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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.

The gharial Gavialis gangeticus is a Critically Endangered crocodilian currently known from only 14 disjunct locations in Nepal and India. The protected stretch of the Babai River in Bardia National Park, Nepal, is home to one of the six subpopulations of gharials that have exhibited recent evidence of reproduction. However, there is limited information available on the gharial population in this region. We conducted surveys during the breeding, nesting and hatching seasons of gharials during 2020–2022 to study the gharial population in the Babai River in Bardia National Park. We located one breeding group of gharials in Soth Khola (2–3 individuals) and one in Dhanuse (5–6 individuals), and we observed pre-mating or mating behaviours in all 3 years. We identified potential nesting areas on sand banks of 19–175 m in length. During nesting seasons we found abundant signs of nesting only in Dhanuse, including entry and exit trails of female gharials to and from the water and trial nests. In 2020 and 2021 we did not find any signs of hatching, probably because of flooding. In 2022 we recorded two gharial nests, producing c. 60 hatchlings, in Dhanuse. Our findings indicate that the gharial population in the Babai River is probably nesting annually. We recommend various conservation actions for this gharial population.

Superior Mesenteric Artery Syndrome (SMAS) is a rare but potentially life-threatening condition caused by the compression of the duodenum by the superior mesenteric artery. We report a case of an 11-year-old male who complaint of abdominal pain and intermittent vomiting for last 3 weeks. Diagnosis of SMAS was made with the help of radiological findings. The patient was managed conservatively with nutritional support, prokinetic agents, and stomach decompression. After 2 weeks of treatment, the patient’s symptoms improved, and he was discharged from the hospital.

Introduction: During hanging maneuver liver resection, a tunnel is created at the interface of the liver and Inferior venacava (IVC). Gap between the middle and right hepatic vein is known as Fossa venacava. A gap between the Inferior right hepatic vein and the Caudate vein is known as a Vein gap. The Fossa venacava and Vein gap provide a safe plane for the insertion of forceps during tunneling. The aim of this study is to determine the topography of this safe plane. Methods: A cross-sectional study was done. Twenty livers were used in our study. Major hepatic veins, distance of Vein gap, Fossa venacava, and each vessel present at the interface between liver and IVC was measured by a Vernier caliper. All the collected data was entered and analyzed by using Statistical Package for Social Sciences version 20 (SPSS-20). Results: The average length of retro hepatic IVC was 49.5±10.5 mm and the diameter of 25.6±4.4 mm. The inferior right hepatic vein was present in 60% of cases while the Caudate vein was present in 85% of cases. Fossa venacava had an average distance of 12.3±3.46 mm and the Vein gap was 18.9±7.1 mm. Conclusion: While tunneling between IVC and the liver, Fossa venacava could be as small as 4.6 mm. The shortest distance of the Vein gap could be as small as 5.8 mm. The intermediate course of forceps insertion is safer than the right or left course.

Cap polyposis is a gastrointestinal disease with multiple inflammatory polyps between the distal colon and rectum. Its symptoms overlap with inflammatory bowel disease with typical endoscopic features of multiple sessile polyps in the rectum and sigmoid colon, located at the apices of transverse folds. Microscopically, the polyps consist of elongated, tortuous, and distended crypts covered by a “cap” of inflammatory granulation tissue. In this report, we present a case of a 18-year-old male patient who underwent polypectomy for polyposis in multiple settings. He presented with one year of painless rectal bleeding and polyposis in a recto-sigmoid area on colonoscopy, with a single polyp in the sigmoid area and multiple polyps in the rectum. He was managed with immediate and interval polypectomy. Though cap polyposis is rare, it can be cured as it is laparoscopically resectable.

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: A solitary thyroid nodule is a discrete swelling that is palpable in apparently normal thyroid gland. It can be identified clinically as well as radiologically. This study aims to find the prevalence of malignancy in clinically detected solitary thyroid nodule and to compare the findings in pre-operative fine needle aspiration cytology test with post-operative histopathological examination to assess the accuracy of the test. Materials and Methods: A descriptive cross sectional study was done in patients attending the Otorhinolaryngology outpatient department in our hospital from January to December 2021 with clinically diagnosed solitary thyroid nodules. Ethical approval was taken from the Institutional Review Committee ofNobel Medical College and Teaching Hospital (58412021). The collected data were collected in Microsoft Excel 2013and was analyzed in Statistical Package for the Social Sciences version 21. Point estimate at 95% ConfidenceInterval and descriptive statistics were interpreted as frequency, percentage, or as mean and standarddeviations. Results: Among 37 patients with clinically detected solitary thyroid nodules, malignancy was found in 12 (32.43%) (17.35-47.51 at 95% Confidence Interval).The mean age of presentation was 34 ± 13 years with male female ratio of 1:8.Fine needle aspiration cytology had 64.00% sensitivity and 75.68% specificity in detecting benign lesions and 100% both in detecting malignancy. Conclusion: The prevalence of malignancy by fine needle aspiration cytology among clinically detected solitary thyroid nodules was high as compared to other similar studies done in similar settings

The rising unpredictability in the food supply chain in many parts of the world is related to soil loss and poor agricultural output. The Revised Universal Soil Loss Equation (RUSLE), widely used for estimating soil loss, was applied in the western mid-hills in Nepal, with steep slopes and fragile geology. This region is at high risk for rapid soil erosion and mass wasting. To estimate soil loss, this study utilized the RUSLE model with experimental erosion plots in the Aadhikhola and Tinahukhola watersheds, capturing real-time erosion in the field. The annual soil loss for the Aadhikhola watershed is estimated at ∼41.4 tons ha−1 yr−1. In contrast, in the Tinahukhola watershed, soil loss is low (∼24.1 tons ha−1 yr−1). Although annual rainfall showed an increasing trend in both watersheds, the change in soil loss was statistically insignificant. The high erosion rates from the experimental plots in both watersheds support the model outputs. Results from the experimental plots recorded the rate of soil erosion for different land use as: irrigated agricultural land > rainfed agricultural land > forests. The trends highlight the role of human activities in enhancing soil erosion in these mountainous terrains in terms of medium to long-term perspectives. Therefore, sustainable agriculture practices in these terrains must investigate alternate ways to decrease soil erosion to support people's livelihoods.

Introduction: Coronavirus disease can affect the renal system in various forms ranging from mild proteinuria to acute kidney injury, some even needing renal replacement therapy. This study aimed to find out the prevalence of acute kidney injury in patients admitted with COVID-19 at a tertiary care centre. Methods: This descriptive cross-sectional study was done in patients admitted in COVID-19 ward in our hospital from July 2021 to June 2022. Ethical approval was obtained from the Institutional Review Committee (Reference number: 066-077/078). The serum creatinine level was used for the diagnosis of acute kidney injury. Convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Results: Out of 80 patients with COVID-19, the prevalence of acute kidney injury was 25 (31.25%) (21.09-41.41, 95% Confidence Interval). Conclusions: The prevalence of acute kidney injury in COVID-19 patients was similar to other studies done in similar settings.

Introduction: Dengue and typhoid fever are different entities with overlapping signs and symptoms which are indistinguishable and there have been few reports of co-infections from endemic areas. The resemblance of symptoms makes accurate clinical diagnosis and treatment difficult. Both are major health problems mainly during monsoon and co-infection, if not timely diagnosed and treated can be fatal. The aim of this study was to find out the prevalence of typhoid fever among patients diagnosed with dengue at a tertiary care centre. Methods: A descriptive cross-sectional study was done among patients of age >15 years with dengue fever attending the medicine outpatient department in a tertiary care centre from 1 July 2021 to 30 June 2022. Ethical approval was taken from the Institutional Review Committee (Reference number: 466/2020). Convenience sampling was used. Patients with other risk factors for febrile illness were excluded from the study. Point estimate and 90% Confidence Interval were calculated. Results: Among 95 dengue cases, typhoid fever was observed in 18 (18.95%) (12.36-25.54, 90% Confidence Interval). The mean age of presentation was 35±9 years with a male to female ratio of 0.8:1. Fever was the most common presentation with a mean temperature of 100.8±2.1°F. Conclusions: The prevalence of typhoid fever among dengue-positive cases was higher as compared to other studies done in similar settings.

Varicella pneumonia is uncommon among adults and can present as potentially life-threatening complications of varicella. Here we report a case of a 43-year-old man with no known history of chronic disease and no allergic history who presented to our hospital emergency department with widespread skin eruptions over the entire body and hemoptysis. Varicella pneumonia was diagnosed based on the patient being in contact with his 6-year-old son who had contracted chickenpox 10 days back, typical cutaneous lesions, pulmonary symptoms and radiographic findings. The patient was treated with oral acyclovir and was admitted to the intensive care unit for monitoring. The patient recovered completely after 10 days of treatment.

Introduction: Lung cancer is the leading cause of cancer deaths all over the world and adenocarcinoma is the most common type. Diagnosis is made usually at an advanced stage of lung cancer in patients, making it nearly impossible to cure. The aim of this study is to find out prevalence of adenocarcinoma among patients diagnosed with lung cancer in a tertiary care centre. Methods: A descriptive cross-sectional study was carried out in the Department of Pulmonary Medicine of a tertiary care centre among 69 patients from October, 2018 to September, 2019. Ethical approval was taken from the Institutional Review Committee of a tertiary care hospital (Reference number: 54/2018). A convenience sampling technique was used. Data were entered and analysed using the Statistical Package for the Social Sciences version 21.0. Point estimate at 90% Confidence Interval and descriptive statistics were interpreted as frequency, percentage, or as mean and standard deviations. Results: Among 69 lung cancer patients, adenocarcinoma was seen in 27 (39.13%) (29.47-48.79 at 90% Confidence Interval). Out of 27, 10 (37.04%) were male and 17 (62.96%) were female. Chronic obstructive pulmonary disease was the major comorbidity seen among 17 (62.96%) patients. Conclusions: The prevalence of adenocarcinoma was similar to other studies done in similar settings.

Introduction: Intact tympanic membrane acts as a partition between the external ear and middle ear. Tympanic membrane perforation is one of the commonest causes of conductive hearing loss. Perforation size is the most important determination of hearing loss. The aim of this study was to find out the prevalence of tympanic membrane perforation among patients presenting to the otorhinolaryngology department of a tertiary care hospital. Methods: A descriptive cross-sectional study was carried out in the Department of Otorhinolaryngology and Head Neck Surgery of a tertiary care hospital from March 2021 to August 2021. Ethical approval was taken from Institutional Review Committee (Reference number: 57112021). Convenience sampling was done and data was collected from 414 patients presenting to the department. Collected data were entered, analyzed in Statistical Package for the Social Sciences version 21.0 and documented for study. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage for binary data. Results: Among 414 patients, tympanic membrane perforation was seen in 100 (24.15%) (20.02-28.27 at 95% Confidence Interval). Among 100 patients with a total of 153 perforated eardrums, mild hearing loss was seen in the majority of the cases. Posterior perforation had a mean hearing loss of 40.41±5.96 dB, central had 39.09±3.13 dB, and anterior had 35.15±5.88 dB. Conclusions: Our study showed the prevalence of tympanic membrane perforation to be high when compared to other similar studies. Hearing loss was observed in all cases; the majority with mild hearing loss. The degree of hearing loss was more in larger and posterior perforation.

This study was performed in Nepal’s Langtang and Shey Phoksundo National Parks (NPs) to find out how vulnerable the nomads’ ways of making a living are to climate change. We interviewed 68 household heads between March and May 2022 to obtain information on 13 components and 46 indicators. The original data were backed up by an analysis of the published and unpublished literature that was available. A composite index was used to combine the data, and different vulnerabilities were compared. As nomads in both NPs rely mostly on natural resources for energy, water, and food, the findings revealed that land, energy, water, sanitation, and natural resources are the most important factors influencing nomads’ livelihood vulnerability in both NPs. Although herders in Shey Phoksundo NP suffered less loss as a result of climate change-related natural disasters, human–wildlife conflict was a major issue in both parks. Both the livelihood vulnerability index (LVI) and LVI–IPCC suggested that both national parks were moderately vulnerable to climate change indicators. The results are likely to serve as empirical evidence for future strategies, such as implementing policy measures aimed at reducing the sensitivity of habitat conditions, increasing societal resilience, introducing sustainable livelihood alternatives, and improving individual stability.

Ectopia cordis is a rare congenital defect with the prevalence of 5 to 8 per million live births. Here we report a rare case of preterm female live birth with ectopia cordis associated with omphalocele, cleft lip, and palate. In this case, 14+ weeks ultrasound did not show any fetal abnormalities and parents were unaware of the condition until 35+ weeks when ultrasound detected the anomaly a few days before delivery. After delivery, they didn’t give consent for further intervention which led to neonatal mortality 3 hours after birth. If the condition was diagnosed in time, an earlier intervention could have been done.

There are two species of pangolins –Chinese (Manis pentadactyla) and Indian (M. crassicaudata) – in Nepal. Despite being one of the most illegally traded group of mammals in the world, there is scant information on pangolin trade in Nepal. We synthesized nation-wide information on pangolin seizures for 2015–2020 period to elucidate extent and network of illegal pangolin trade in Nepal. We recorded a total of 56 pangolin seizures in Nepal in 2015–2020 period. Pangolin scales were confiscated in all 56 seizures totaling to 154.12 kg along with confiscation of live and dead pangolins, and whole pangolin hide in some seizures. That amount of scales would have fetched up to $19,922 in local market and the price could reach up to $116,993 in an international black market. At least 209 pangolins could have been killed and illegally traded in Nepal between 2015 and 2020. Pangolin trade is widespread throughout Nepal with seizures recorded from almost a quarter of all 77 districts and almost third of 61 districts where pangolins are found. Most seizures occurred in country’s capital Kathmandu (n = 29). Additionally, we identified districts adjoining Kathmandu, and districts bordering Nepal-China and Nepal-India as major routes and points in pangolin trade network. A total of 95 people were involved in pangolin poaching that included local residents from 26 districts in Nepal. The pool of convicts was dominated by males and Nepali nationals between 20 and 30 years old. Most major ethnic groups in Nepal were involved in pangolin trade with the highest involvement of people from the Tamang ethnicity (36%). Presence of pangolins is reported from all 18 districts from where seizures were recorded and 26 districts from where convicts originated suggesting active involvement of locals in pangolin poaching and trafficking. We have generated baseline information on illegal pangolin trade in Nepal for 2015–2020. We expect that this information will be helpful to law enforcement agencies to curb existing pangolin trade in Nepal.

The Chinese pangolin Manis pentadactyla is categorized as Critically Endangered on the IUCN Red List but little is known about its status in Nepal. Although indirect sign surveys have reported its presence in several community forests in Kavrepalanchok district, no photographic or video evidence has previously been documented. We used camera traps to investigate the occurrence of pangolins in 20 community forests in Panauti Municipality in Kavrepalanchok. A total of 75 0.01 km2 plots were surveyed using camera traps during September 2022–February 2023, with a total survey effort of 803 trap-days. The cameras recorded a total of 16 individual video footage events of Chinese pangolins in six of the community forests. This is the first camera-trap evidence of the species' presence in these forest patches, and in Kavrepalanchok district. The pangolins displayed behaviours such as sniffing, gathering plant material and digging, between 18.00 and 1.00. The camera-trap records provide more accurate species identification and reliable information than indirect sign surveys, indicating camera traps are a useful surveying tool for rare, nocturnal and elusive pangolins.