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Background The veins in the upper limb are classified as superficial or deep, with deep veins, such as the venae comitantes and axillary vein, coming after the major arteries. The subcutaneous tissue contains the superficial veins, which link to the deep veins. These veins include the basilic, cephalic, median cubital, and median antebrachial veins. These superficial veins are clinically significant for phlebotomy, transfusion, and cardiac catheterization, and it joins the median cubital vein at the elbow. It is essential to comprehend the structure and patterns of cubital superficial veins in order to design dialysis access and minimise hazards. Materials and Methods Studying the superficial venous organisation in the cubital fossa of 192 MBBS preclinical sciences students, ages 18 to 24, was a cross-sectional observational study carried out at the Nobel Medical College Teaching Hospital in Nepal. A tourniquet and skin marker/tailor's chalk were used in the study to examine 384 anterior aspects of the arms. Six sets of veins were distinguished from the skin's veins. Tiny veins, cubital wounds, or thick tissue layers disqualified students. Results A study of 192 preclinical sciences students at Nobel Medical College Teaching Hospital in Biratnagar found that type II variant was the most common venous pattern in the cubital fossa region, followed by type I in 24.75%, and the lowest being the type VI pattern in 3.35%. Conclusion It was discovered that the patterns of superficial veins at the cubital fossa did not significantly alter based on the gender or nationality of the individual. Overall, the most common venous pattern was type II, though type I was more frequently seen in female subjects but the difference was statistically insignificant.

Mesodiverticular band associated with Meckel’s diverticulum can lead to surgical emergencies like intestinal obstruction or volvulus and may prove fatal as this pathology is quite rare, it may escape the clinical diagnosis. This band needs to be excised during emergent laparotomy along with Meckel’s diverticulectomy. A high level of clinical suspicion and surgical acumen is required to manage this rare condition and have an uneventful recovery of the patient.

Ainhum is an extremely rare and challenging case where there is development of a constricting ring along the digits leading to autoamputation. As rare case .it is being reported from India as not many literatures on this case from this part of the continent.

Phytobezoar causing acute intestinal obstruction is a rare event. A case of accidental ingestion of mango seed causing intestinal obstruction is being reported requiring surgical intervention to extract the mango seed from the ileum. This condition must be kept in mind during the mango season while dealing with a case of intestinal obstruction in an emergency.

Pilonidal sinus disease (PSD) is a chronic inflammatory disease affecting the soft tissue of the sacrococcygeal region and remains a challenging disease for surgeons to treat. With controversies in management to prevent recurrence leading to economic burden to the patient, these cases require special care by expert surgeons. From Jan 2023 to Nov 2023, 10 patients with pilonidal sinus were treated with complete excision of the tract and reconstruction using a rhomboid flap. The factors evaluated included the duration of surgery, postoperative pain, length of hospital stay, and postoperative complications. The patients were followed up on an outpatient basis, monthly for the first three months. The majority of the patients were young males with a mean age of 28 years. The surgery time was 40 to 75 minutes, and the mean operation time was 55 minutes. The stitches were removed after 2 weeks. Among complications, two patients developed mild discharge with infection. In one patient, necrosis at the tip of the flap was noted. We recommend the Rhomboid flap as a method of choice for surgical management of Pilonidal sinus in a postgraduate medical college as it is easy to teach, learn, and perform and gives complete recovery of the patient with negligible recurrence rate.

This study presents a valuable dataset on air quality in the densely populated Dhaka Export Processing Zone (DEPZ) of Bangladesh. It included a dataset of Particulate Matter (PM2.5, PM10) and CO concentrations with Air Quality Index (AQI) values. PM data was collected 24h, and CO data was collected 8h monthly from 2019 to 2023 using respirable dust sampler APS-113NL for PM2.5, APS-113BL for PM10, and LUTRON AQ9901SD Air Quality Monitor Data Logger used to measure CO concentration data. Data sampling locations are selected based on population density, and employment data for DEPZ is also included, highlighting a potential rise in population density. This article also forecasted pollutant concentrations, AQI values, and health hazards associated with air pollutants using the Auto Regressive Moving Average (ARIMA) model. The performance of the ARIMA model was also measured using root mean squared error (RMSE) and mean absolute error (MAE). However, this can be used to raise awareness among the public about the health hazards associated with air pollution and encourage them to take measures to reduce their exposure to air pollutants. In addition, this data can be instrumental for researchers and policymakers to assess air pollution risks, develop control strategies, and improve air quality in the DEPZ.

Abstract Leishmania donovani is the causal organism of leishmaniasis with critical health implications affecting about 12 million people around the globe. Due to less efficacy, adverse side effects, and resistance, the available therapeutic molecules fail to control leishmaniasis. The mitochondrial primase of Leishmania donovani (LdmtPRI1) is a vital cog in the DNA replication mechanism, as the enzyme initiates the replication of the mitochondrial genome of Leishmania donovani. Hence, we target this protein as a probable drug target against leishmaniasis. The de-novo approach enabled computational prediction of the three-dimensional structure of LdmtPRI1, and its active sites were identified. Ligands from commercially available drug compounds were selected and docked against LdmtPRI1. The compounds were chosen for pharmacokinetic study and molecular dynamics simulation based on their binding energies and protein interactions. The LdmtPRI1 gene was cloned, overexpressed, and purified, and a primase activity assay was performed. The selected compounds were verified experimentally by the parasite and primase inhibition assay. Capecitabine was observed to be effective against the promastigote form of Leishmania donovani, as well as inhibiting primase activity. This study's findings suggest capecitabine might be a potential anti-leishmanial drug candidate after adequate further studies.

Retroperitoneal cystic tumours often cause a diagnostic dilemma and present several clinical challenges because of their rarity, relative late presentation, anatomical location, close relationship with several vital structures in the retroperitoneal space and the surgical expertise required for the management. We present three challenging retroperitoneal cystic space occupying lesions – hydatid cyst, dermoid cyst, and cystic lymphangioma. All 3 cases underwent surgery after initial diagnostic difficulty and had smooth postoperative recovery. Retroperitoneal cyst needs surgical expertise for complete excision which is often difficult due to neighbouring important vital anatomical structures.

Background: Cardiovascular disease (CVD), one of the non-communicable diseases, has become a major public health problem and it is a leading cause of morbidity and mortality in both developing and developed countries. The important CVD risk factors are obesity, hypertension, diabetes, hyperlipidaemia, unhealthy diet, physical inactivity and tobacco use. Cardiovascular risk approach is feasible and cost-effective tool, which helps to identify those at high risk for developing CVDs, so that immediate preventive measures or action can be taken to reduce the risk. Objectives: estimate the ten-year risk of developing cardiovascular disease using Framingham heart risk assessment score. Materials and Methods: A community-based, cross-sectional study was conducted among adults residing in a rural area of Dakshina Kannada District for a period of 6 months from July 2013 to December 2013. The data was collected using pretested semi structured questionnaire through interview methods. Anthropometric measurement and blood investigation (fasting blood sugar and lipid profile) was done. The Framingham Risk Score is a gender-specific algorithm used to estimate the 10-year cardiovascular risk of an individual Results: Among 712 study participants, 95 (13.3%) and 20 (2.8%) participants had intermediate and high risk of developing cardiovascular disease in 10 years respectively. The proportion of intermediate CVD risk prediction and high-risk predication was more in males as compared to females. Conclusion: The cardiovascular risk factors like obesity, physical inactivity, diabetes and hypertension are widely prevalent among adults in rural areas. The high-risk prediction for developing CVD among study participants in next 10 years was 2.8%. Keywords: Cardiovascular risk factors, Framingham risk score, 10 years CVD risk prediction, Prevalence

Background: The placenta is a uterine organ in pregnancy which facilitates exchange of materials between maternal and fetal circulation. Decreased maternal hemoglobin decreases oxygen supplementation to fetus among anemic mothers which may cause low birth weight. The aim of this study was to compare the ratio of placenta to birth weight among anemic and non-anemic mothers. Materials and Methods: A comparative cross-sectional study was conducted in 82 anemic pregnancies and 203 non-anemic pregnancies in Department of Obstetrics & Gynecology, Nobel Medical College Teaching Hospital, Biratnagar. Participants with haemoglobin concentration lower than 11 g/dl were included in anemic group and 11g/dl or more in non-anemic group. The difference of means of placental weight, birth weight and placenta to birth weight ratio in anemic and non-anemic groups was determined by Student’s t-test. Results: In anemic group, mean placental weight was 578.78±141.80 g, mean birth weight was 2973.17±680.97 g and mean placenta to birth weight ratio was 0.20±0.05. In non-anemic group, mean placental weight was 575.96±128.88 g, mean birth weight was 3125.91±590.89 g and mean placenta to birth weight ratio was 0.19±0.05. Significant difference was observed in means of placenta to birth ratio in anemic and non-anemic groups (p-value 0.05). Conclusion: Mean placental weight and mean ratio of placenta to birth weight was higher in pregnant women with anemia than in non-anemic pregnant women and significant difference was observed in means of placenta to birth ratio between anemic and non-anemic groups.

Background: Sciatic nerve, the thickest nerve of our body (around 2cm wide at its origin), leaves the pelvic cavity from the greater sciatic foramina below the piriformis muscle and between the greater trochanter of femur and ischial tuberosity. As variations have been reported in the level of division of sciatic nerve into its terminal branches, the current study aims to determine the most common site of division of sciatic nerve in Nepalese population. Materials and Methods: The current study is a cross-sectional and descriptive study which was carried out in the Department of Anatomy, Nobel Medical College, where twenty-three cadavers were used and both the lower limbs were examined. Depending upon the level of division of the sciatic nerve into its terminal branches, it was categorized into six different groups (A-F). Results: It was seen that the sciatic nerve had already divided into its terminal branches before its exit into the gluteal regionin 23.91% extremities. The second commonestsite for the termination of sciatic nerve into its terminal branch was found to be at the middle region of the back of the thigh in 19.57% followed by its division in the popliteal fossa in 17.39%. Conclusion: From the current study we conclude that the level of division of sciatic nerve was variable and it is wise to go for other means to find out the level of termination of sciatic nerve before performing any procedure in that area.

Introduction: The main blood supply for arm is provided by the brachial artery. It shows variation in branching and termination patterns in some individuals. Variation in brachial artery may cause difficulties during various clinical and surgical procedures. The present study aims to find out the prevalence of higher termination of brachial artery in cadavers in the department of anatomy of a medical college. Methods: A descriptive cross-sectional study was carried out from 10th January 2020 to 20th April 2021 after the ethical approval was taken from the Institutional Review Committee of Nobel Medical College (reference number: IRC-NMCTH 280/2020). The study was done in 58 upper limbs of 29 properly embalmed cadavers. Convenient sampling was done. They were carefully dissected. The level of termination of brachial artery was noted. The length of the brachial artery and the distance between its termination and the intercondylar line of humerus was recorded. Results: Higher termination of brachial artery was observed in 3 (5.17%) extremities; one (1.72%) at middle third of arm and two (3.45%) at lower third of arm. In 52 (89.66%) extremities, the site of termination was at the level of neck of radius. The brachial artery terminated a few centimeters below its usual site at the level of upper part of shaft of the radius in 3 (5.17%) extremities. Conclusions: The prevalence of higher termination of brachial artery in cadavers is slightly lower than the studies performed in similar settings. It is not an uncommon finding. It may have impact on clinical and surgical procedures.

Introduction: Foot is a complex segmented structure formed by the articulation of 26 different bones which are held together by multiple ligaments, extrinsic tendons and the intrinsic muscles of the feet. The assessment of median longitudinal arch serves as an important reference in determining the degree of pes planus or pes cavus. This study aims to find the prevalence of pes planus among the undergraduate medical students of a medical college. Methods: A descriptive cross-sectional study was carried out in the first- and second-year undergraduate medical students of a teaching hospital after taking ethical approval from Institutional Review Committee. The study was conducted from 15th November 2019 to 14th November 2020. Eighty-seven participants were involved in study using the random sampling technique. Foot prints were collected from the participants in the A4 size paper after applying ink over plantar surface of the foot. Measurements were done using the Autodesk Autocad software. Statistical Package for the Social Sciences was used. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Out of the total subjects, 14 (8.04%) (5.14-10.94 at 95% Confidence Interval) presented with flat foot. Similarly, high arched foot was seen in 29 (16.67%) of subjects whereas normal arched foot was seen in 131 (75.29%) subjects. Conclusions: From the current study we conclude that the prevalence of pes planus was slightly higher than that compared with the similar studies.

The outbreak of Coronavirus Disease 2019 (COVID-19) has been declared as a Public Health Emergency of International Concern (PHEIC) by the World Health Organization (WHO), which is being rapidly spread by the extremely spreadable and pathogenic 2019 novel coronavirus (2019-nCoV), also known as SARS-CoV-2. Pandemic incidence of COVID-19 has created a severe threat to global public health, necessitating the development of effective drugs or inhibitors or therapeutics agents against SARS-CoV-2. Spike protein (S) of the SARS-CoV-2 plays a crucial role in entering viruses into the host cell by binding to angiotensin-converting enzyme 2 (ACE-2), and this specific interaction represents a promising drug target for the identification of potential drugs. This study aimed at the receptor-binding domain of S protein (RBD of nCoV-SP) and the ACE-2 receptor as a promising target for developing drugs against SARS-CoV-2. Over 100 different flavonoids with antioxidant, anti-inflammatory, and antiviral properties from different literatures were taken as a ligand or inhibitor for molecular docking against target protein RBD of nCoV-SP and ACE-2 using PyRX and iGEMDOCK. Top flavonoids based on docking scores were selected for the pharmacokinetic study. Selected flavonoids (hesperidin, naringin, ECGC, and quercetin) showed excellent pharmacokinetics with proper absorption, solubility, permeability, distribution, metabolism, minimal toxicity, and excellent bioavailability. Molecular dynamics simulation studies up to 100 ns exhibited strong binding affinity of selected flavonoids to RBD of nCoV-SP and ACE-2, and the protein-ligand complexes were structurally stable. These identified lead flavonoids may act as potential compounds for developing effective drugs against SARS-CoV-2 by potentially inhibiting virus entry into the host cell.

COVID-19, caused by Severe Acute Respiratory Syndrome Corona Virus 2, is declared a Global Pandemic by WHO in early 2020. In the present situation, though more than 180 vaccine candidates with some already approved for emergency use, are currently in development against SARS-CoV-2, their safety and efficacy data is still in a very preliminary stage to recognize them as a new treatment, which demands an utmost emergency for the development of an alternative anti-COVID-19 drug sine qua non for a COVID-19 free world. Since RNA-dependent RNA polymerase (RdRp) is an essential protein involved in replicating the virus, it can be held as a potential drug target. We were keen to explore the plant-based product against RdRp and analyze its inhibitory potential to treat COVID-19. A unique collection of 248 plant compounds were selected based on their antiviral activity published in previous literature and were subjected to molecular docking analysis against the catalytic sub-unit of RdRp. The docking study was followed by a pharmacokinetics analysis and molecular dynamics simulation study of the selected best-docked compounds. Tellimagrandin I, SaikosaponinB2, Hesperidin and (-)-Epigallocatechin Gallate were the most prominent ones that showed strong binding affinity toward RdRp. All the compounds mentioned showed satisfactory pharmacokinetics properties and remained stabilized at their respective binding sites during the Molecular dynamics simulation. Additionally, we calculated the free-binding energy/the binding properties of RdRp-ligand complexes with the connection of MM/GBSA. Interestingly, we observe that SaikosaponinB2 gives the best binding affinity (∆Gbinding = −42.43 kcal/mol) in the MM/GBSA assay. Whereas, least activity is observed for Hesperidin (∆Gbinding = −22.72 kcal/mol). Overall our study unveiled the feasibility of the SaikosaponinB2 to serve as potential molecules for developing an effective therapy against COVID-19 by inhibiting one of its most crucial replication proteins, RdRp.

Introduction: Appendicitis is one of the most common causes of acute abdomen. The clinical presentation of appendicitis and its susceptibility to acute inflammation may be affected by the length and position of vermiform appendix. Length and position of appendix are variable. The aim of the study was to find the prevalence of retrocaecal appendix among patients undergoing appendectomy for appendicitis. Methods: A descriptive cross-sectional study was performed in 264 patients undergoing appendectomy in Department of Surgery, Nobel Medical College, Biratnagar, Nepal 1st May, 2018 to 15th May, 2019. Ethical approval was taken. Simple random sampling was done. The position of appendix was noted before appendectomy. Subgroup analysis was done on the basis of gender and length of appendix recorded in centimeters with a measuring scale immediately after removal of appendix. Data was collected in excel and was analyzed in SPSS version 16. Results: Prevalence of retrocaecal appendix among patients with appendicitis was 95 (35.98%). Similarly, other positions noted were pelvic in 67 (25.37%), post-ileal in 61 (23.10%), pre-ileal in 11 (4.16%) and subcaecal in 30 (11.36%) individuals. The length of appendix ranged from 1.7 cm to 14.7 cm. The mean length was 8.67±2.44 cm. Conclusions: The most common position of appendix in patients with appendicitis is retrocaecal position followed by pelvic position in both males and females.

Neuropsychiatric manifestations of systemic lupus erythematosus are varied. Presently nineteen in number, they are classified as whether affecting the central or the peripheral compartments of the nervous system. Its diagnosis however remains difficult, more so when two or more of the syndromes are found concomitantly in the same patient and when they occur in absence of the more classical rash, serositis, and haematological manifestations. We present a case of lupus where myelopathy as well as demyelination existed simultaneously as the initial neurologic manifestation.

Background: The advent of laparoscopic surgery has benefited the patient and surgeon; however creation of pneumoperitoneum for same has bearings during the perioperative period. These effects of pneumoperitoneum are associated with significant haemodynamic changes, increasing the morbidity of the patient. Aim: The present study compared the efficacy of dexmedetomidine and esmolol on hemodynamic responses during laparoscopic cholecystectomy Materials and Methods: A total of 90 patients aged 20-60 y, American Society of Anaesthesiologists (ASA) physical status I or II, of either sex, planned for laparoscopic cholecystectomy were included. The patients were randomly divided into three groups of 30 each. Group D received dexmedetomidine loading dose 1 mcg/kg over a period of 15 min and maintenance 0.5 mcg/kg/h throughout the pneumoperitoneum. Group E received esmolol loading dose 1 mg/kg over a period of 5 min and maintenance 0.5 mg/kg/h throughout the pneumoperitoneum. Group C received same volume of normal saline. Measurements: Heart rate (HR), systolic blood pressure, diastolic blood pressure and mean arterial pressure (MAP) were recorded preoperative, after study drug, after induction, after intubation, after pneumoperitoneum at 15 min intervals, post pneumoperitoneum and postoperative period after 15 min. Propofol induction dose, intraoperative fentanyl requirement and sedation score were also recorded. Results: In group D, there was no statistically significant increase in HR and blood pressure after pneumoperitoneum at any time intervals, whereas in Group E, there was a statistical significant increase in MAP after pneumoperitoneum at 15, 45, and 60 min only and HR during the whole pneumoperitoneum period. There was a significant decrease in induction dose of propofol and intraoperative fentanyl requirement in Group D and E, compared to Group C (p

M. tuberculosis harbors an essential phosphoserine phosphatase (MtSerB2, Rv3042c) that contains two small- molecule binding ACT-domains (Pfam 01842) at the N-terminus followed by the phosphoserine phosphatase (PSP) domain. We found that exogenously added MtSerB2 elicits microtubule rearrangements in THP-1 cells. Mutational analysis demonstrates that phosphatase activity is co-related to the elicited rearrangements, while addition of the ACT-domains alone elicits no rearrangements. The enzyme is dimeric, exhibits divalent metal- ion dependency, and is more specific for l- phosphoserine unlike other classical PSPases. Binding of a variety of amino acids to the ACT-domains influences MtSerB2 activity by either acting as activators/inhibitors/have no effects. Additionally, reduced activity of the PSP domain can be enhanced by equimolar addition of the ACT domains. Further, we identified that G18 and G108 of the respective ACT-domains are necessary for ligand-binding and their mutations to G18A and G108A abolish the binding of ligands like l- serine. A specific transition to higher order oligomers is observed upon the addition of l- serine at ∼0.8 molar ratio as supported by Isothermal calorimetry and Size exclusion chromatography experiments. Mutational analysis shows that the transition is dependent on binding of l- serine to the ACT-domains. Furthermore, the higher-order oligomeric form of MtSerB2 is inactive, suggesting that its formation is a mechanism for feedback control of enzyme activity. Inhibition studies involving over eight inhibitors, MtSerB2, and the PSP domain respectively, suggests that targeting the ACT-domains can be an effective strategy for the development of inhibitors.

Anaerobic digestion (AD) is a prominent treatment method for the sludge produced from sewage treatment plants. Poor solid reduction and longer retention time are the main drawbacks of AD. Thermal hydrolysis (TH) is a potential pretreatment method for solubilization of sewage sludge (SS) solids thereby improving biogas production during AD post-treatment. In this study, the SS sample (total solids = 1.75 wt% and total chemical oxygen demand (COD) = 15,450 mg L−1) was subjected to TH pretreatment (temperature = 140–180°C and reaction time = 60 minutes) in a 0.7-L capacity stainless-steel high-pressure reactor. At a reaction temperature of 180°C, the maximum solid solubilization (total dissolved solids = 4652 mg L−1) and improved dewaterability (time to filter = 4.7 s.L g−1) were observed. The biochemical methane potential test results showed almost doubling of methane generation from 145 to 284 mL gCOD−1 after TH pretreatment at 180°C. The life cycle assessment approach was used to compare various SS treatment and disposal scenarios, two of which included hydrothermal pretreatment. The scenarios involving hydrothermal pretreatments showed the least global warming potential. [ABSTRACT FROM AUTHOR]

Aim: Neonatal hyperbilirubinemia is defined as yellowish discoloration of the skin, conjunctive, and sclera from the elevated serum or plasma bilirubin in the newborn. The standard of care for the management of neonatal hyperbilirubinemia is phototherapy to prevent long-term neurological sequelae. The aim of this study was to ascertain the predictability of significant rebound hyperbilirubinemia (SRH) in neonates after phototherapy and the factors associated with it. Materials and Methods: Neonates ≥ 35 weeks of gestation, who received treatment for hyperbilirubinemia and admitted in our hospital from 15th of March 2019 to 15th of September 2020 were enrolled after taking parental consent. SRH was defined as bilirubin levels crossing the treatment threshold within 72 hours of phototherapy termination. Logistic regression analysis was used to identify the predictability of SRH. Results: Out of 400 neonates treated with phototherapy, 10% developed SRH. Prematurity (Gestational age < 37 weeks), low birth weight (Birth weight < 2000 gram), ABO and Rh incompatibility, Glucose-6-phophate dehydrogenase deficiency (G6PD) deficiency, sepsis, and longer duration of primary phototherapy were found to be significantly associated with rebound hyperbilirubinemia. The probability of SRH increases for all American Academy of Paediatrics (AAP) risk categories as the gestational age decreases and total serum bilirubin at the stoppage of phototherapy increases. Conclusions: The presence of risk factors should be taken into account while planning discharge and follow-up of neonates admitted for neonatal hyperbilirubinemia to prevent long-term complication of bilirubin neurotoxicity. [ABSTRACT FROM AUTHOR]