Search

Key Clinical Message Pneumomediastinum (PM) and subcutaneous emphysema (SCE) following foreign body aspiration are very rare. Pneumomediastinum (PM) occurs due to alveolar rupture, whereas subcutaneous emphysema occurs if air leak persists. It is benign in nature, but in some cases, it might be fatal. Therefore, proper assessment and management are required to limit the life‐threatening complications and FB should always be suspected whenever spontaneous PM and SCE is seen. PM and SCE are very rare presentations of foreign body aspiration in children of age less than 3 years and in such circumstances, the possibility of foreign body should be considered. There is also a rare possibility of spontaneous expectoration of a foreign body dislodged in the trachea.

Key Clinical Message Brucellosis, especially with osteoarticular involvement, is uncommon and difficult to diagnose, but it should be considered in a case presenting with prolonged fever, joint pain, and back pain. The diagnosis requires a combination of history, serological examinations, and radiographic studies. When the condition is detected and treated early, the prognosis is good. Abstract Brucella exploits host immune defenses to establish the chronic infection brucellosis, an endemic zoonotic disease. While human brucellosis affects multiple organs, osteo articular involvement is rare. We report the case of a 41‐year‐old woman with a history of goat farming who presented with fewer associated with low back pain and multiple joint pain for 4 months. Brucellosis was documented by positive serological tests (ELISA). Radiological findings suggested of right sacroiliitis and fracture line on the right sacral ala though had no history of trauma. Treatment consisted of NSAIDs and multiple antibiotic therapy. At follow‐up, her low back pain, joint pain, and fever had subsided. After 4 weeks of follow‐up, her symptoms were completely relieved with no recurrence. Brucellosis with atypical localization should be considered with a high index of suspicion based on detailed history and physical examination to ensure timely diagnosis and treatment.

ABSTRACT Autoimmune pulmonary alveolar proteinosis (PAP) is characterized by antibodies to granulocyte–macrophage colony‐stimulating factor (GM‐CSF), alveolar macrophage dysfunction, and surfactant accumulation. Whole lung lavage (WLL) is the treatment of choice in patients with PAP and severe hypoxemia. In resource‐limited settings, WLL can be performed in the intubated, anesthetized patient who is being one lung ventilated using a Y‐type bladder irrigation catheter for saline instillation and drainage.

Key Clinical Message Invasive fungal mucormycosis and its outcome as SIADH and orbital apex syndrome is uncommon. Mucormycosis in paranasal sinuses can even lead to intracranial invasion and its treatment with the use of amphotericin B can cure improve the prognosis of the disease. Early diagnosis and prompt treatment with antifungal, endoscopic surgery, and controlling of diabetes can be beneficial. Abstract Mucormycosis is an opportunistic invasive fungal infection which is rare and fatal and can even cause intracranial invasion leading to SIADH. The infrequency with which mucormycosis with SIADH is encountered makes it a formidable diagnostic challenge. 70‐year‐old women uncontrolled diabetes mellitus presented with bilious vomiting and persistent headache with ptosis, proptosis, absence of extraocular movement, pupillary light reflex, and light perception of left eye. Radiographic investigation, KOH mount, and Biopsy showed mucormycosis in sinus with intracranial extension leading to SIADH. Further investigation revealed hyponatremia, decreased plasma osmolality. Then, when diabetes was controlled and hydrocortisone and amphotericin was given along with Endoscopic sinus debridement, SIADH was well controlled. This case illustrates the potential of mucormycosis in paranasal sinuses can even lead to intracranial invasion and its treatment with the use of amphotericin B can cure improve the prognosis of the disease. Prompt diagnosis through clinical history, radiological investigation, and laboratory parameters are important and its treatment is crucial for the better prognosis.

Abstract Environmental parameters along elevational gradients affect the number of butterflies and the variety of species. However, which variables play significant roles and how they operate can be difficult to untangle. Here, we examine the relationships between observed butterfly richness (overall and subgroups) at different elevation gradients and remotely sensed environmental variables (vegetation productivity, surface temperature, landscape heterogeneity, and moisture stress) using generalized linear models. We surveyed butterflies with a fixed‐point count method in 19 elevation bands within 1600–5200 m above sea level in Manang district, trans‐Himalayan region, north‐central Nepal. The number of butterflies in each elevation band was studied and estimated, then interpolated across the lowest and highest elevation to estimate butterfly species richness. Then, the selection of models was performed on butterfly richness and elevations to test the best model support based on the lowest value of the Akaike information criterion and a multimodel averaging for other environmental variables. Altogether, 94 butterfly species, representing 20 subfamilies and six families, were recorded throughout the study periods. We obtained cubic model support for overall species richness, Papilionidae, and Hesperiidae, quadratic to Nymphalidae and Pieridae, and the linear model to Lycaenidae. In our study, vegetation productivity was found to have a significant positive impact on butterfly communities. Our study further suggests species richness of Papilionidae and Hesperiidae has a strong positive correlation with surface temperature and landscape heterogeneity and negative associations with moisture stress but other subgroups of butterfly communities including overall species richness showed insignificant relationships with these variables. This study provides significant information related to the responses of montane butterflies to environmental variables along elevational gradients from the Himalayas Nepal. However, further detailed studies on the functional behaviors of butterflies potentially offer more insights into their distribution patterns and ecological relationship in the montane environment.

Abstract Frailty is a multidimensional syndrome associated with a decline in reserve capacity across multiple organ systems involving physical, psychological, and social aspects. Weakness is the earliest indicator of the frailty process. Multi‐morbidity is the state of presence of two or more chronic diseases. Frailty and chronic diseases are interlinked as frail individuals are more prone to develop chronic diseases and multi‐morbid individuals may present with frailty. They share common risk factors, pathogenesis, progression, and outcomes. Significant risk factors include obesity, smoking, aging, sedentary, and stressful lifestyle. Pathophysiological mechanisms involve high levels of circulating inflammatory cytokines as seen in individuals with frailty and chronic diseases such as hypertension, cardiovascular diseases, type 2 diabetes mellitus, chronic kidney disease, and anemia. Hence, frailty and chronic diseases go hand in hand and it is of utmost importance to identify them and intervene during early stages. Screening frailty and treating multi‐morbidity incorporate both pharmacological and majorly non‐ pharmacological measures, such as physical activities, nutrition, pro‐active care, minimizing polypharmacy and addressing reversible medical conditions. The purpose of this mini‐review is to highlight the interrelation of frailty and chronic diseases through the discussion of their predictors and outcomes and how timely interventions are essential to prevent the progression of one to the other.

Abstract Talquetamab is an approved therapy for relapsed multiple myeloma. This study examined dysgeusia and weight loss occurrences, alongside investigating symptom reversibility post‐treatment cessation. Dysgeusia was prevalent, persisting in 15% of patients. On average, patients lost 6% of their weight during treatment, with weight loss persisting in about half of the patients post‐discontinuation. Weight loss and dysgeusia are important adverse events to consider while on talquetamab treatment. Extending dose intervals can potentially prevent such adverse events and should be studied in future prospective clinical trials.

ABSTRACT This case report documents the first confirmed outbreak of African swine fever (ASF) in a wild boar (Sus scrofa) in Nepal. The case was identified in a wild boar carcass found in Shuklaphanta National Park in February 2023. Post‐mortem findings, including splenomegaly, haemorrhagic lymph nodes and congested organs, were suggestive of ASF, which was confirmed by real‐time PCR. Epidemiological evidence indicates potential transmission from nearby ASF‐infected domestic pigs. This case underscores the critical need for rigorous biosecurity protocols, comprehensive surveillance and targeted wildlife management strategies to prevent further transmission between domestic pig and wild boar populations.

ABSTRACT Human fatalities and injury from wildlife attacks often result in a negative attitude toward conservation. This research was undertaken to investigate the patterns and conflict‐causing factors of human killing and injury by large mammals, especially by Asian elephant (Elephas maximus), common leopard (Panthera pardus), and Bengal tiger (Panthera tigris tigris) in the Bardia—Banke Complex of western Nepal. We collected human death and injury records caused by wildlife in the Bardia—Banke Complex between 2019 and 2023, based on relief applications submitted by the victim's family. Additionally, camera trap monitoring was conducted following incidents of human–tiger and human–leopard conflicts. A total of 76 incidents involving human casualties and injuries were considered for analysis. Incidents of livestock depredation, crop raiding, and property damage were excluded from the analysis. Most of the attacks on humans were caused by tigers (75%), followed by elephants (16%) and leopards (9%). Almost all incidents occurred in daytime (97%). The highest number of conflicts were recorded in 2021, with 20 incidents. Most of the cases (84%) occurred within 1 km of forest edge. Khata corridor and the western side of the Bardia National Park, i.e., Karnali River corridor, were identified as high‐conflict areas. The primary causes of the conflict manifested in cattle grazing (28%), grass cutting (28%), firewood collection (11%), fishing (8%), vegetable collection (5%), sand collection (4%), during rescuing friends (3%), grazing captive elephants (3%), highway rides (3%), sleeping in Chaupadi Goth (3%), walking nearby forest areas (3%), playing nearby forest areas (1%), while feeding pig (1%), and working in agricultural lands (1%). To promote human–wildlife coexistence, community‐based patrols (33%), habitat restoration (26%), electric fencing (26%), and insurance (7%) were identified as the preferred strategies. Therefore, we recommend that stakeholders and concerned bodies increase awareness among local community about the use of forest resources, wildlife behavior, and human–wildlife conflict mitigation strategies.

Abstract The common bean, Phaseolus vulgaris L., is an important legume grown in all parts of Nepal to supply dietary protein for humans and livestock. They are rich in a variety of bioactive compounds and thus possess health‐promoting effects in the prevention of chronic diseases, including cancer, cardiovascular diseases, obesity, and diabetes. The present study examined the nutritional and proximate composition and screened the bioactive compounds present in beans grown in the high‐altitude regions of Nepal. The analysis of 18 beans indicated the moisture (6.48%–8.83%), crude protein (17.39%–23.54%), carbohydrate (58.74%–66.37%), crude fat (0.78%–1.58%), crude fiber (3.36%–4.75%), total ash (3.33%–4.69%), and total energy (340.24–350.16 kcal/100 g). The results showed that the common beans were also good sources of nutritionally important minerals, including copper (2.72–8.77 mg/kg), calcium (843.86–2763.62 mg/kg), iron (38.93–73.69 mg/kg), magnesium (1540.63–2083.52 mg/kg), sodium (205.91–695.81 mg/kg), potassium (13,560.21–16,957.05 mg/kg), and zinc (19.80–31.00 mg/kg) on a dry weight basis. Quantification of bioactive compounds revealed the highest concentration of total phenolic content (TPC) in the beans from Jumla (5.96 mg GAE/g) than Dolakha and Darchula. However, the total flavonoid content was higher in Dolakha beans (3.47 mgQE/g). The EP‐15‐03FB landrace from Jumla was superior in terms of protein, phytochemical, and TPC. The results of this study will provide valuable information on the nutritional and phytochemical contents of beans and serve as a basis for further utilization of common beans.

Key Clinical Message Appropriate anesthetic technique for fracture fixation in multiple myeloma is crucial in minimizing perioperative complications. The use of pericapsular nerve group block followed by spinal anesthesia for the operative management of pathological fracture in multiple myeloma patient along with proper pre‐ and postanesthetic care ensures better outcome for the patient. Abstract Multiple myeloma is a malignant plasma cell disease that often presents with anemia, renal failure, hyperkalemia and osteolytic bone lesions. The advancements in drug therapy of multiple myeloma have prolonged the lifespan of the affected people, resulting in a rise in cases of surgical management of fractures in such patients. Anesthetic management, despite being of utmost importance in minimizing perioperative complications in such patients, has not been widely studied, especially in this part of the world. Hence, we report a case of 64 years diabetic, HbSAg positive male with hypothyroidism and a known case of multiple myeloma since the last 6 years, under medication for his comorbidities who suffered acetabular fracture. In this case report, the use of pericapsular nerve group block followed by spinal anesthesia for the operative management of the fracture has been discussed along with several pre‐ and postanesthetic considerations. With appropriate anesthetic techniques and proper pre‐ and postanesthetic care, better outcomes can be guaranteed.

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 Objective Electroencephalographic (EEG) abnormalities especially non‐convulsive status epilepticus (NCSE) have been found to be associated with worse outcomes in critically ill patients. We aimed to assess the prevalence of non‐convulsive seizures and electroencephalographic abnormalities in critically ill patients. Furthermore, we aimed to investigate any association between the type of EEG abnormality and outcomes including ICU mortality and successful ICU discharge. Methods This was a cross‐sectional observational study carried out among critically ill patients in a mixed medical‐surgical ICU from January 1, 2018 to May 15, 2020. A total of 178 records of 30 min bedside EEG records were found. EEG findings were grouped as normal, non‐convulsive seizures (NCS), non‐convulsive status epilepticus (NCSE), and other abnormalities. Descriptive analytical tools were used to characterize the case details in terms of the type of EEG abnormalities. Chi square test was used to describe the EEG abnormalities in terms of mortality. The status epilepticus severity scores (STESS) were further calculated for records with NCSE. These data were then analyzed for any association between STESS and mortality for cases with NCSE. Results The prevalence of EEG abnormality in our cohort of all critically ill patients was found to be 7.3% (170/2234). Among the patients with altered sensorium in whom EEG was done, 42.9% had non‐conclusive seizure activity with 25.2% in NCSE. Though the study was not adequately powered, there was a definite trend towards a lower proportion of successful ICU discharge rates seen among patients with higher STESS (>2) with only 33.3% being discharged for patients with a STESS of 6 versus 92.9% for those with STESS 3. Significance When combined with a strong clinical suspicion, even a 30‐min bedside EEG can result in detection of EEG abnormalities including NCS and NCSE. Hence, EEG should be regularly included in the evaluation of critically ill patients with altered sensorium. Plain Language Summary Electroencephalographic (EEG) abnormalities and seizures can have high prevalence in critically ill patients. These abnormalities notably, non‐convulsive status epilepticus (NCSE) has been found to be associated with poor patient outcomes. This was a retrospective observational study analyzing 178 EEG records, from a mixed medical‐surgical ICU. The indication for obtaining an EEG was based solely on the clinical suspicion of the treating physician. The study found a high prevalence of EEG abnormalities in 96.5% in whom it was obtained with 42.9% having any seizure activity and 28.8% having NCSE. The study was not powered for detection of association of the EEG abnormalities with clinical outcomes. However, a definite trend towards decreased chances of successful discharge from the ICU was seen. This study used strong clinical suspicion in patients with altered sensorium to obtain an EEG. High detection rates of EEG abnormalities were recorded in this study. Hence, combination of clinical judgement and EEG can improve detection of EEG abnormalities and NCSE.

Abstract Talquetamab recently received approval for relapsed refractory multiple myeloma. However, there is currently no available data on how patients perform with BCMA based agents after progression on talquetamab. Herein, we present the outcome of 10 patients who received BCMA based therapies following talquetamab. The median follow‐up was 9.5 months (range: 6–24 months). The median progression free survival was 5.5 months (range: 1–10 months). Patients had varying grades of cytokine release syndrome and Immune effector cell‐associated neurotoxicity syndrome. Our results suggest that treatment with talquetamab followed by BCMA based therapies is feasible and can be considered as clinically indicated.

Abstract Purpose The aim of this study is to evaluate the outcomes of retrograde intra renal surgery (RIRS) in the setting of large or multiple stones in children (15 mm, or both. Outcomes included stone free rate (SFR) and complications within 30 days. Results In total, 344 patients were included with 197 and 147 in Groups 1 and 2, respectively. Ureteric access sheaths were more frequently used in Group 2 (39.5% vs. 56.8%, p = 0.021). The operation time was significantly longer in Group 2 (p

Abstract A novel control mechanism is presented for rural microgrids, standing out in the current literature with its advanced approach to load prioritisation and energy allocation. The system's main goal is to maximise energy supply to essential loads while effectively managing available resources. Distinct from traditional methods, this mechanism dynamically classifies loads according to user‐defined priorities, adjustable based on the control system's computational power and complexity. A critical feature is the utilisation of the Particle Swarm Optimisation (PSO) algorithm to optimise demand side management (DSM). This innovative approach leverages day‐ahead load and generation forecasts to ensure optimal energy distribution across load levels, maintaining continuous power supply to high‐priority loads and reducing blackout risks due to generation and load fluctuations. Analyses under stochastic scenarios demonstrate the robustness of the control action, with percentile‐based day‐ahead forecasting allowing for adaptation to significant variations in renewable energy generation patterns. The implementation results are significant, maintaining 100% supply continuity to essential loads throughout the day, even with generation fluctuations up to ‐20%. This marks a considerable improvement in load satisfaction, increasing it from 83% to 96%. A significant advancement in microgrid control is contributed, providing an adaptive, user‐centric approach that enhances load management and energy distribution, and facilitates more resilient and efficient microgrid systems in the face of highly variable renewable energy sources (RESs).

Abstract Parks are an integral component of cities. Ensuring city residents have equitable and easy access to parks is crucial for human well‐being. In temperate climates, park accessibility is particularly important in the summer months when these green spaces provide an area to recreate, exercise and escape indoor temperatures and heat emanating from paved and built surfaces. However, there are well‐known disparities in park accessibility in cities globally that may threaten the health of city residents, especially with global warming. We examined some of the largest city parks (>50 ha) in Toronto, Canada, by comparing park activity, housing demographics and daily weather patterns. We found that parks that provided more green space area per resident were situated in neighbourhoods that had higher proportions of single‐detached housing, higher automobile use and fewer multistorey apartments. We also found a strong correlation between park activity with population density and the number of amenities in the park. Surprisingly, we found no relationship between park activity and daily weather patterns, although park use was higher on weekends and holidays. These results suggest denser communities are at a disadvantage because they have proportionately less park area within walking distance in addition to having no private green spaces (e.g. backyards). We recommend revising municipal zoning around certain parks and the creation of new green spaces as methods to balance park provisioning in the city. Our findings suggest that designing and maintaining accessible, amenity‐rich parks is an important strategy for promoting health and well‐being in urban populations. Read the free Plain Language Summary for this article on the Journal blog.

Abstract Background and Aims Susceptibility‐weighted imaging (SWI) can help in the diagnosis of thrombus within the vessel in acute ischemic stroke, known as susceptibility vessel sign (SVS), and detection of SVS within the vessel can predict treatment modality and outcome. In this study, the purpose is to correlate the SVS on SWI with different parameters of stroke. Methods This prospective cross‐sectional study enrolled consecutive stroke patients with vessel occlusion on magnetic resonance angiography (MRA) over 1 year. The relationship between SVS on SWI with risk factors, territory involved, and length of thrombus was correlated with the National Institutes of Health Stroke Scale (NIHSS). Results A total of 105 patients were enrolled in this study. Sixty‐two percent (66 out of 105) of patients showed SVS on SWI with MRA‐positive occlusion. A positive correlation was observed between SVS on SWI and the risk factor (p = 0.003, chi‐square test), with 86% of patients with heart disease and 47% with hypertension exhibiting SVS. Additionally, a positive correlation was observed between SVS on SWI and territorial occlusion (p = 0.000, chi‐square test). A moderate positive correlation was observed between the NIHSS and thrombus length (p = 0.002, Pearson's correlation coefficient), with a Pearson's coefficient of 0.367. Conclusions SWI can be useful in identifying the location of the thrombus, and NIHSS can determine the thrombus length in acute stroke. A higher incidence of SVS can be associated with risk factors, and it also depends upon the site of occlusion of the vessel.

Key Clinical Message Shiitake mushroom‐induced flagellate dermatitis is a rare but important condition to consider in patients presenting with pruritic skin lesions following mushroom ingestion, especially in regions where such cases are uncommon. Early recognition and appropriate management with oral and topical steroids are crucial for effective symptom resolution and preventing complications. Clinicians should be aware of the characteristic rash and the temporal relationship between mushroom consumption and rash onset. Educating patients about the risks associated with consuming raw or undercooked shiitake mushrooms is essential to prevent recurrence.

Key Clinical Message Amelogenesis imperfecta (AI) is a rare developmental anomaly characterized by poorly developed or absent tooth enamel, which complicates orthodontic treatment due to weak enamel‐bracket bond strength. This case report presents a successful management of AI using fixed orthodontic appliances and prosthodontic rehabilitation. Abstract Amelogenesis imperfecta (AI) causes enamel defects, complicating oral hygiene, reducing masticatory function and lowering self‐esteem. This case report details an 18‐year‐old female with AI who underwent fixed orthodontic treatment followed by prosthodontic rehabilitation. The multidisciplinary approach restored function and aesthetics, significantly improving her quality of life.

Key Clinical Message Antinuclear antibody‐negative full‐house lupus nephritis though previously reported, is fairly uncommon. Some patients go on to develop antibodies later in the disease course. The presence of RO‐52 antibody in this case suggests an underlying immunological cause. Swift management based on strong clinical suspicion can be life‐saving to the patient. Abstract Lupus nephritis (LN) is a serious complication of systemic lupus erythematosus (SLE) and is more likely to progress to end‐stage renal disease (ESRD). With the recent EULAR/ACR criteria mandating antinuclear antibody (ANA) positivity as an entry criterion, clinicians are faced with a diagnostic dilemma in diagnosing cases of seronegative SLE. We present the case of a 25‐year‐old female who presented with photosensitive malar rash, hair loss, oral ulcers, menorrhagia, and kidney dysfunction, suggestive of SLE. Her ANA tests were negative, raising doubts about the diagnosis. Biopsy was delayed owing to anemia and thrombocytopenia, and clinical judgment led to the patient being diagnosed with LN, with prompt treatment resulting in significant improvement. Renal biopsy subsequently confirmed the case as diffuse class IV LN with full‐house nephropathy. This case highlights the limitations of relying solely on ANA positivity in diagnosing LN and underscores the need for a comprehensive diagnostic approach for SLE that incorporates clinical features, immunological markers, and patient demographics. ANA‐negative SLE patients demand heightened clinical suspicion, especially when other diagnostic parameters align with the disease. Swift intervention with immunosuppressive therapy, as seen in this case, can be life‐saving.

Abstract Natural killer cell‐derived extracellular vesicles (NK‐EVs) are candidate biotherapeutics against various cancers. However, standardised potency assays are necessary for a reliable assessment of NK‐EVs' cytotoxicity. This study aims to thoroughly evaluate a highly sensitive resazurin phenoxazine‐based cell viability potency assay (measurement of the cellular redox metabolism) for quantifying the cytotoxicity of NK‐EVs against leukaemia K562 cells (suspension model) and breast cancer MDA‐MB‐231 cells (adherent model) in vitro. The assay was evaluated based on common analytical parameters setforth by regulatory guidelines, including specificity, selectivity,accuracy, precision, linearity, range and stability. Our results revealed that this resazurin‐based cell viability potency assay reliably and reproducibly measured a dose‐response of NK‐EVs’ cytotoxic activity against both cancer models. The assay showed precision with 5% and 20% variation for intra‐run and inter‐run variability. The assay signal showed specificity and selectivity of NK‐EVs against cancer target cells, as evidenced by the diminished viability of cancer cells following a 5‐hour treatment with NK‐EVs, without any detectable interference or background. The linearity analysis of target cancer cells revealed strong linearity for densities of 5000 K562 and 1000 MDA‐MB‐231 cells per test with a consistent range. Importantly, NK‐EVs’ dose‐response for cytotoxicity showed a strong correlation (|ρ| ∼ 0.8) with the levels of known cytotoxic factors associated with the NK‐EVs’ corona (FasL, GNLY, GzmB, PFN and IFN‐γ), thereby validating the accuracy of the assay. The assay also distinguished cytotoxicity changes in degraded NK‐EVs, indicating the ability of the assay to detect the potential loss of sample integrity. Compared to other commonly reported bioassays (i.e., flow cytometry, cell counting, lactate dehydrogenase release assay, DNA‐binding reporter assay and confluence assay), our results support this highly sensitive resazurin‐based viability potency assay as a high‐throughput and quantitative method for assessing NK‐EVs’ cytotoxicity against both suspension and adherent cancer models for evaluating NK‐EVs’ biotherapeutics.

Key Clinical Message Managing diabetic ketoacidosis (DKA) in individuals with severe dyslipidemia necessitates a comprehensive approach. While rehydration and continuous insulin infusion are fundamental components of DKA management due to the underlying insulin deficiency, the presence of severe hyperlipidemia with eruptive xanthomas warrants additional consideration. Early initiation of lipid‐lowering agents can expedite the resolution of cutaneous lesions and substantially mitigate the risk of severe complications such as pancreatitis, along with attenuating long‐term cardiovascular risks. Abstract Xanthomas are the benign lesions which are generated by localized lipid deposits in the skin, tendons, and subcutaneous tissue. They appear clinically as yellowish papules, nodules, or plaques. Acute pancreatitis and eruptive xanthomas can occur as complications of hyperlipidemia. Uncontrolled diabetes mellitus in one of the risk factors for hypertriglyceridemia. Early recognition and treatment of the eruptive xanthomatosis as a warning sign of hypertriglyceridemia can decrease the morbidity and mortality due to acute pancreatitis. Here, we discuss a case of 37‐years old female patient with uncontrolled type II diabetes mellitus presented with acute pancreatitis and eruptive xanthomas as result of raised triglycerides and uncontrolled diabetes.

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 Comparisons of plant traits between native and invasive congeners are useful approaches for identifying characteristics that promote invasiveness. We compared germination patterns and seedling growth of locally sympatric populations of native Mimosa himalayana and two varieties of invasive M. diplotricha (var. diplotricha and var. inermis) growing in southeastern Nepal. Seeds were germinated under a 12‐h photoperiod or complete dark, low (25/15°C day/night) and high (30/20°C) temperatures, different water stress levels (0, −0.1, −0.25, −0.5, −0.75 and −1.0 MPa), and soil depths (0, 2, and 4 cm). Plant height, biomass allocations, and relative growth rate (RGR) of seedlings were measured. Invasive M. diplotricha had higher germination percentage, rate, and shorter germination time compared with the native species. Germination of both congeners declined as water stress increased, but the decline was more pronounced in native species. Seedling emergence declined with increasing depth in all taxa. The seedlings of invasive species were taller with higher leaf number and allocated greater proportion of biomass to shoot, whereas the native congener allocated greater biomass to root. The RGR was nearly twice as high in invasive species as it was in the native congener. Seedling height and number of leaves were always higher in invasive than in native species, and the native–invasive differences increased over time. Better germination and higher growth performance of invasive species than the congeneric native one suggests that seed germination and seedling growth can be useful traits for the prediction of species' invasiveness in their introduced range during risk assessment process.

Abstract Background and Aims Autism spectrum disorder (ASD) is a neurodevelopmental condition that impacts the brain, characterized by challenges in social communication and interaction, often accompanied by repetitive behaviors or focused interests. This study sheds light on the prevalence of ASD within the Southeast Asian region. Methods The study protocol was registered in PROSPERO (Registration No: CRD42023413915). Appropriate search terms and Boolean operators were employed to explore electronic databases for relevant articles. Data thus extracted were prepared in Excel and analyzed in Comprehensive Meta‐Analysis Software. The effect measure utilized in the study was represented by the proportion, and the choice between a fixed or random‐effect model depended on the observed heterogeneity. Visual feedback was provided through the use of forest plots and funnel plots. Results A total of 14 studies were included in the qualitative and quantitative synthesis after screening the imported studies. The prevalence of ASD was six per 1000 population (proportion: 0.006; CI: 0.002–0.017; I2: 99.263%). Among the ASD cases, 64.4% (proportion: 0.644; CI: 0.590–0.693; I2: 9.937%) were males and 35.6% (proportion: 0.356; CI: 0.307–0.410; I2: 9.937%) were females. Conclusion The prevalence of ASD in Southeast Asia was estimated to be six cases per 1000 individuals, with a higher prevalence among males. This study contributes to our understanding of ASD prevalence in the region, although it is essential to note certain limitations in estimating prevalence.

Abstract Superior mesenteric artery (SMA) syndrome, also known as Wilkie's syndrome, is a rare disease presenting as an acute abdomen. It has a clinical presentation similar to intestinal obstruction and is often missed during diagnosis. Reduced weight leading to loss of fat pad between SMA and aorta is the main pathophysiology. Diagnosis is made through barium meal and CT scan. Conservative management remains the treatment of choice; however, surgery is opted for in refractory cases. Key Clinical Message Superior mesenteric artery (SMA) syndrome, also known as Wilkie's syndrome, is a rare disease presenting as an acute abdomen with clinical features similar to intestinal obstruction. This is a case of SMA syndrome in an adult male with a decrease in aortomesenteric angle, with no predisposing condition.

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.

Key Clinical Message Patients mimicking appendicitis symptoms in a rural setting or those post‐appendectomy, indicating cecal volvulus, should always be considered. Swift action can prevent catastrophic consequences. Abstract We present a case of a 14‐year‐old female who initially underwent open appendectomy for acute appendicitis and subsequently experienced symptoms of abdominal distention, vomiting, and fever. Her condition deteriorated following the appendectomy, despite a prior appendectomy for similar symptoms at a different facility. A computed tomography (CT) scan identified cecal volvulus as the underlying issue. This led to the performance of a laparotomy, cecopexy, and decompressive ileostomy. After six weeks, ileostomy closure was successfully carried out, and the patient currently enjoys good health. This case highlights the significance of considering uncommon factors as potential contributors to postoperative complications in young patients.

Abstract Background and Aims Despite the decriminalization of abortion in Nepal in 2002, unsafe abortion is still a significant contributor to maternal morbidity and mortality. Nepal has witnessed a significant drop in abortion‐related severe complications and maternal deaths owing to the legalization of abortion laws, lowered financial costs, and wider accessibility of safe abortion services (SAS). However, various factors such as sociocultural beliefs, financial constraints, geographical difficulties, and stigma act as barriers to the liberal accessibility of SAS. This review aimed to determine key barriers obstructing women's access to lawful, safe abortion care and identify facilitators that have improved access to and quality of abortion services. Methods A systematic search strategy utilizing the databases PubMed, CINAHL, Scopus, and Embase was used to include studies on the accessibility and safety of abortion services in Nepal. Data were extracted from included studies through close reading. Barriers and facilitators were then categorized into various themes and analyzed. Results Of 223 studies, 112 were duplicates, 73 did not meet the inclusion criteria, and 18 did not align with the research question; thus, 20 studies were included in the review. Various barriers to SAS in Nepal were categorized as economic, geographic, societal, legal/policy, socio‐cultural, health systems, and other factors. Facilitators improving access were categorized as economic/geographic/societal, legal/policy, socio‐cultural, and health systems factors. The patterns and trends of barriers and facilitators were analyzed, grouping them under legal/policy, socio‐cultural, geographic/accessibility, and health systems factors. Conclusion The review identifies financial constraints, unfavorable geography, lack of infrastructure, and social stigmatization as major barriers to SAS. Economics and geography, legalization, improved access, reduced cost and active involvement of auxiliary nurse‐midwives and community health volunteers are key facilitators.

Abstract Background Tuberculosis (TB) is a serious public health concern around the world including Asia. TB burden is high in Asian countries and significant population harbor latent tuberculosis infection(LTBI). Aim This systematic review and meta‐analysis aims to evaluate the prevalence of LTBI in Asian countries. Method We performed a systematic literature search on PubMed, Embase, and ScienceDirect to identify relevant articles published between January 1, 2005, and January 1, 2023 investigating the overall prevalence of latent TB among people of Asia. Subgroup analysis was done for Asian subregions during the study period of 2011 to 2016 and 2017 to 2023, for tuberculin skin test (TST) and interferon gamma release assay (IGRA), respectively, as well as for QuantiFERON‐TB (QFT) and TSPOT TB tests. Der Simonian and Laird's random‐effects model was used to pool the prevalence of LTBI found using TST and IGRA. Result A total of 15 studies were included after a systematic search from standard electronic databases. The analysis showed that the prevalence of latent TB in Asia was 21% (95% confidence interval [CI]: 19%–23%) and 36% (95% CI: 12%–59%) according to IGRAs and TSTs (cut off 10 mm) results, respectively. Based on IGRA, the prevalence of latent TB was 20% (95% CI: 13%–25%) in 2011 to 2016 and 21% (95% CI: 18%–24%) in 2017 to 2023. Using QFT, the prevalence was 19% (95% CI: 17%–22%) and using TSPOT, the prevalence was 26% (95% CI: 21%–31%). According to the United Nations division of Asia, the prevalence was higher for the Southern region and least for the Western region using TST and higher in the South‐Eastern region and least in the Western region using the IGRA test. Conclusion Almost a quarter of the Asian population has LTBI. Its diagnosis often poses a diagnostic challenge due to the unavailability of standard test in certain areas. Given this prevalence, a mass screening program is suggested with the available standard test and public awareness along with anti‐TB regimen should be considered for individuals who test positive. However, for it to be implemented effectively, we need to take the affordability, availability, and cost‐effectiveness of such interventions into account.

Introduction. Traumatic pneumothorax is a life-threatening condition requiring vigilant clinical assessment and urgent management. Lung ultrasound (LUS) is considered to be a safer, rapid, and accurate modality for the early diagnosis of traumatic pneumothorax. The principle objective of this study was to evaluate the diagnostic accuracy of bedside LUS performed by trained novice physicians in the diagnosis of traumatic pneumothorax as compared to supine chest X-rays (CXRs) and/or computed tomography (CT) scans and/or air leak during needle/tube thoracostomy as composite standard. Methods. It is a prospective, cross-sectional, single-blinded study using a nonprobability quota sampling technique. A total of 96 patients presenting to the emergency department (ED) with polytrauma and chest injuries within a period of twelve months were included. The diagnostic accuracy of bedside LUS performed by trained novice physicians was calculated in terms of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) and compared with the composite standard. Results. The sensitivity of LUS in diagnosing traumatic pneumothorax as compared to the composite standard was 100% (95% confidence interval (CI): 59.05%–100.00%), whereas its specificity was 97.75% (95% CI: 92.12%–99.73%). Similarly, the PPV and NPV of LUS were 77.7% (95% CI: 39.99%–97.19%) and 100% (95% CI: 95.85%–100.00%), respectively. Conclusion. The results of the study showed that the application of LUS in detecting traumatic pneumothorax had similar diagnostic accuracy as supine CXR. Bedside LUS is widely available, portable, and inexpensive. It also has the capability of real-time imaging and can be repeated as necessary with less risk of radiation exposure. Therefore, physicians working in tertiary and rural health institutions must be trained adequately in order to uplift the clinical utility of LUS for the timely and cost-effective detection of traumatic pneumothorax.

Key Clinical Message Dengue fever can also have various neurological complications but involvement of the spinal cord is often unusual. This is a case where the patient had transverse myelitis as a complication of dengue fever. Abstract Dengue fever can have various neurological complications but involvement of the spinal cord is often unusual. We report a case of a 49‐year‐old female, a known case of dengue fever, who presented with urine retention, inability to stand and walk with tingling sensation of bilateral lower limbs. Her vibration and joint position sensation was reduced below T2 level along with altered reflexes but MRI could not explain the examination findings. She was diagnosed clinically as transverse myelitis (TM) in the background of dengue fever. She showed drastic improvement with treatment of steroids. As TM as a complication in a patient with dengue fever is rare, and due to the paucity of similar case reports in Nepal, this case report is of value for the scientific community.

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.

Abstract Shrub volume is used to calculate numerous, essential ecological indicators in rangeland ecosystems such as biomass, fuel loading, wildlife habitat, site productivity, and ecosystem structure. Field techniques for biomass estimation, including destructive sampling, ocular estimates, and allometric techniques, use shrub height and canopy widths to estimate volume and translate it to biomass with species‐specific allometric equations. These techniques are time‐consuming and pose challenges, including removal of plant material and training of observers. We compared canopy volume estimates from field‐based measurements with drone‐collected canopy volume estimates for seven dominant shrub species within mountain big sagebrush (Artemisia tridentata subsp. vaseyana) plant communities in southern Idaho, USA. Canopy height and two perpendicular width measurements were taken from 103 shrubs of varying sizes, and volume was estimated using a traditional allometric equation. Overlapping aerial images captured with a DJI Mavic 2 Professional drone were used to create a 3D representation of the study area using structure‐from‐motion photogrammetry. Each shrub was extracted from the point cloud, and volume was estimated using allometric and volumetric methods. The volumetric method, which involved converting point clouds to raster canopy height models with 2.5‐ and 5‐cm grid cells, outperformed the allometric method (R2 > 0.7) and was more reproducible and robust to user‐related variability. Drone‐estimated volume best‐matched field‐estimated volume (R2 > 0.9) for three larger species: A. tridentata subsp. tridentata, A. tridentata subsp. vaseyana, and Purshia tridentata. The volume of smaller shrubs (canopy widths

Key Clinical Message Middle meningeal artery embolization is a valuable alternative for chronic subdural hematoma refractory to Burr hole surgery. In a 61‐year‐old patient, this endovascular intervention effectively resolved the hematoma alleviating associated symptoms.

Key Clinical Message Lindane induces severe side effects, including fatality, while Cetrimide causes esophageal damage. With no antidotes available, our patient ingested both, requiring prompt gastric lavage and comprehensive treatment.

Key Clinical Message Splenic hematoma secondary to snake bite is a potential complication due to snake envenomation and poses a significant risk to the health of the patients. Although relatively rare, this complication once diagnosed, should be initiated with timely anti‐venom administration and supportive care. Clinicians must be aware of any signs of hematological abnormalities in snakebite patients, as the development of splenic hematoma can have serious implications for patient outcomes. Awareness of this potential complication and multidisciplinary collaboration among medical teams are crucial to ensuring effective management and optimal patient care in these clinical scenarios. Understanding this concern can improve patient prognosis and advance the overall approach to snakebite management in healthcare settings.

Abstract Lung transplantation remains an important therapeutic option for idiopathic pulmonary arterial hypertension (IPAH), yet short‐term survival is the poorest among the major diagnostic categories. We sought to develop a prediction model for 90‐day mortality using the United Network for Organ Sharing database for adults with IPAH transplanted between 2005 and 2021. Variables with a p value ≤ 0.1 on univariate testing were included in multivariable analysis to derive the best subset model. The cohort comprised 693 subjects, of whom 71 died (10.2%) within 90 days of transplant. Significant independent predictors of early mortality were: extracorporeal circulatory support and/or mechanical ventilation at transplant (OR: 3; CI: 1.4–5), pulmonary artery diastolic pressure (OR: 1.3 per 10 mmHg; CI: 1.07–1.56), forced expiratory volume in the first second percent predicted (OR: 0.8 per 10%; CI: 0.7–0.94), recipient total bilirubin >2 mg/dL (OR: 3; CI: 1.4–7.2) and ischemic time >6 h (OR: 1.7, CI: 1.01–2.86). The predictive model was able to distinguish 25% of the cohort with a mortality of ≥20% from 49% with a mortality of ≤5%. We conclude that recipient variables associated with increasing severity of pulmonary vascular disease, including pretransplant advanced life support, and prolonged ischemic time are important risk factors for 90‐day mortality after lung transplant for IPAH.

Abstract Introduction Human leukocyte antigen‐G (HLA‐G) is a non‐classical class I HLA molecule shown to regulate the immunomodulation of maternal immune cells to prevent fetal tissue destruction. Low levels of freely circulating maternal soluble HLA‐G (sHLA‐G) have been observed in pre‐eclampsia, however, no pooled evidence exists. This meta‐analysis aimed to generate pooled findings on the association of sHLA‐G levels with pre‐eclampsia and is the first study to perform a trimester‐wise comparison of the levels of sHLA‐G in preeclamptic cases and normal pregnant controls. Methods The databases PubMed, Emba, Web of Science, and Google Scholar through May 31, 2023. Preeclamptic women were defined as cases and normal pregnancies as controls. Data on the level of sHLA‐G in cases and controls was extracted and subjected to a meta‐analysis using a random‐effects model. The pooled effect was expressed in terms of standardized mean difference (SMD). Sensitivity analysis was performed to investigate the effect of the exclusion of each study on the pooled results. Publication bias was assessed statistically. Results Nine studies with altogether 567 PE cases and 1132 normal pregnancy controls were included in the meta‐analysis. The first and third trimester levels of sHLA‐G in PE cases were significantly lower than that of normal pregnant controls: (SMD: −0.84 [−1.29; −0.38]; p = .003; I2 = 54%) and (SMD: −0.39 [−0.71; −0.06]; p = .02; I2 = 79%) respectively. Sensitivity analysis revealed significant fluctuations in the pooled findings when few studies were excluded, raising questions on the consistency of results among studies. Conclusion Although we found that first and third‐trimester sHLA‐G levels in pre‐eclampsia are significantly lower, taking into consideration the inconsistent results from the sensitivity analysis, our findings advocate the demand for more studies with larger sample sizes to generate solid ground pooled evidence on the predictive role of sHLA‐G in pre‐eclampsia.

Abstract Background and Aim Obesity affects nearly 650 million adults worldwide, and the prevalence is steadily rising. This condition has significant adverse effects on cardiovascular health, increasing the risk of hypertension, coronary artery disease, heart failure, and atrial fibrillation (AF). While anticoagulation for obese patients with AF is a well‐established therapy for the prevention of thromboembolism, the safety and efficacy of different anticoagulants in this specific population are not well explored. This meta‐analysis aimed to compare direct oral anticoagulants (DOAC) to vitamin K antagonists in obese populations with AF. Methods The PRISMA guidelines were followed for this meta‐analysis, registered in PROSPERO (CRD42023392711). PubMed, PubMed Central, Embase, Cochrane Library, and Scopus databases were searched for relevant articles from inception through January 2023. Two independent authors screened titles and abstracts, followed by a full‐text review in Covidence. Data were extracted in Microsoft Excel and analyzed using RevMan v5.4 using odds ratio as an effect measure. Results Two thousand two hundred fifty‐nine studies were identified from the database search, and 18 were included in the analysis. There were statistically significant reductions in the odds of ischemic and hemorrhagic stroke in the DOAC group compared with the VKA group (OR 0.70, CI 0.66–0.75) and (OR 0.47, CI 0.35–0.62), respectively. In addition, the DOAC group exhibited lower odds of systemic embolism (OR 0.67, CI 0.54–0.83), major bleeding (OR 0.62, CI 0.54–0.72), and composite outcome (OR 0.72, CI 0.63–0.81). Conclusion Based on the findings from this meta‐analysis, DOACs demonstrate superior safety and efficacy in obese patients with AF compared with VKAs. These results may have significant implications for guiding anticoagulation strategies in this patient population.

Key Clinical Message Incidence of bilateral inguinal hernia encompassing bilateral ovaries in adult female is very thin and concomitant association with Mayer–Rokitansky–Küster–Hauser syndrome is out of ordinary. Along with surgical management of hernia, these females need multidisciplinary slant to manage gynecological, social, and emotional issues. Abstract In mature females, bilateral ovarian inguinal hernias are a rarity. In this situation, ultrasonography is the basic adjunct to confirm the diagnosis. Mayer–Rokitansky–Küster–Hauser syndrome is typically linked to ovarian hernias in grown‐up females. The most important ways to avoid problems are early diagnosis and surgical repair. A 25‐year‐old lady presented to our outpatient clinic with a history of swelling in bilateral inguinal region for 1 month. On the ultrasound examination, the right ovary was visualized in the right high inguinal canal, and the left ovary was seen at the level of deep inguinal ring with no visualization of the uterus in its normal anatomical position. The patient underwent bilateral inguinal exploration under spinal anesthesia, and herniated contents were successfully reduced back to anatomical locations. Clinical care for such a clinical condition must be multifaceted, involving intensive counseling, relocating the uterus, fallopian tube, and ovary to preserve fertility, and preventing consequences like incarceration and strangulation.

Key Clinical Message Sebaceous cysts are a prevalent form of benign cutaneous cysts that often manifest as epidermal cysts when their size exceeds 5 cm in diameter. Despite their infrequent occurrence, cases of massive epidermal cysts measuring 5 cm or larger have been documented. Malignant transformations within epidermal cysts are exceedingly rare but not impossible. Although their development into malignancies is a rare event, it is essential to acknowledge the potential for benign epidermal cysts to undergo such transformation. In clinical terminology, these cysts predominantly affect the facial, cervical, and dorsal regions. They usually remain asymptomatic, with their formation attributed to the sequestration of epithelial remnants during embryonic fusion or trauma. In this report, we present a remarkable case of a colossal epidermal cyst found on the upper back of a 75‐year‐old male individual, highlighting the uncommon nature of such occurrences within the medical domain. This case adds to the literature by presenting a rare case report highlighting the clinical presentation, probable consequences, and surgical therapy of larger epidermal cysts.

Abstract Granulosis rubra nasi (GRN) is a rare genodermatosis involving the eccrine glands with an unknown aetiology. It is clinically characterized by localized hyperhidrosis, erythema, papules, pustules, and vesicles over central region of face and usually manifests during early childhood. GRN is asymptomatic, spontaneously resolves during puberty, and treatment options have inconsistent results. We hereby present a case of GRN in 38 years female with sites and dermoscopy findings not defined so far.

Abstract Quality complementary feeding (CF) of infants and young children is key to their growth and development. But in Jordan, providing appropriate CF remains a challenge. This study assesses trends in infant and young child feeding (IYCF) practices, and consumption by infants and young children aged 6–23 months of breast milk substitutes (BMSs), sugar‐sweetened beverages (SSBs), and micronutrient‐rich foods in Jordan from 1990 to 2017. We combined dietary data on infants and young children from six Demographic and Health Surveys (DHS) (n = 14,880 children) to compute IYCF indicators. The latter included minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum acceptable diet (MAD), as well as intake of micronutrient‐rich foods and food groups, specific SSBs, and infant formula. We conducted trend analyses using logistic regression models adjusted for child's age in month, child age squared, governorates, urban/rural residence, mother's educational attainment, and household wealth quintiles. We found that the proportion of consumption of micronutrient‐rich food groups declined significantly between 1990 and 2017, with fewer infants and young children consuming eggs (OR = 0.39, p ≤ 0.001, 2002 reference), meat, poultry, and fish (OR = 0.25, p ≤ 0.001, 2002 reference), dairy (OR = 0.59, p ≤ 0.001, 2002 reference) and Vitamin A‐rich fruits and vegetables (OR = 0.66, p ≤ 0.001, 2002 reference). Conversely, there was increased use of BMSs and sugar‐sweetened juices that paralleled a decline in the share of infants and young children meeting appropriate CF practices and consuming micronutrient‐rich foods and food groups. By 2017, children aged 6–23 months were significantly less likely to meet MDD, MMF, and subsequently MAD; the odds of consuming BMSs were almost three times the reference (OR = 3.8, p ≤ 0.001, 1990 reference), as were the odds of consuming sugar sweetened juices (OR = 3.63, p ≤ 0.001, 1990 reference). Food insecurity and undernutrition are low in Jordan; however, overweight and obesity rates are increasing concurrently as are micronutrient deficiencies. This highlights the need for policymakers to address factors at individual and household levels (behaviours and practices) as well as environmental issues (increasing access to unhealthy and ultraprocessed foods).

Abstract Introduction The growth and development of an individual is greatly influenced by their nutritional state during the first 5 years of life. Stunted growth and suboptimal weight gain remain major public health concerns during the most critical stages of growth and early childhood development. This study aims to assess the prevalence of stunting among children under 5 years of age and identify its associated factors in remote district of Nepal. Methods We conducted a survey with 487 mothers of children under 5 years of age in a remote area of Nepal. Smartphones were installed with KoBocollect software to collect the data. Trained health researchers collected the data including the anthropometric measurement (height, weight and mid‐upper arm circumference, MUAC) for assessment of the nutritional status. We followed World Health Organization guidelines for the anthropometric measurement and calculated the Z‐score using Emergency Nutrition (ENA) software. Regarding the questions related to dietary diversity, we used a validated questionnaire: household dietary diversity score, child dietary diversity score and women dietary diversity score. We analysed all the data from the survey using SPSS version 24. We performed descriptive and multivariable analyses to find the nutritional status and factors associated with stunting. Result We found a high prevalence of stunting, that is, 56.7% among children under 5 years of age. Sociodemographic variables like age, sex of the child and ethnicity were significantly associated with the prevalence of stunting. Male children (60.7%) were more likely to be stunted compared to females (51.8%). We found that children from the Brahmin/Chhetri ethnic group were more likely to be stunted compared to children from Dalit and Janajati. Mothers who delivered their youngest child by skilled health personnel were less likely to have their children to be stunted. Similarly, children aged 24–59 months were 2.5 times more likely to be stunted than those aged 6–23 months. Conclusion Stunting among children under 5 years of age is very high in the remote district of Nepal. Sex, age of the child, ethnicity and delivery by a health professional were associated with the prevalence of stunting. There is a need for awareness and public health intervention to reduce the prevalence of stunting and improve the nutritional status of children under 5 years of age in remote districts of Nepal. Furthermore, assessment of the nutritional status of children in other remote districts of Nepal is important.

Abstract Background Primary breast diffuse large B‐cell lymphoma (PB‐DLBCL) is a rare subtype of extranodal DLBCL, and the standard treatment remains controversial. In this study, we aimed to define the optimal treatment management in the rituximab era. Methods A total of 5089 newly diagnosed DLBCL patients treated with rituximab‐containing immunochemotherapy between 2008 and 2019 from the Chinese Southwest Oncology Group‐affiliated institutes were identified, of whom 135 diagnosed with PB‐DLBCL were eligible for this analysis. Results PB‐DLBCL accounted for 2.7% of all DLBCLs. With a median follow‐up of 4.2 years, the 5‐year overall survival and progression‐free survival rates were 84.8% and 71.6%, respectively. Breast and central nervous system (CNS) relapses were the main cause of treatment failure. We observed that consolidative breast radiotherapy (RT) significantly decreased breast relapse risk (5‐year risk, 2.9% vs. 20.1%, p = 0.007). The CNS relapse risk was lower for patients who received high‐dose methotrexate (HD‐MTX) than for patients who did not (5‐year risk, 0% vs. 15.2%, p = 0.015). We further screened the genetic mutation profile of 20 patients from two institutes, and found that MYD88 (25%) and CD79B mutations (25%) frequently occur in PB‐DLBCL. In addition, four patients with MYD88 and/or CD79B mutations experienced CNS relapse, while three patients with MYD88 and/or CD79B mutations who received HD‐MTX did not experience CNS relapse. Conclusion Collectively, our results indicate combined modality therapy including rituximab‐containing immunochemotherapy and consolidative breast RT is a promising approach for PB‐DLBCL, while HD‐MTX is useful for preventing CNS relapse.

Abstract Hydatid cyst is a zoonosis caused by ingestion of eggs of Echinococcus‐a tapeworm. Following ingestion of the eggs, oncosphere larvae are released which penetrate the intestinal wall to invade various organs of the body including liver, lungs, and skeletal muscles via. blood vessels. Due to their contractile nature and high lactic acid content, skeletal muscles are typically not a suitable site for attachment of hydatid cyst. In our case report presented below, we report a rare case of an isolated hydatid cyst of paraspinal muscle presenting as a slow‐growing asymptomatic mass in the back, posing a clinical diagnostic dilemma.