tissues (leaf and fruit); (iii) BayesB, mixed models, and random forest resulted in the best predictive results across traits for optimizing phenomic prediction; and finally (iv) attention was drawn to the possibility of using phenomic prediction across environments. Altogether, for the first time in the blueberry literature, the utility of NIRS for phenomic‐assisted selection is demonstrated. While the primary focus is on blueberries, this approach can be evaluated in other fruit trees.

ABSTRACT Background Patients with high dental anxiety are found to visit dental offices less frequently and have a higher number of severely diseased teeth so they are at a greater need for intensive oral care and rehabilitation. Objectives The aim of this study was to assess the prevalence of dental anxiety and its impact on the dental status of Nepali adult patients. Material and Methods A semi‐structured questionnaire of the Modified Dental Anxiety Scale (MDAS) in the Nepali version was used for data collection. The data analysis was done using Statistical Package for Social Sciences (SPSS IBM, Chicago, IL, USA, version 24). Variables were calculated as frequency and percentage, while the comparisons of different factors were done using the ANOVA and t‐test. A difference with p

Abstract Transformative technologies such as artificial intelligence (AI) make difficult tasks more accessible and convenient. Since 2018, the use of AI in research has increased drastically, with annual publication rates of 3–5 times higher than pre‐2017. Currently, >100,000 manuscripts using AI are published annually within science and engineering, and >20,000 of these belong to the agricultural and environmental fields. Given the magnitude of use, clear communication on how AI is used and how it helps advance scientific knowledge is essential. Clear communication is perhaps more necessary with AI than previous technologies due to its broad and flexible spectrum of uses, the “black‐box” nature of deep‐learning algorithms, and ongoing debates regarding AI's predictive power versus knowledge of first‐principles mechanistic and process‐based theories and models. In this commentary, we provide guidelines and discussion points to the scientific community to ensure transparent and effective communication of AI research in agricultural and environmental research publications.

Abstract Arid and semiarid regions cover more than one‐third of the land surface, where the interplay between water, land use, and management strongly influences carbon (C) sequestration. Yet, information on the C management practices and how local biophysical conditions affect the C sequestration potential is limited. We explored the opportunities, research gaps, and future directions of land C sequestration in arid and semiarid regions, using New Mexico as an example. We also identified the major land use types and their potential for C storage and sequestration. Our results showed that innovations in cropland and rangeland management, protection of existing forests, and restoration of degraded forest lands after drought and wildfire enhanced C sequestration in arid and semiarid lands. Landscape‐scale C balance studies with fine‐scale mapping, improving water and nutrient use efficiency, and policy incentives to support farms will unlock the full potential of C sequestration in croplands, rangelands, and forest lands. Future research should focus on the response of land management practices to climate anomalies and their potential to sequester C and offset greenhouse gas emissions as a natural climate solution in arid and semiarid regions.

ABSTRACT Background and Aim Postoperative pancreatic fistula (POPF) remains a significant challenge following pancreatoduodenectomy (PD), contributing to morbidity and mortality. Various risk assessment models have been established to predict the likelihood of POPF. An updated alternate fistula risk score (ua‐FRS) has been recently refined and validated within European cohorts. However, the validation of this score in South Asian cohorts remains relatively unexplored. This study aims to validate the applicability of ua‐FRS for the prediction of POPF in patients undergoing PD in the South Asian population, particularly Nepal. Methods This cross‐sectional, observational study was conducted by a single team across three tertiary care centers in Kathmandu, Nepal from July 2021 to October 2023. A total of 98 patients were studied in terms of their sex, body mass index (BMI), diameter of the main pancreatic duct (MPD), pancreatic consistency, pathological site, and estimated blood loss. The accuracy of ua‐FRS for the prediction of postoperative pancreatic fistula after pancreatoduodenectomy was evaluated using the receiver operative characteristics curve. Results Univariate analysis revealed that sex, pancreatic gland texture, the diameter of the main pancreatic duct, the site of pathology, and BMI were statistically significant factors. However, in the multivariate analysis, only BMI and the diameter of the MPD retained their statistical significance, with p‐values less than 0.005. The ua‐FRS demonstrated high sensitivity and specificity in predicting postoperative pancreatic fistula, as evidenced by an area under the curve (AUC) of 0.802. Conclusion The ua‐FRS has validation in the context of the South Asian population to predict POPF following PD, offering a reliable tool to guide perioperative management.

Abstract The implications of global warming present significant threats to both crop productivity and environmental sustainability. The global population greatly depends on rice as a staple food, contributing significantly to global warming and agricultural greenhouse gas (GHG) emissions. Agricultural soils play a crucial role in the release and uptake of essential GHGs, including methane (CH4), nitrous oxide (N2O), and carbon dioxide (CO2), serving as both sources and sinks within the agricultural ecosystem. Notably, rice fields alone account for approximately 30% and 11% of global CH4 and N2O emissions from agricultural activities, respectively. As the demand for rice is expected to rise in the future, it becomes increasingly critical to address GHG emissions and minimise the detrimental environmental effects associated with rice production. This review provides a comprehensive synthesis of the available data regarding the influence of different crop management practices on GHG emissions in rice fields. We recognise the substantial potential for reducing GHG emissions through modifications in traditional crop management systems. Our analysis evaluates various options, such as adjustments in cropping practices, regulation of organic and fertiliser inputs, management of tillage techniques and irrigation strategies, and the selection of suitable cultivars, all of which can contribute to GHG emission reduction. It is crucial to consider that changes in management practices may have simultaneous and sometimes contradictory effects on different gases through various mechanisms. Therefore, our comprehensive evaluation aims to assess the potential global warming impact of each approach, considering the magnitude of their effects on all gases. This assessment seeks to identify suitable crop management practices that effectively reduce GHG emissions in rice cultivation while considering the overall environmental impact.

Abstract Background Clinically relevant‐postoperative pancreatic fistula (CR‐POPF) is one of the dreaded complications of pancreatoduodenectomy. Vascularity of the stump of the pancreas during pancreatico‐enteric anastomosis is considered one of the major determinants of POPF. Indocyanine green (ICG) is one of the modality for vascular assessment; hence, we aimed to evaluate the role of ICG fluorescence imaging to assess the vascularity of the pancreatic stump during pancreatoduodenectomy. Methodology The study was conducted at Kathmandu Medical College, Kathmandu, Nepal, during the period of 1 year (June 01, 2022–July 31, 2023). All of the patients who were undergoing pancreatoduodenectomy were included in the study. In all cases, intraoperatively, ICG fluorescence detection at the pancreatic stump margin was evaluated using near‐infrared light. Results A total of 28 patients underwent PD during this period. The ICG fluorescence imaging was positive at the pancreatic stump margin in 25 out of the 28 patients (89%), and in three cases, the florescence was negative. In patients who had negative fluorescence, revision of the stump margin was performed. Clinically relevant POPF was noted in 2 out of 28 cases, which had a soft pancreas with a small duct, although the pancreatic stump margin had good ICG florescence per‐operatively. Conclusion ICG is inexpensive and a safe dye to use in clinical practice. We can objectively assess the pancreatic stump vascularity using intraoperative ICG fluorescence imaging, thereby potentially decreasing postoperative pancreatic fistula.

Key Clinical Message Foreign bodies such as bone with a sharp end can penetrate the esophageal wall and lie extramurally. When a foreign body is not found on rigid oesophagoscopy, reassessing with imaging is important. The transcervical approach is a better alternative for such patients to remove the foreign bodies.

Key Clinical Message Lateral medullary syndrome, resulting from cerebellar/brainstem infarction, can occur due to cardioembolic stroke from atrial fibrillation caused by rheumatic heart disease. This rare association highlights the importance of strict arrhythmia management, prophylactic anticoagulation, and timely diagnosis to prevent debilitating neurological outcomes.

ABSTRACT The study was based on primary data from 473 lentil farmers selected randomly to analyze productivity, profitability, efficiency, and sensitivity of lentil farms in Nepal. Methods like benefit–cost, break‐even, margin safety, and sensitivity analysis, scaling technique, Cobb–Douglas type of production function, and stochastic frontier were adopted to derive farm economics, allocative, and cost efficiency levels. With average productivity of 672 kg/ha, lentil farmers in the study area were earning about 41% profit as of gross return with a profitability index of 0.78. About 45% margin of safety and estimates of benefit–cost ratio above one on all sensitivity measures is indicative of low risk and robust enterprise. Resources allocated in lentil production were found inefficient, and to achieve maximum return, expenses on land preparation, seed, nutrient, and plant protection cum irrigation should be increased by 27.6%, 80%, 33.1%, and 97%, respectively. Similarly, expenses on labor and harvesting activities need to be decreased by 30.1% and 23.6%. Labor cost and seed cost were the most important variables, and a 1% increase would surge the total production costs by 0.42% and 0.19%, respectively. The cost efficiency was estimated as 1.137 mean value, meaning that over 13.7% of the costs in lentil farms is wasted while comparing best‐practiced farm. Only about 48% of farms is fairly efficient at efficiency levels 1.0 to 1.09, but the majority is inefficient, which needs to minimize the waste of resources. Although suffering from climatic risks and production‐related problems, lentil enterprise is profitable, less risky, less sensitive, and fairly to inefficient in resource use. Wise attention is need on the part of farm management and resource utilization. Farmers are suggested to maintain farm size around 0.5 ha or below 1 ha, use only improved varietal seed, cut labor expenses with the use of machinery, and perform adequate tillage during sowing followed by effective disease management practices.

Key Clinical Message In babies presenting with an omphalocele, other components of the prune belly syndrome should be scrutinized for early diagnosis and timely intervention. Abstract A male baby on his 13th day of life presented with an omphalocele. On evaluation, he had congenital absence of left kidney and bilateral cryptorchidism. Therefore, he was diagnosed with prune belly syndrome. He responded well to abdminoplasty, and wait and watch policy was applied for his cryptorchidism.

Key Clinical Message Hyperuricemic patients (≥7.8 mg/dL) can develop polyarticular tophaceous gout from intermittent arthritis if untreated. Acute flares and tophi development can be avoided by lowering blood urate levels with xanthine oxidase inhibitors.

Key Clinical Message Cerebral venous sinus thrombosis in itself is rarely encountered clinical entity and its association with immune thrombocytopenic purpura (ITP) makes it more unusual presentation. No any as such standard guidelines exist that guides the prompt evidence based management in such concurrent cases but neuroendovascular modality can play a pivotal role.

Abstract The negative impact of large carnivore presence in human‐dominated landscapes manifests as livestock depredation and in extreme cases as attacks on humans. In the case of conflict with leopards in Nepal, attacks resulting in human fatality have become more frequent over time, thus creating an urgent socio‐ecological and management issue. We estimated the occurrence of leopard attacks in Nepal from human‐leopard conflict cases reported in the media. We used occupancy models to analyse data collected from online news reports on incidents of leopard attacks on humans to explore drivers of leopard attacks on a landscape scale. Our results suggest that the probability of occurrence of leopard attack is associated with human population density, terrain ruggedness and livestock density. The human population density effect may be indicative of a density‐dependent relationship, where attacks are more likely in areas where an increased abundance of humans increases encounter rates with leopards. The positive effect of livestock density suggests that livestock may be drawing leopards into human settlements, and consequently increasing the likelihood of attacks on humans. Terrain ruggedness might be offering ideal conditions to facilitate attacks on humans, for example remoteness and high amounts of cover to launch ambush attacks. We provide inference and insights into key determinants of leopard attacks on humans on a landscape scale. These insights can be used to guide future research, inform mitigation measures to reduce leopard attacks and foster a better understanding of the interaction between people and leopards. This study demonstrates the applicability and novelty of using a hierarchical modelling framework applied to freely and publicly available media reports to inform the applied management of human‐wildlife conflict at a national scale. Read the free Plain Language Summary for this article on the Journal blog.

Abstract Accelerating biomass improvement is a major goal of Miscanthus breeding. The development and implementation of genomic‐enabled breeding tools, like marker‐assisted selection (MAS) and genomic selection, has the potential to improve the efficiency of Miscanthus breeding. The present study conducted genome‐wide association (GWA) and genomic prediction of biomass yield and 14 yield‐components traits in Miscanthus sacchariflorus. We evaluated a diversity panel with 590 accessions of M. sacchariflorus grown across 4 years in one subtropical and three temperate locations and genotyped with 268,109 single‐nucleotide polymorphisms (SNPs). The GWA study identified a total of 835 significant SNPs and 674 candidate genes across all traits and locations. Of the significant SNPs identified, 280 were localized in mapped quantitative trait loci intervals and proximal to SNPs identified for similar traits in previously reported Miscanthus studies, providing additional support for the importance of these genomic regions for biomass yield. Our study gave insights into the genetic basis for yield‐component traits in M. sacchariflorus that may facilitate marker‐assisted breeding for biomass yield. Genomic prediction accuracy for the yield‐related traits ranged from 0.15 to 0.52 across all locations and genetic groups. Prediction accuracies within the six genetic groupings of M. sacchariflorus were limited due to low sample sizes. Nevertheless, the Korea/NE China/Russia (N = 237) genetic group had the highest prediction accuracy of all genetic groups (ranging 0.26–0.71), suggesting that with adequate sample sizes, there is strong potential for genomic selection within the genetic groupings of M. sacchariflorus. This study indicated that MAS and genomic prediction will likely be beneficial for conducting population‐improvement of M. sacchariflorus.

Abstract Background The presence of intestinal parasites influences the growth and well‐being of canids. Additionally, infected dogs and their faeces with considerably higher eggs/oocysts released per gram (epg/opg) of zoonotic parasites contribute to parasitic spillover to humans, domestic animals and sympatric wildlife. Objectives The current study aimed to reveal the prevalence of intestinal parasites (protozoa and helminths) and to list the zoonotically significant parasites in free‐roaming street dogs in Lalitpur Metropolitan City, Nepal. Methods Fresh faecal samples (n = 332) were collected from feral dogs of varying ages and sexes and transported to the research laboratory. The copro microscopic examination was carried out via direct wet mount, formalin ethyl acetate sedimentation, saturated salt flotation, acid‐fast staining and sporulation techniques. Results Coproscopy revealed an overall 95.7% (318/332) prevalence rate with 23 diverse species of intestinal parasites (10 protozoa and 13 helminths). Among them, 5 protozoa and 11 helminths possessed zoonotic potential, and their overall prevalence was 92.5%. Helminth's overall prevalence was double that of the protozoa (87.7% vs. 43%). Polyparasitism was dominant over mono parasitism (79.5% vs. 16.3%), and co‐infection of up to seven species of parasites at a time was recorded. Conclusions Urban street dogs harboured a higher prevalence of intestinal parasites that varied with age and sex. Since most of the reported parasites are zoonotic, dog density and parasitic richness indicate a greater spillover risk to humans and domestic animals. Furthermore, this study also provides appropriate ‘baseline’ data for assessing effective control measures against parasitic infestations among street dogs and controlling their transmission to humans.

Key Clinical Message Diastematomyelia, tethered cord, intradural extramedullary dermoid tumor and lipomyelomeningocele such disease entities themselves are rare in their own form and concurrent presentation of all those pathological states in a single individual can be considered one of the rarest forms of spinal dysraphism globally. Moreover for prompt management with optimal prognosis needs refined neurosurgical intervention guided by intraoperative neuromonitoring so as to bring about the best quality of life in the patient.

Abstract Background The potent immune effects of interleukin‐2 (IL‐2) for cancer therapy can be increased by genetic fusion of IL‐2 to the Fc domain of an antibody (IL‐2‐Fc) or tumor targeted by genetic fusion to a whole antibody known as an immunocytokine (ICK). Methods An anti‐CEA ICK (M5A‐IL‐2) was compared to an IL‐2‐Fc fusion protein using tumor therapy and PET imaging in CEA transgenic immunocompetent mice bearing CEA positive colon or breast tumors. Combination with stereotactic radiation therapy (SRT) was performed with either ICK or IL‐2‐Fc. Results ICK and IL‐2‐Fc had comparable antitumor effects in both tumor models, although ICK had higher tumor uptake and slower blood clearance than an IL‐2‐Fc. Analysis of IFNγ+/CD8+ and FoxP3+/CD4+ T cells revealed higher levels of IFNγ‐producing CD8+ T cells in ICK treated mice versus more efficient Treg elimination in IL‐2‐Fc treated mice. No significant or lasting toxicity was detected for either agent. Combination therapies with SRT revealed comparable efficacy and induction of immune memory for both ICK and IL‐2‐Fc when mice were rechallenged post‐therapy. Conclusions IL‐2‐Fc had comparable antitumor efficacy to CEA‐targeted M5A‐IL‐2 ICK, while both fusion proteins induced immune memory when combined with SRT. Differences in the therapeutic mechanisms of both agents were observed.

Abstract Miscanthus is a high‐yielding bioenergy crop that is broadly adapted to temperate and tropical environments. Commercial cultivation of Miscanthus is predominantly limited to a single sterile triploid clone of Miscanthus × giganteus, a hybrid between Miscanthus sacchariflorus and M. sinensis. To expand the genetic base of M. × giganteus, the substantial diversity within its progenitor species should be used for cultivar improvement and diversification. Here, we phenotyped a diversity panel of 605 M. sacchariflorus from six previously described genetic groups and 27 M. × giganteus genotypes for dry biomass yield and 16 yield‐component traits, in field trials grown over 3 years at one subtropical location (Zhuji, China) and four temperate locations (Foulum, Denmark; Sapporo, Japan; Urbana, Illinois; and Chuncheon, South Korea). There was considerable diversity in yield and yield‐component traits among and within genetic groups of M. sacchariflorus, and across the five locations. Biomass yield of M. sacchariflorus ranged from 0.003 to 34.0 Mg ha−1 in year 3. Variation among the genetic groups was typically greater than within, so selection of genetic group should be an important first step for breeding with M. sacchariflorus. The Yangtze 2x genetic group (=ssp. lutarioriparius) of M. sacchariflorus had the tallest and thickest culms at all locations tested. Notably, the Yangtze 2x genetic group's exceptional culm length and yield potential were driven primarily by a large number of nodes (>29 nodes culm−1 average over all locations), which was consistent with the especially late flowering of this group. The S Japan 4x, the N China/Korea/Russia 4x, and the N China 2x genetic groups were also promising genetic resources for biomass yield, culm length, and culm thickness, especially for temperate environments. Culm length was the best indicator of yield potential in M. sacchariflorus. These results will inform breeders' selection of M. sacchariflorus genotypes for population improvement and adaptation to target production environments.

Abstract Miscanthus is a genus of perennial grasses native to East Asia that shows promise as a biofuel energy source. Breeding efforts for increasing biofuel capability in this genus have focused on two species, namely M. sinensis (Msi) and M. sacchariflorus (Msa). For these efforts to succeed, it is critical that both Msi and Msa, as well as their interspecific crosses, can be grown at a wide range of latitudes. Therefore, the purpose of this study was to investigate how well existing data from Msi and Msa trials grown at locations throughout the northern hemisphere can train state‐of‐the‐art genomic selection (GS) models to predict genomic estimated breeding values (GEBVs) of dry yield for untested Msi and Msa accessions in untested environments. We found that accounting for genotype by environment interaction in the GS model did not notably improve predictive ability. Additionally, we observed that locations at lower latitudes showed higher predictive ability relative to locations at higher latitudes. These results suggest that it is crucial to increase the number of trial locations at higher latitude locations to investigate the source of this correlation. This will make it possible to train GS models using data from environments that are similar to growing conditions at the locations targeted by Msi and Msa breeders. Such an increase of trial locations in target environments could pave the way toward advancing breeding efforts for overwintering ability in Msi and Msa, and ultimately support the potential of Miscanthus as a biofuel crop.

Abstract Agroforestry in Nepal is a multifaceted and sustainable approach that harmonizes agricultural, environmental, and socioeconomic goals. This study conducted a comprehensive review of agroforestry systems in Nepal, emphasizing their impact on food security, rural livelihoods, and environmental sustainability. By bridging research gaps and highlighting environmental advantages, it provides valuable insights for evidence‐based policymaking, making it a significant resource for Nepal and beyond. The study employed a comprehensive desktop review methodology using a PRISMA Flow Diagram for data collection and utilized academic databases to include literature related to agroforestry practices, their impacts, and associated socioeconomic and environmental aspects. Agroforestry systems in Nepal offer a comprehensive approach to sustainable agriculture, economic empowerment, and environmental conservation while enhancing resilience to climate change. While these systems provide multiple benefits, including enhanced soil quality and increased carbon sequestration, they also face challenges related to technical knowledge and market access. To fully harness the potential of agroforestry and address food (SDG 2), and energy security, and land degradation, bridging the gap between researchers and farmers, promoting information dissemination, and establishing support mechanisms are essential. Aligning with government strategies and international initiatives can pave the way for a more sustainable and prosperous future for Nepal's rural communities and environment.

Abstract Climate change poses a threat to water security where both current and future generations are concerned, with its accompanying impacts set to be greater in low‐ and middle‐income countries (LMICs). As a result, questions pertaining to climate change adaption in LMICs are receiving increased attention from academics and policymakers alike. It is broadly accepted that top‐down approaches to developing resilience to climate change challenges have been shown to be limited and that concerted efforts need to be made to engage local communities in advancing adaptive strategies. Based on the above, we make two main arguments: (1) while there has been a shift towards acknowledging the importance of community‐driven data in generating a broader and deeper understanding of climate change, far better use could be made of local knowledge and (2) efforts at community‐based solutions to problems of resilience are currently limited by issues of capacity, specifically linked to the need for further education and training, and improved representation with respect to gender, class and caste (as well as financial support). To illustrate these arguments, we present evidence provided by rural communities located in two countries affected heavily by climate change: Ethiopia and Nepal.

Any program aimed at improving rice quality must investigate and comprehend the variety and heterogeneity of germplasm genotypes. Genetic variability analysis aids the breeders in determining the best criteria and selection procedure to be utilized in order to enhance the desired attributes. Twenty genetic materials were used in a two-year (2021-2022) field experiment at the G.P. Koirala College of Agriculture and Research Center in Morang, Nepal. This study aimed to determine the genetic diversity by principal component analysis (PCA) and cluster analysis, as well as to assess the path coefficient (PC), genetic deviation, and character association based on grain yield (GY) and other yield-attributing variables. For all the parameters under study, variance analysis across all genotypes showed substantial differences (P

Abstract Discovery and analysis of genetic variants underlying agriculturally important traits are key to molecular breeding of crops. Reduced representation approaches have provided cost‐efficient genotyping using next‐generation sequencing. However, accurate genotype calling from next‐generation sequencing data is challenging, particularly in polyploid species due to their genome complexity. Recently developed Bayesian statistical methods implemented in available software packages, polyRAD, EBG, and updog, incorporate error rates and population parameters to accurately estimate allelic dosage across any ploidy. We used empirical and simulated data to evaluate the three Bayesian algorithms and demonstrated their impact on the power of genome‐wide association study (GWAS) analysis and the accuracy of genomic prediction. We further incorporated uncertainty in allelic dosage estimation by testing continuous genotype calls and comparing their performance to discrete genotypes in GWAS and genomic prediction. We tested the genotype‐calling methods using data from two autotetraploid species, Miscanthus sacchariflorus and Vaccinium corymbosum, and performed GWAS and genomic prediction. In the empirical study, the tested Bayesian genotype‐calling algorithms differed in their downstream effects on GWAS and genomic prediction, with some showing advantages over others. Through subsequent simulation studies, we observed that at low read depth, polyRAD was advantageous in its effect on GWAS power and limit of false positives. Additionally, we found that continuous genotypes increased the accuracy of genomic prediction, by reducing genotyping error, particularly at low sequencing depth. Our results indicate that by using the Bayesian algorithm implemented in polyRAD and continuous genotypes, we can accurately and cost‐efficiently implement GWAS and genomic prediction in polyploid crops.

Abstract This study evaluates cover crop (CC) effects on microbial community structure in a winter wheat–sorghum–fallow rotation with pea, oat, and canola; mixtures of pea and oat; pea and canola; pea, oat, and canola; and six species mixture (SSM) of pea, oat, canola, hairy vetch, forage radish, and barley as CCs, and fallow as treatments. Soil microbial community structure was analyzed at CC termination (phase I), 36 days (phase II), and a year (phase III) after termination using an ester‐linked fatty acid methyl ester analysis. Total microbial biomass (TMB) under oats was significantly greater than under canola (by 47%) in phase I (p ≤ 0.05). The TMB was >48% under pea, pea + canola, and SSM, and arbuscular mycorrhizal fungi was 70%–93% more under pea, canola, and their mixtures than fallow in phase II. While microbial abundance varied with CCs at and after 36 days post‐termination, these effects did not persist for a year. Long fallow period after cropping or cover cropping appears detrimental to microbial community proliferation.

Key Clinical message Neostigmine and atropine offer a promising treatment option for postdural puncture headache (PDPH) following spinal anesthesia in cesarean section, providing effective relief with a favorable risk–benefit profile. Abstract Postdural puncture headache (PDPH) is a common consequence of cesarean section surgeries after spinal anesthesia. This case study describes the successful treatment of PDPH with intravenous neostigmine and atropine. A 31 years female who underwent elective cesarean section with spinal anesthesia developed a severe headache on the 6th postoperative day and was diagnosed to have PDPH. PDPH failed to respond to conventional treatment modalities like hydration, a Non‐steroidal anti‐inflammatory drug, and sphenopalatine ganglion block. Epidural blood patch could not be performed due to lack of consent. A trial dose of intravenous neostigmine (20 mcg/kg) along with atropine (10 mcg/kg) successfully provided symptomatic and clinical relief. The combination of neostigmine and atropine demonstrates a rapid onset of action, providing patients with effective analgesia while avoiding the need for invasive procedures such as epidural blood patches and offers quicker pain relief. This promising result warrants additional research.

Key Clinical Message We report the case of chyluria secondary to disseminated tuberculosis in a 13‐year‐old female child who presented with passage of white colored urine since 5 months, progressive weight loss for 3 months, abdominal distension for 2 months, generalized swelling of body for 15 days, and pain in abdomen for 10 days. Child had good recovery following treatment with antitubercular drugs. Though chyluria is uncommon in children, tuberculosis could be considered as a differential, after ruling out filariasis.

Abstract Introduction Cats (Felis catus) are the only felines that live in close contact with humans. Since cats can act as vectors, carriers, reservoirs and definitive hosts of many gastrointestinal (GI) parasites, parasitic assessment could contribute to their survival and well‐being. Aims The current study aimed to assess the diversity and prevalence of GI parasites in domestic and feral cats from Ratnanagar in Chitwan in Central Nepal. Methods A total of 107 fresh faecal samples of cats (90 household cats and 17 feral cats) of varied ages and sex were collected and transported to the laboratory. The copromicroscopic examination was carried out following direct wet mount, formalin‐ethyl acetate sedimentation, saturated salt flotation, acid‐fast staining and sporulation techniques. Furthermore, associated risk factors were evaluated to ascertain the predictor of risks for parasitic acquisition. Results The current study revealed an overall 95.3% prevalence rate with a 100% rate in feral cats and 94.4% in household cats. Altogether, 18 (17 known and one unknown) different species of GI parasites were reported with the helminths (95.3%; 11 species) and the protozoa (55.1%; seven species). Besides age and sex, outdoor lifestyle, absence or unknown history of medication and hunting behaviour of the felines are the predictors of risk. Furthermore, mixed infection was comparatively higher than single infection in the faecal samples. Conclusions Cats harbour a higher prevalence and greater diversity of GI parasites, and parasitism varies with age and sex. This finding can be essential for veterinarians and public health authorities for strategic treatment and for assessing the zoonotic transmission of the parasites from these felines. Importantly, an effective medication strategy for cats and owners is recommended.

Key Clinical Message Subarachnoid block with local anesthetic agents is a well‐established anesthesia technique among pregnant females for labor analgesia and cesarian delivery. Although it is considered a reliable and safe technique for both mothers and fetuses, unexpected high or low levels of block may occur due to accidental injection of these agents into different meningeal spaces other than intended. Hypotension, bradycardia, headache, and failed anesthesia are common complications of spinal anesthesia. Though rare, neurological complications like aphonia, dysphagia, and tingling sensation have also been reported. The article reports a case of a 22‐year‐old primigravida who sustained transient aphonia following intrathecal administration of bupivacaine for an emergency cesarian section for meconium‐stained liquor with fetal distress. There were no other neurological manifestations or features suggestive of high spinal block. The sensory level of the block was fixed to T6 with hemodynamic stability throughout aphasia with an episode of hypotension preceding aphonia. Aphonia commenced 9 min after the spinal anesthesia continued for a total duration of 15 min. Neurological examination, relevant investigations, and consultations were done to make a diagnosis. Thus, it is important to be aware of the possible neurological complications associated with spinal anesthesia.

Key Clinical Message Primary abdominal pregnancy is the rarest form of ectopic pregnancy in which the fertilized ovum is directly implanted into peritoneal cavity. This condition poses significantly high risk of maternal morbidity and mortality. Here, we present a case of 5 weeks of primary omental pregnancy managed by laparotomy.

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.

Key Clinical Message Neurogenic fever (NF) is a potentially life‐threatening complication commonly seen in patients with pontine hemorrhage. This case report highlights the successful use of oral baclofen and propranolol as an effective treatment strategy to manage NF. Abstract Neurogenic fever (NF) is a common complication following pontine hemorrhage and poses significant challenges for clinicians in terms of diagnosis, management, and patient outcomes. This study delves into the efficacy of treatment methods involving baclofen and propranolol for neurogenic fever in patients with pontine hemorrhage. The results demonstrated a significant reduction in the duration and intensity of fever. Moreover, the treatment modality was well‐tolerated and devoid of any adverse effects. These findings suggest that the use of oral baclofen and propranolol may be a promising therapeutic option for managing neurogenic fever in patients with pontine hemorrhage.

Abstract Spontaneous extradural hematoma in Sickle cell disease is rare neurological complication with few cases reported in the English literature. We report a case of a 16‐year‐old male patient who was previously diagnosed with Sickle Cell Beta Thalassemia and presented with severe headache and vomiting for 3 days. An emergency CT scan of the head demonstrated right‐sided acute parietal extradural hematoma with mass effect. Patient underwent emergent craniotomy with evacuation of the hematoma. Patient recovered completely. Although calvarial infarction has been associated with extradural hematoma, an absence of it makes our case distinct. A high index of suspicion should be made in SCD patients for possibility of EDH in progressive headache.

Key Clinical Message Breast milk alone is a poor and inadequate source of vitamin D. Many guidelines suggest supplementation of vitamin D to the newborns to prevent vitamin D deficiency. However, due to practices of outdoor breastfeeding and sunbathing, vitamin D supplementation may not be routinely required in our settings. Overzealous use of vitamin D supplementation and over‐the‐counter prescription may result in hypervitaminosis D.

Abstract We report the case of a 62‐year‐old man who presented with shortness of breath, cough, bilateral lower limbs' swelling, and blackish discoloration of multiple fingertips over the past 2 months. Anti‐Ribonucleoprotein antibodies were found to be present, and gadolinium‐based cardiac MRI showed non‐vascular subendocardial enhancement with diffuse symmetrical thickening of the left ventricular wall. A diagnosis of Mixed connective tissue disease with secondary cardiac amyloidosis was thus made, and the patient was successfully managed with intravenous cyclophosphamide, corticosteroids, and other supportive measures. Although extremely rare, this case shows that secondary cardiac amyloidosis should be considered while managing patients with MCTD.

Key Clinical Message Aortic aneurysm is a potentially life‐threatening condition with higher incidence in patients with systemic lupus erythematosus(SLE). Patients usually present with nonspecific symptoms and diagnosis is typically made incidentally through imaging studies. Management strategies include medical therapy to control inflammation and hypertension, surgical intervention for large or symptomatic aneursyms, and close monitoring for early detection of complications. We present a case of a 49‐year female with multiple joint pain and other nonspecific symptoms for 7 years. Anti‐ds DNA and ANA titre were significantly high and CT angiogram showed ascending aortic aneurysm measuring 5.5 cm. Conservative management was started with steroids, hydroxychloroquine, and antihypertensives, while awaiting surgery. However she suddenly collapsed, probably due to aneurysm rupture and could not be revived. Our case report therefore emphasizes the importance of close surveillance and timely intervention to minimize the morbidity and mortality in these patients.

Abstract Background and Aims Hepatitis B is a leading cause of chronic liver disease and subsequent liver transplantation. This is a vaccine‐preventable illness. Health workers continue to be at risk for blood‐borne pathogens due to occupational exposures. The overall goals of our study were to determine the prevalence of exposure to needle sticks and sharp‐related injuries (NSSI) and hepatitis B vaccination status among healthcare workers (HCWs) of Nepalgunj Medical College Teaching Hospital (NGMCTH), Kohalpur, Banke, Nepal. Methods A descriptive cross‐sectional study was conducted among HCWs at the NGMCTH following ethics approval by the NGMCTH Ethics Review Committee. A pretested structured questionnaire was used to compile the data. Data was collected from September 15, 2021 to September 14, 2022. Collected data entered in Microsoft Excel and analyzed using statistical package for social sciences version 22. Analyzed data were presented using simple descriptive statistics with appropriate figures and tables. Results A total of 304 among 506 HCWs (60.1%) participated in the survey were exposed to Needle sticks. Nine of whom (3.7%) were injured substantially (more than 10 times). Among nursing students, 21.3% had experience with NSSI. 71.7% of HCWs had received at least one dose of the hepatitis B vaccine, of whom 61.9% (44.5% of total HCWs) had received three doses. Conclusions This study demonstrated that more than two‐quarters of HCWs were exposed to NSSI. Despite being at risk, vaccination status was still low, and less than half only received three complete doses. Precaution should be taken when working with instrumentation and procedures. Hepatitis B immunization programs for HCWs should be delivered at no cost with 100% coverage and protection. Raising awareness about hepatitis B infection and immunization remains crucial to primary prevention.

Abstract Osteitis Condensans Illi (OCI) is an underrecognized cause of low back pain involving iliac bones with relative sparing of sacroiliac joint. We present a case of 48‐year‐old female who was diagnosed as a case of OCI after having back symptoms for 4 years.

Key Clinical Message Glycogen storage diseases (GSDs) are rare autosomal disorders that result from defects in glycogen metabolism. There are more than 12 types, each with distinct clinical features. Clinical scenario, biochemical abnormalities are useful for suspicion whereas liver biopsy and enzyme assay provides definite diagnosis. We report a case of two sisters with similar clinical symptoms suggestive of the disease.

Abstract Background Intestinal infection, caused by various protozoans and helminths, represents one of the significant health concerns in pigeons around the world. Objectives The present study aimed to determine the diversity and prevalence of the intestinal parasites in pigeons found in Ratnanagar Municipality, Chitwan, in central Nepal. Methods The fresh faecal samples (n = 155) were non‐invasively collected from different households and temples pigeons The individual samples were immediately preserved in the 2.5% potassium dichromate solution and transported to the research laboratory. Following direct wet mount and concentration methods, the samples were observed under a compound microscope. Results The results showed 87.1% prevalence rate with 16 parasite species that included 8 protozoan and 8 helminth faunae. The faecal samples of temple pigeons contained a higher prevalence rate with higher parasitic richness (95.6%; 16 species) than household pigeons (75.4%; 12 species). Mixed infection up to four different species was recorded in both types of sampling populations. Conclusions Pigeons harbour a greater prevalence and wider diversity of intestinal parasites and the parasitism varies based on the habitats. Proper management and effective deworming practices are recommended to control intestinal parasitic infection in these avian hosts.

Abstract Both earthquakes and floods occur frequently in the Himalayas. Since bridge structures are designed considering earthquake forces alone, floods are causing significant damage to bridges almost every year. Thus, it is obvious that floods and earthquakes are the two most important natural hazards that could alter the performance of bridges in the Himalayas. Furthermore, settlement and scouring are commonly observed in many bridges in Nepal and neighbouring regions. To this end, the conventional earthquake force‐based analysis approaches become conservative as the conventional approaches do not account for multi‐hazard impacts and design considerations. To fulfil the gap regarding multi‐hazard vulnerability characterization, this study presents a comparative assessment of single and multiple natural hazards that are likely to impact Nepali highway bridges. Seismic fragility functions for representative reinforced concrete (RC) bridges are developed for earthquake only and earthquake and scouring scenarios. Parametric variation of likely scouring depth obtained from the hydrological analysis is used to depict the probabilistic scenario to obtain fragility functions for various scour levels. The sum of the findings outlines that the seismic vulnerability of RC bridges increases significantly when scouring precedes seismic excitation.

Abstract Background The Asiatic wild water buffalo (Bubalus arnee) is an endangered species that is conserved in the Koshi Tappu Wildlife Reserve (KTWR), Nepal, and was recently translocated to the Chitwan National Park (CNP). Gastrointestinal (GI) parasites are the cause of significant negative health and production impacts on animals worldwide. Methods A coprological survey of GI parasites of wild water buffalo was carried out in the CNP in 2020. Fresh dung samples (n = 25) were collected from wild water buffaloes and analysed using sedimentation and flotation techniques for morphological identification of parasite cysts, oocysts and eggs. Results Nine different GI parasites were recorded of which Entamoeba spp. (20 samples, 80%) were the most common. The presence of Entamoeba spp. was further validated using polymerase chain reaction (PCR) analysis and DNA sequencing. The PCR results were positive for all of the microscopically positive samples, and the species was identified as Entamoeba bovis. Three samples were sequenced and formed a cluster of E. bovis, which was separated from other Entamoeba spp. in phylogenetic analysis. Conclusion This is the first report for molecular detection of E. bovis from wild water buffaloes in Nepal. Future work should focus on the prevalence of such infections in water buffaloes in forest environments.