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Environmental crises, land degradation, declining factor productivity, and farm profitability questioned the sustainability of linear economy-based existing agricultural production model. Hence, there is a dire need to design and develop circular economy-based production systems to meet the twin objectives of environmental sustainability and food security. Therefore, the productive capacity, natural resource conserving ability, and biomass recycling potential of four intensified maize-based systems viz. maize (Zea mays) + sweet potato (Ipomoea batatas)-wheat, maize + colocasia (Colocasia esculenta)-wheat, maize + turmeric (Curcuma longa), and maize + ginger (Zingiber officinale) were tested consecutively for three years (2020, 2021 and 22) in a fixed plot manner at Dehradun region of the Indian Himalaya against the existing maize-wheat systems. The result showed that the maize + sweet potato-wheat system significantly reduced runoff loss (166.3 mm) over the maize-wheat system. The highest through fall (68.12 %) and the lowest stem flow (23.54 %) were recorded with sole maize. On the contrary, the maize + sweet potato system has the highest stem flow (36.15 %) and the lowest through fall. Similarly, the maize + sweet potato system had 5.6 times lesser soil erosion and 0.77 t ha−1 higher maize productivity over the maize-wheat system. Furthermore, the maize + sweet potato system recorded significantly higher soil moisture (19.3%), infiltration rate (0.95 cm h−1), and organic carbon (0.78%) over the rest of the systems. The maize + sweet potato system also recycled the highest nitrogen (299.2 kg ha−1), phosphorus, (31.0 kg ha−1), and potassium (276.2 kg ha−1) into the soil system. Hence, it can be inferred that concurrent cultivation of sweet potato, with maize, is a soil-supportive, resource-conserving, and productive production model and can be recommended for achieving the circular economy targets in the Indian Himalayas.

Oculopalatal tremor (OPT) is a complex neurological disorder characterized by acquired oscillatory nystagmus synchronized with tremors of the soft palate and other muscles. The article discusses the pathology, clinical manifestations, and diagnostic methods of OPT. A comprehensive literature search was conducted in PubMed and Google Scholar using keywords and relevant articles were studied and analysis was done. Vertical pendular nystagmus is the hallmark, while other muscles such as the neck, head, larynx, and diaphragm may be affected. The pathophysiology is due to lesions of the Guillain–Mollaret triangle (GMT), which causes hypertrophy of the inferior olivary. Neuroimaging reveals hypertrophy of the inferior olivary medulla, which aids in diagnosis. Drug treatments such as gabapentin and memantine can reduce nystagmus, although the visual quality may not permanently improve. The study explores the complexity of the pathophysiology and clinical presentation of OPT. New treatments that target abnormal neuronal connections with drugs such as quinine or mefloquine are being investigated. The potential of deep brain stimulation (DBS) remains uncertain, with promising aspects but limited efficacy. A synergy of technology and treatment is proposed to advance OPT treatment. Future studies will aim to clarify the nuances of responses to OPT and may include a comparative study of medication and DBS. OPT is mainly caused by a disruption in GMT/dentato-rubro-olivary pathway, presenting with tremor, and nystagmus is diagnosed with magnetic resonance imaging. Gabapentin and memantine have proved to be effective in improving the condition except for visual changes.

Atmospheric particles can undergo aging as they are transported over long distances and mix with particles from other sources. This can lead to the accumulation of pollutants and the formation of complex aerosol mixtures with diverse chemical and physical properties. To investigate the process of aging in ambient atmosphere, 24h sampling of PM2.5 aerosol particles on Quartz microfiber filter with a tin substrate was carried out from November 2020 to March 2021 at CSIR-National Physical Laboratory, New Delhi (28°38'10″ N and 77°10′17'' E), using fine particle sampler. Based on the observations of weather and meteorological parameters, a few episodic cases have been selected, and samples were analyzed at bulk and individual particle level. The objective of the present study is to investigate the aging characteristics of aerosols, enabling us to understand the mixing of aerosols (at both bulk and individual particle levels) and the variation in fresh and deformed (aged with other species) graphitic content in the episodic cases. The Raman Spectroscopy technique employed measures the intensity of graphitic (G band; around 1580 cm−1) and disordered graphitic (D band; around 1320 cm−1) content of aerosols. Individual particle microscopic observations reveal the occurrence of open chain fractals of black carbon in variable monomer sizes, sometimes agglomerated with metals like Cu, Cr, Ca etc., along with the presence of S- rich and organic aerosols while the Raman Spectrum (bulk sample analysis) highlights graphitic and disordered (when graphite interacts with other chemical species) graphitic intensities. Comparing the intensities of heavy haze and moderate haze with non-haze days (for comparison purpose, March 23, 2021 with the lowest PM2.5 concentration ∼ 62 μg/m3, has been considered as a non-haze day), it was observed that the intensities recorded on haze days were 45 to 200 times higher for the G band and 43 to 93 times higher for the D band; while for moderate haze days, the intensities were 4 to 61 times higher for the G band and 2 to 29 times higher for the D band. These findings suggest chemical processing of BC during haze days.

Abstract Background Microglia are increasingly understood to play an important role in the pathogenesis of Alzheimer’s disease. The rs75932628 (p.R47H) TREM2 variant is a well-established risk factor for Alzheimer’s disease. TREM2 is a microglial cell surface receptor. In this multi-modal/multi-tracer PET/MRI study we investigated the effect of TREM2 p.R47H carrier status on microglial activation, tau and amyloid deposition, brain structure and cognitive profile. Methods We compared TREM2 p.R47H carriers (n = 8; median age = 62.3) and participants with mild cognitive impairment (n = 8; median age = 70.7). Participants underwent two [18F]DPA-714 PET/MRI scans to assess TSPO signal, indicative of microglial activation, before and after receiving the seasonal influenza vaccination, which was used as an immune stimulant. Participants also underwent [18F]florbetapir and [18F]AV1451 PET scans to assess amyloid and tau burden, respectively. Regional tau and TSPO signal were calculated for regions of interest linked to Braak stage. An additional comparison imaging healthy control group (n = 8; median age = 45.5) had a single [18F]DPA-714 PET/MRI. An expanded group of participants underwent neuropsychological testing, to determine if TREM2 status influenced clinical phenotype. Results Compared to participants with mild cognitive impairment, TREM2 carriers had lower TSPO signal in Braak II (P = 0.04) and Braak III (P = 0.046) regions, despite having a similar burden of tau and amyloid. There were trends to suggest reduced microglial activation following influenza vaccine in TREM2 carriers. Tau deposition in the Braak VI region was higher in TREM2 carriers (P = 0.04). Furthermore, compared to healthy controls TREM2 carriers had smaller caudate (P = 0.02), total brain (P = 0.049) and white matter volumes (P = 0.02); and neuropsychological assessment revealed worse ADAS-Cog13 (P = 0.03) and Delayed Matching to Sample (P = 0.007) scores. Conclusions TREM2 p.R47H carriers had reduced levels of microglial activation in brain regions affected early in the Alzheimer’s disease course and differences in brain structure and cognition. Changes in microglial response may underlie the increased Alzheimer’s disease risk in TREM2 p.R47H carriers. Future therapeutic agents in Alzheimer’s disease should aim to enhance protective microglial actions.

Abstract Background With an increasing burden of stroke, it is essential to minimize the incidence of stroke and improve stroke care by emphasizing areas that bring out the maximum impact. The care situation remains unclear in the absence of a national stroke care registry and a lack of structured hospital-based data monitoring. We conducted this systematic review and meta-analysis to assess the status of stroke care in Nepal and identify areas that need dedicated improvement in stroke care. Methods A systematic literature review was conducted to identify all studies on stroke epidemiology or stroke care published between 2000 and 2020 in Nepal. Data analysis was done with Statistical Package for Social Sciences (SPSS) and Comprehensive Meta-analysis (CMA-3). Results We identified 2533 studies after database searching, and 55 were included in quantitative and narrative synthesis. All analyses were done in tertiary care settings in densely populated central parts of Nepal. Ischemic stroke was more frequent (70.87%) than hemorrhagic (26.79%), and the mean age of stroke patients was 62,9 years. Mortality occurred in 16.9% (13-21.7%), thrombolysis was performed in 2.39% of patients, and no studies described thrombectomy or stroke unit care. Conclusion The provision of stroke care in Nepal needs to catch up to international standards, and our systematic review demonstrated the need to improve access to quality stroke care. Dedicated studies on establishing stroke care units, prevention, rehabilitation, and studies on lower levels of care or remote regions are required.

Corona has severely impacted many sectors in the past 2. 5 years, and forests are one of the major hits among all sectors affected by the pandemic. This study presents the consolidated data on deforestation patterns across the globe during COVID and also analyzes in depth the region-specific contributing factors. Exacerbated deforestation during COVID alarms biodiversity conservation concerns and pushes back the long-term efforts to combat pollution and climate change mitigation. Deforestation also increases the risk of the emergence of new zoonotic diseases in future, as deforestation and COVID are intricately related to each other. Therefore, there is a need to check deforestation and inculcation of conservation measures in building back better policies adopted post-COVID. This review is novel in specifically providing insight into the implications of COVID-19 on forests in tropical as well as temperate global regions, causal factors, green policies given by different nations, and recommendations that will help in designing nature-based recovery strategies for combating deforestation and augmenting afforestation, thus providing better livelihood, biodiversity conservation, climate change mitigation, and better environmental quality.

Genetic modifications are made through diverse mutagenesis techniques for crop improvement programs. Among these mutagenesis tools, the traditional methods involve chemical and radiation-induced mutagenesis, resulting in off-target and unintended mutations in the genome. However, recent advances have introduced site-directed nucleases (SDNs) for gene editing, significantly reducing off-target changes in the genome compared to induced mutagenesis and naturally occurring mutations in breeding populations. SDNs have revolutionized genetic engineering, enabling precise gene editing in recent decades. One widely used method, homology-directed repair (HDR), has been effective for accurate base substitution and gene alterations in some plant species. However, its application has been limited due to the inefficiency of HDR in plant cells and the prevalence of the error-prone repair pathway known as non-homologous end joining (NHEJ). The discovery of CRISPR-Cas has been a game-changer in this field. This system induces mutations by creating double-strand breaks (DSBs) in the genome and repairing them through associated repair pathways like NHEJ. As a result, the CRISPR-Cas system has been extensively used to transform plants for gene function analysis and to enhance desirable traits. Researchers have made significant progress in genetic engineering in recent years, particularly in understanding the CRISPR-Cas mechanism. This has led to various CRISPR-Cas variants, including CRISPR-Cas13, CRISPR interference, CRISPR activation, base editors, primes editors, and CRASPASE, a new CRISPR-Cas system for genetic engineering that cleaves proteins. Moreover, gene editing technologies like the prime editor and base editor approaches offer excellent opportunities for plant genome engineering. These cutting-edge tools have opened up new avenues for rapidly manipulating plant genomes. This review article provides a comprehensive overview of the current state of plant genetic engineering, focusing on recently developed tools for gene alteration and their potential applications in plant research.

The 20-year study investigated the effects of conservation practices (CPs) and farmers' practices (FPs) on various soil quality parameters, yield, and economics of horticultural land use systems. CPs demonstrated significant improvements in soil organic carbon (SOC), available nitrogen (N), phosphorus (P), and potassium (K), compared to FPs. Horticultural systems exhibited higher SOC and available N and P contents than FPs, with substantial variations among different fruit species. CPs also enhanced soil quality index, functional diversity, culturable microbial populations, enzyme activity, and soil microbial biomass carbon (SMBC) compared to FPs. It was observed that the SMBC values were 25.0–36.6% and 4.12–25.7% higher in 0–15 cm and 15–30 cm, respectively, under CPs compared to FPs for all the land use systems. In CPs, dehydrogenase activities (DHAs) in surface soils were 9.30 and 7.50 times higher under mango- and citrus-based horticultural systems compared to FPs. The CPs adopted in aonla, guava, mango, litchi, and citrus-based horticultural systems increased SOC by ~27.6, 32.6, 24.4, 26.8, and 22.0%, respectively, over FPs. Canopy spread, fruit yield, litter yield, and soil moisture were significantly higher in fruit-based horticultural systems under CPs. Economic viability analysis indicated higher net present values (NPVs), benefit-cost ratio (BCR), and shorter payback periods (PBPs) for horticultural land use systems under CPs. Principal component analysis (PCA) revealed that CPs had a more positive influence on soil parameters, particularly DHA, acid and alkali phosphatase activity, available N, P, and K contents, soil microbial load, and organic carbon. The maximum ecosystem services were contributed through mango-based land uses among all land uses. Mango-based horticultural systems exhibited the least impact from both CPs and FPs, while peach-based systems were most affected by CPs. Overall, the findings highlight the benefits of conservation practices in improving soil quality, microbial populations, enzyme activity, and crop productivity in horticultural systems.

BackgroundGlobally, the majority of strokes affect people residing in lower- and lower-middle-income countries (LMICs), but translating evidence-based knowledge into clinical practice in regions with limited healthcare resources remains challenging. As an LMIC in South Asia, stroke care has remained a healthcare problem previously unaddressed at a national scale in Nepal. The Nepal Stroke Project (NSP) aims to improve acute stroke care in the tertiary healthcare sector of Nepal. We hereby describe the methods applied and analyze the barriers and facilitators of the NSP after 18 months.MethodsThe NSP follows a four-tier strategy: (1) quality improvement by training healthcare professionals in tertiary care centers; (2) implementation of in-hospital stroke surveillance and quality monitoring system; (3) raising public awareness of strokes; and (4) collaborating with political stakeholders to facilitate public funding for stroke care. We performed a qualitative, iterative analysis of observational data to analyze the output indicators and identify best practices.ResultsBoth offline and online initiatives were undertaken to address quality improvement and public awareness. More than 1,000 healthcare professionals across nine tertiary care hospitals attended 26 stroke-related workshops conducted by Nepalese and international stroke experts. Monthly webinars were organized, and chat groups were made for better networking and cross-institutional case sharing. Social media-based public awareness campaigns reached more than 3 million individuals. Moreover, live events and other mass media campaigns were instituted. For quality monitoring, the Registry of Stroke Care Quality (RES-Q) was introduced. Collaboration with stakeholders (both national and international) has been initiated.DiscussionWe identified six actions that may support the development of tertiary care centers into essential stroke centers in a resource-limited setting. We believe that our experiences will contribute to the body of knowledge on translating evidence into practice in LMICs, although the impact of our results must be verified with process indicators of stroke care.

Introduction: Arthroscopic ACL reconstruction is one of the most successful surgeries in sports medicine. But the donor site morbidities have been reported with bone patellar tendon bone graft and hamstring tendon graft. The objective of the study is to evaluate the functional outcome of and donor site (ankle) morbidities with full thickness peroneus longus tendon (PLT) autograft in arthroscopic anterior cruciate ligament (ACL) reconstruction. Methods: A Prospective study was done in 30 patients with ACL injury. Knee stability and function were evaluated using the Lachman test, pivot shift test, International Knee Documentation Committee score (IKDC) and Lysholm knee score. Donor ankle was assessed using American Orthopedic Foot and Ankle Score (AOFAS) and grading muscle power by Medical Research Council scale. Data collected preoperatively and postoperatively at 6 & 12 months were compared. Results: The IKDC score was normal or nearly normal in 24 patients and abnormal in 6 patients. The mean Lysholm score had excellent or good results in 24 patients. The Lachman test showed normal findings in 24 patients, 6 patients had 1+ laxity. The pivot-shift test was negative in 22 patients and 8 patients had 1+ glide. The mean AOFAS score was 100±0.0 (preoperatively) and 96.0±9.6 (at final follow up). No patient experienced ankle pain and instability. Conclusion: PLT autograft gave painless stable knee, with a good range of motion. It didn’t have any morbid effect on ankle and gait parameters. So, PLT autograft can be suitable graft with respect to its strength, safety and donor site morbidity. Keywords: ACL, Peroneus Longus Tendon, Knee Arthroscopy

BackgroundStroke is a major global health problem and was the second leading cause of death worldwide in 2020. However, the lack of public stroke awareness especially in low- and middle-income countries (LMICs) such as Nepal severely hinders the effective provision of stroke care. Efficient and cost-effective strategies to raise stroke awareness in LMICs are still lacking. This study aims to (a) explore the feasibility of a social media-based stroke awareness campaign in Nepal using a cost-benefit analysis and (b) identify best practices for social media health education campaigns.MethodsWe performed a stroke awareness campaign over a period of 6 months as part of a Stroke Project in Nepal on four social media platforms (Facebook, Instagram, Twitter, TikTok) with organic traffic and paid advertisements. Adapted material based on the World Stroke Day Campaign and specifically created videos for TikTok were used. Performance of the campaign was analyzed with established quantitative social media metrics (impressions, reach, engagement, costs).ResultsCampaign posts were displayed 7.5 million times to users in Nepal. 2.5 million individual social media users in Nepal were exposed to the campaign on average three times, which equals 8.6% of Nepal's total population. Of those, 250,000 users actively engaged with the posts. Paid advertisement on Facebook and Instagram proved to be more effective in terms of reach and cost than organic traffic. The total campaign cost was low with a "Cost to reach 1,000 users" of 0.24 EUR and a "Cost Per Click" of 0.01 EUR.DiscussionSocial media-based campaigns using paid advertisement provide a feasible and, compared to classical mass medias, a very cost-effective approach to inform large parts of the population about stroke awareness in LMICs. Future research needs to further analyze the impact of social media campaigns on stroke knowledge.

This paper presents a miniaturized planar dual-band short-ended metamaterial antenna with the backed ground plane to improve antenna bandwidths and radiation characteristics. The proposed dual-band metamaterial (MTM) antenna has been made up of the composite right- or left-handed transmission line (CRLH-TL) concept. Here, the backed ground plane has been employed to generate an extra coupling capacitance (CC), which shifts the ZOR frequency in the lower band while also improving ZOR matching and increasing the impedance bandwidth of the higher-order mode. In this proposed MTM antenna, interdigital capacitance (IDC) has been used in place of a simple series gap, which shifts the higher-order impedance bandwidth into a lower frequency band for second-band Wi-MAX applications (3.3–3.7 GHz). The proposed antenna offers a short-ended MTM, and hence the ZOR frequency is controlled by a series of LC lumped parameters. The proposed antenna offers dual-band behavior with measured −10 dB impedance bandwidths of 5.55% and 41.57% at centered frequencies of 2.70 GHz and 4.33 GHz, respectively. The overall electrical size of the designed antenna is 0.225λ0 × 0.144λ0 × 0.0144λ0 at ZOR (f0 = 2.70 GHz), where λ0 is the free space wavelength; therefore, it is applicable for different Wi-MAX application bands (2.5–2.7 GHz/3.3–3.8 GHz). Furthermore, the proposed dual-band MTM antenna provides compactness, low loss, stable gain, and radiation efficiency, and also offers omnidirectional radiation patterns in the E-plane and dipolar type radiation patterns in the H-plane, respectively.

Abstract Cerebral venous thrombosis can be caused by different conditions such as infectious, structural, hypercoagulable states, hematological, hormonal, collagen, vascular diseases, and oral contraceptive pills among other causes. Adenomyosis has been rarely associated with Cerebral venous thrombosis (CVT). Increased CA‐125 and iron deficiency anemia in adenomyosis may predispose to CVT.

Abstract India produces around 19.0 million tonnes of tomatoes annually, which is insufficient to meet the ever-increasing demand. A big gap of tomato productivity (72.14 t ha–1) between India (24.66 t ha–1) and the USA (96.8 t ha–1) exist, which can be bridged by integrating trellis system of shoot training, shoot pruning, liquid fertilizers, farmyard manure, and mulching technologies. Therefore, the present experiment was conducted on tomato (cv. Himsona) during 2019–2020 at farmers' fields to improve tomato productivity and quality. There were five treatments laid in a randomized block design (RBD) with three replications; T1 [Farmer practice on the flatbed with RDF @ N120:P60:K60 + FYM @6.0 t ha−1 without mulch], T2 [T1 + Polythene mulch (50 microns)], T3 [Tomato plants grown on the raised bed with polythene mulch + FYM @ 8.0 t ha−1 + Single shoot trellis system + Side shoot pruning + Liquid Fertilizer (LF1—N19:P19:K19) @ 2.0 g l–1 for vegetative growth + Liquid Fertilizer (LF2—N0: P52: K34) @ 1.5 g l–1 for improving fruit quality], T4 [Tomato plants grown on the raised bed with polythene mulch + FYM @ 8.0 t ha−1 + Single shoot trellis system + Side shoot pruning + LF1 @ 4.0 g l–1 + LF2 @ 3.0 g l–1], and T5 [Tomato plants grown on the raised bed with polythene mulch + FYM @ 10.0 t ha−1 + Single shoot trellis system + Side shoot pruning + LF1 @ 6.0 g l–1 + LF2 @ 4.5 g l–1]. The results revealed that tomato plant grown on the raised beds with polythene mulch, shoot pruning, trellising, liquid fertilizers, and farmyard manure (i.e., T5) recorded higher shoot length, dry matter content, and tomato productivity by 20.75–141.21, 18.79–169.4, and 18.89–160.87% as compared to T4–T1 treatments, respectively. The T5 treatment also recorded the highest water productivity (28.39 kg m–3), improved fruit qualities, net return (10,751 USD ha–1), benefit–cost ratio (3.08), microbial population, and enzymatic activities as compared to other treatments. The ranking and hierarchical clustering of treatments confirmed the superiority of the T5 treatment over all other treatments.

Residence Time Distribution (RTD) is a suitable method to find out the hydrodynamics of any industrial or lab-scale reactor. Radiotracer 198Au was used to trace the liquid phase of the industrial scale continuous three tube pulp digester. The radiotracer was injected instantaneously as an impulse input in the liquid phase and concentration versus time data were collected at the inlet and outlet of each tube using a data acquisition system. The flow modeling of continuous pulp digester has been done in two ways. Firstly, the whole digester was considered a single reactor. Secondly, each tube of the digester was considered a single reactor separately. For the second case, the convolution procedure was opted to deal with a non-ideal input signal for the second and third tubes. Axial dispersion model and tank in series with a back-mixing model were used to simulate the experimental data. Mean residence time and Peclet numbers were calculated for each tube and the whole digester.

Abstract Cerebral Venous Thrombosis is a rare extra‐intestinal manifestation of ulcerative colitis. Ulcerative colitis is a hypercoagulable state and, if poorly managed, can predispose to thrombosis, including thrombosis of the cerebral veins.

Plant flowering is antagonistically modulated by similar FLOWERING LOCUS T (FT) and TERMINAL FLOWER 1 (TFL1) proteins. In mango (Mangifera indica L.), flowering is induced by cold temperatures, unless the tree is juvenile or the adult tree had a high fruit load (HFL) in the summer. Here, we studied the effects of juvenility and fruit load on the expression of four MiFT/TFL1 genes cloned from the mango ‘Shelly’ cultivar. Ectopic expression of MiFT1 in Arabidopsis resulted in early flowering, whereas over-expression of MiFT2 and the two cloned MiTFL1 genes repressed flowering. Moreover, juvenility was positively correlated with higher transcript levels of MiFT2 and both MiTFL1s. In trees with a low fruit load, leaf MiFT1 expression increased in winter, whereas HFL delayed its upregulation. MiFT2 expression was upregulated in both leaves and buds under both fruit load conditions. Downregulation of both MITFL1s in buds was associated with a decrease in regional temperatures under both conditions; nevertheless, HFL delayed the decrease in their accumulation. Our results suggest that cold temperature has opposite effects on the expression of MiFT1 and the MiTFL1s, thereby inducing flowering, whereas HFL represses flowering by both suppressing MiFT1 upregulation and delaying MiTFL1s downregulation. The apparent flowering-inhibitory functions of MiFT2 are discussed.

Abstract Background No longitudinal, long-term, follow-up studies have explored the association between presence and severity of variations in extracranial venous anatomy, and clinical outcomes in patients with multiple sclerosis (MS). Objective This prospective 5-year follow-up study assessed the relationship of variations in extracranial venous anatomy, indicative of chronic cerebrospinal venous insufficiency (CCSVI) on Doppler sonography, according to the International Society for Neurovascular Disease (ISNVD) proposed consensus criteria, with clinical outcomes and disease progression in MS patients. Methods 90 MS patients (52 relapsing-remitting, RRMS and 38 secondary-progressive, SPMS) and 38 age- and sex-matched HIs were prospectively followed for 5.5 years. Extracranial and transcranial Doppler-based venous hemodynamic assessment was conducted at baseline and follow-up to determine the extent of variations in extracranial venous anatomy. Change in Expanded Disability Status Scale (∆EDSS), development of disability progression (DP) and annualized relapse rate (ARR) were assessed. Results No significant differences were observed in MS patients, based on their presence of variations in extracranial venous anatomy at baseline or at the follow-up, in ∆EDSS, development of DP or ARR. While more MS patients had ISNVD CCSVI criteria fulfilled at baseline compared to HIs (58% vs. 37%, p = 0.03), no differences were found at the 5-year follow-up (61% vs. 56%, p = 0.486). Discussion This is the longest follow-up study assessing the longitudinal relationship between the presence of variations in extracranial venous anatomy and clinical outcomes in MS patients. Conclusion: The presence of variations in extracranial venous anatomy does not influence clinical outcomes over the 5-year follow-up in MS patients.

Abstract Introduction The autoimmune disease myasthenia gravis can mimic a variety of neurological disorders leading to a delay in diagnosis and treatment. In the older population, due to confusion with signs of the ageing process or comorbidities due to ageing, there are many underdiagnosed or misdiagnosed cases of myasthenia gravis. A majority of myasthenia gravis symptoms appear as ocular or motor symptoms and there are very few cases of bulbar symptoms. We present a case of myasthenia gravis with only hypophonia as a clinical feature. Case presentation We present a case of a 51-year-old Madheshi woman whose only complaint was sudden onset of hypophonia which later showed a fluctuating nature throughout the daytime. There was only reduced pitch in her voice with no nasal tone or dysarthria (so-called dysphonia), which created a diagnostic dilemma. Later, a neurological examination and other relevant investigations suggested myasthenia gravis. Conclusions Sudden onset and focal neurological deficit can raise the diagnostic dilemma of myasthenia gravis. Relevant laboratory tests and clinical examinations are important to diagnose this disease properly. In resources-deprived nations like Nepal, where several investigations are expensive and access to them is difficult, it becomes very difficult to achieve a solid diagnosis for rare presentations of diseases.

Abstract Objective The aim of this study was to identify the association of parental MTHFR C677T gene polymorphism in couples with and without RPL history. Results During the study, 21.4% (15/70) of Ala222Val polymorphism was observed among RPL couples while no polymorphism was seen among normal, healthy couples. Our study did not find any association between MTHFR C677T polymorphism and gender (p > 0.05), gestational period (p > 0.05), geographical region (p > 0.05) and menstrual history (p > 0.05). However, significant association was seen between MTHFR C677T polymorphism and number of losses (p

Tuberculosis (TB) is a recurrent and progressive disease, with high mortality rates worldwide. The drug-resistance phenomenon of Mycobacterium tuberculosis is a major obstruction of allelopathy treatment. An adverse side effect of allelopathic treatment is that it causes serious health complications. The search for suitable alternatives of conventional regimens is needed, i.e., by considering medicinal plant secondary metabolites to explore anti-TB drugs, targeting the action site of M. tuberculosis. Nowadays, plant-derived secondary metabolites are widely known for their beneficial uses, i.e., as antioxidants, antimicrobial agents, and in the treatment of a wide range of chronic human diseases (e.g., tuberculosis), and are known to “thwart” disease virulence. In this regard, in silico studies can reveal the inhibitory potential of plant-derived secondary metabolites against Mycobacterium at the very early stage of infection. Computational approaches based on different algorithms could play a significant role in screening plant metabolites against disease virulence of tuberculosis for drug designing.

Bacteria employ numerous resistance mechanisms against structurally distinct drugs by the process of multidrug resistance. A study was planned to discover the antibacterial potential of a graphene oxide nanosheet (GO), a graphene oxide–zinc oxide nanocomposite (GO/ZnO), a graphene oxide-chitosan nanocomposite (GO–CS), a zinc oxide decorated graphene oxide–chitosan nanocomposite (GO–CS/ZnO), and zinc oxide nanoparticles (ZnO) alone and in a blend with antibiotics against a PS-2 isolate of Pseudomonas aeruginosa. These nanocomposites reduced the MIC of tetracycline (TET) from 16 folds to 64 folds against a multidrug-resistant clinical isolate. Efflux pumps were interfered, as evident by an ethidium bromide synergy study with nanocomposites, as well as inhibiting biofilm synthesis. These nanoparticles/nanocomposites also decreased the mutant prevention concentration (MPC) of TET. To the best of our knowledge, this is the first report on nanomaterials as a synergistic agent via inhibition of efflux and biofilm synthesis.

Development of malignant glioma after trauma is a rare occurrence. Trauma and scarring have been known to be the predisposing factor for the development of meningiomas. Many people have discussed about the development of glioma post trauma but without proper evidence of documents prior to trauma with no evidence of tumor. We present you a case with evidence of not having tumor during trauma.

Chiari Malformation-I is a congenital disorder characterized by the anatomical defect of the base of skull with tonsillar herniation (≥5 mm) below the foramen magnum, which is detected on MRI. It has a diverse range of symptoms with non-specific presentation leading to the chances of misdiagnosis and untimely recognition of the disorder. Syringomyelia is the most common result of Chiari-I. The selection of surgical or non-surgical management depends upon the patient symptoms and the presence of absence of Syringomyelia. The objective of this case report is to give a broad perspective on Chiari Malformation-I from the symptoms and clinical findings obtained in a patient with Syringomyelia associated with Chiari Malformation-I and to discuss about the different surgical options as well as the psychological support required for the management of the condition.

Cerebral Venous Thrombosis (CVT) is a rare form of Stroke characterized by thrombus formation in the cerebral veins. CVT is a result of various reasons among which the hyperthyroidism is not so frequently encountered. This is probably the first case report published from Nepal. The aim of this case report is to give the message that persistent severe headache in patient with hyperthyroidism can be the red flag and needs to be investigated further. We present a case of a 35 years old female who presented with complaints of severe headache and persistent in nature associated with vomiting since 5 days. She was a diagnosed subacute thryroiditis and under medicine from 1 month before presenting to us. Her Magnetic Resonance Venography (MRV) brain showed venous thrombosis within superior saggital sinus, left transverse sinus and sigmoid sinus. Her thyroid function test showed pretreatment T3 of 2.98 ng/ml T4 of 1.02 mg/ ml and TSH of 0.12 μIU/L. She was kept on anticoagulants and other supportive measures. The patient showed improving status with the conservative management.

Acute transverse myelitis is a focal infl ammatory disorder of the spinal cord. One of the main etiologic factors include, multiple sclerosis, post-infectious and post-traumatic events although autoimmune phenomenon is the most common cause. Transverse Myelitis (TM) due to etiology other than Multiple Sclerosis has shown spinal cord involvement of two or more segments. Annually millions of active immunization with vaccines is carried out globally with few transverse myelitis caused because of the adverse reactions due to these vaccinations. In order to improve accuracy of reporting, research and diagnosis, the Transverse Myelitis Consortium Working Group (TMCWG) have produced criteria for the diagnosis of ATM. Here we report a case of TM in adult, diagnosed as TM consistent with the TMCWG criteria and probably this is the first ever been reported case from Nepal.

Central Pontine Demyelination is a neurological disease caused by rapidly fl uctuating serum osmolality resulting in severe damage of the myelin sheath of nerve cells in the brainstem, more precisely in the area of pons. This condition is associated with electrolyte disorders, especially severe hyponatremia and its rapid correction. Its clinical course is characterized by alterations in the mental status to debilitating neurological status i.e. coma. Chronic hyponatremia and its correction, with or without evaluating safe limit could result in pontine demyelination. Demyelination might also occur with normal sodium levels, and even if serum sodium levels are corrected within safe limits. The objective of this case report is to give a broad perspective on Central Pontine Demyelination and to discuss about the different factors contributing to the demyelination and the various causes, pathophysiology and the management of this condition.

The weekly aphid population on timely sown mustard crop and daily weather parameters recorded at ICAR-Directorate of Rapeseed–Mustard Research, Bharatpur and Hisar stations, during rabi seasons of 2003-04 to 2013-14 were used to develop forewarning model for aphid. In most of the cases, the appearance of population and its peak activity occurred during 51 standard meteorological week (SMW) and 8 SMW. The study revealed that the thermal time or growing degree days (GDD) consistently explained the aphid multiplication significantly in all seasons. The impact of other weather parameters on pest population was observed to be significant only in some seasons. The aphid population increased exponentially with increase in GDD. Further, the exponential coefficient varied among the varieties. The population build up was compared with the model predicted values in three common species (Brassica juncea, B. rapa ssp. sarson and B. napus) grown at two stations. The results revealed that the predicted values derived using the model, were in close agreement with those of the observed.

Increased collateral facial vein (FV) flow may be associated with structural damage in patients with multiple sclerosis (MS). The objective was to assess differences in FV flow and magnetic resonance imaging (MRI)-derived outcomes in MS. The study included 136 MS patients who underwent neck and head vascular system examination by echo-color Doppler. Inflammatory MRI markers were assessed on a 3T MRI using a semi-automated edge detection and contouring/ thresholding technique. MRI volumetric outcomes of whole brain (WB), gray matter (GM), white matter (WM), cortex, ventricular cerebrospinal fluid (vCSF), deep gray matter (DGM), thalamus, caudate nucleus (CN), putamen, globus pallidus (GP), and hippocampus were calculated. Independent t-test and ANCOVA, adjusted for age, were used to compare groups based on FV flow quartiles. Thirty-four MS patients with FV flow ≤327.8 mL/min (lowest quartile) had significantly lower WB (P327.8 mL/min (higher quartiles). There were no differences in T1-, T2- and gadolinium- enhancing lesion volumes between the quartile groups. The lack of an association between FV blood flow and inflammatory MRI measures in MS patients, but an association with brain atrophy, suggests that the severity of neurodegenerative process may be related to hemodynamic alterations. MS patients with more advanced global and regional brain atrophy showed low or retrograde FV volume flow.

Primary Renal Lymphoma (PRL) is rare and its existence has been called into question due to the absence of lymphatic tissue within renal parenchyma. Non-specific abdominal pain with mass in the lumbar region and otherwise unexplained renal failure is the most common presentation. Almost all patients eventually develop extrarenal lymphomatous disease and few patients survive beyond one year. Surgical treatment is rarely feasible as primary modality of treatment since the tumour often encases major vessels and surrounding organs necessitating major resection. Instead, an attempt can be made to downstage the tumour with chemotherapy before attempting surgery. Here we present a case of primary renal Non-Hodgkins Lymphoma (NHL) which was treated with chemotherapy but the patient succumbed to disease before the third cycle.

The present investigation was conducted to elucidate the interrelationship among various agronomic andquality traits and their direct and indirect effect on foliage yield in 39 distinct cultivars of vegetable amaranth (A. tricolor).Among the agronomic traits, plant height and number of inflorescence exhibited significant positive association with foliageyield, while chlorophyll a, chlorophyll b, carotenoid, fiber and ascorbic acid were positively correlated with foliage yield.Chlorophyll a and chlorophyll b exhibited significant positive association with carotenoid, fiber and ascorbic acid. Ascorbicacid was positively correlated with fiber and carotenoid. Protein was associated with plant height, branches per plant and 500seed weight. Chlorophyll a, carotenoid and inflorescence length revealed high positive direct effect on foliage yield, whilebranches plant-1, leaf size, seed yield, chlorophyll b, moisture content and ascorbic acid showed negative path coefficient withfoliage yield. Suitable traits have been marked out to enhance foliage yield in vegetable amaranth.