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Pulmonary arteriovenous malformation (PAVM) is a rare vascular anomaly characterized by abnormal communication between the pulmonary artery and vein. It is a rare cause of hemoptysis. Computed tomographic angiography (CTA) has become the preferred and dependable diagnostic approach for identifying PAVM. PAVM embolization is the primary recommended treatment for this condition. We present a case of a 43-year-old male with a complex PAVM in the left lower lobe presenting with hemoptysis treated with an endovascular approach. Following the procedure, the patient's symptoms resolved.

Key Clinical Message Balloon kyphoplasty is a promising treatment option for osteoporotic vertebral compression fractures with posterior cortical defect, offering pain relief, vertebral height restoration, and low risk of cement leakage. Abstract Millions of people worldwide suffer from osteoporotic vertebral compression fractures (OVCFs) annually, which cause pain and functional limitations, particularly in the elderly. Conservative treatments such as pain management, rest, and medication are frequently used, while surgical options such as vertebroplasty and kyphoplasty are considered. We present a case of 68‐year‐old female with vertebral compression fracture of L1 vertebra with posterior cortical defect and posterior wall retropulsion. She was treated successfully with balloon kyphoplasty. Kyphoplasty appears to be a better option than vertebroplasty in cases with posterior cortical defect due to lower chance of cement leakage.

The work aims to develop and comprehensively analyze an advanced overcurrent relay system for protecting power transmission networks. Overcurrent relays are critical components used either as main protection relays or as backup protection relays in the power transmission protection system. The primary function of these relays is to trip and disconnect the faulty circuit whenever the current exceeds a pre-defined threshold limit or pre-set current value. Ensuring the safety and reliability of electrical power systems heavily relies on the accuracy and performance evaluation of overcurrent relays. As a result, the design and simulation evaluation are conducted using the powerful MATLAB/Simulink platform. This paper presents an in-depth investigation into the design and performance assessment of an overcurrent relay, utilizing the MATLAB/Simulink simulation environment. By evaluating its effectiveness under various fault scenarios, including L-G (Line-to-Ground), L-L-G (Line-to-Line-Ground), and L-L-L-G (Line-to-Line-to-Line-Ground) faults with varying fault locations, the relay’s accuracy, selectivity, and response speed are comprehensively examined.

Quality education at the age of foundation to produce dynamic manpower is a public concern in developing countries including Nepal. Preschool children do not get proper care and support from their parents due to insufficient knowledge of proper feeding habits, nutrition status and methods of psychosocial stimulation, which may affect their proper cognitive development. This study aimed to identify the factors that influence cognitive development in preschool children aged 3-5 years in Rupandehi district of western Terai, Nepal. In this school based cross-sectional survey, a total of 401 preschool children were selected using a multistage random sampling technique. The study was conducted from 4th February to 12th April, 2021 in Rupandehi district of Nepal. Data on the children's socio-economic and demographic status, level of psychosocial stimulation, nutritional status, and stage of cognitive development were collected through scheduled interviews and direct observation. Stepwise regression analysis was performed to determine the predictors of cognitive development in preschool children. A p-value less than 0.05 considered as statistical significance. Of 401 participants, 44.1% had a normal nutritional status based on height for age Z-score (HAZ). Only 1.2% of primary caregivers provided their children with high levels of psychosocial stimulation, and 49.1% of children had a medium level of cognitive development. Furthermore, cognitive development in preschoolers is positively associated with nutritional status based on the height for age z score (β = 0.280; p

Introduction: Essential thrombocythemia, a myeloproliferative condition with an increased number of circulating platelets, is a rare hematological malignancy. The aim of the study is to find out the prevalence of essential thrombocythemia among patients with myeloproliferative neoplasms presenting in haematology unit of a tertiary care centre. Methods: This was a descriptive cross-sectional study at a tertiary care centre from September, 2020 to September, 2021 (Reference number: 48 (6-11) E2077/076). All the patients with a diagnosis of essential thrombocythemia and willing to give consent were included in the study while the patients with incomplete investigations were excluded. A sample size of 72 patients was taken and convenience sampling was done. Data were entered in Microsoft Excel 2010 and analysis was done by the Statistical Package for the Social Sciences Version 22.0. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data along with mean and standard deviation for continuous data. Results: Among 72 patients with myeloproliferative neoplasms, the prevalence of essential thrombocythemia was found to be 17 (23.61%) (13.80-33.42 at a 95% Confidence Interval). The mean age of patients was 55.41±11.20 years with a male to female ratio of 9:8. The mean hemoglobin level and platelet count in patients were found to be 11.20±2.1 g/dl and 677000±262067.70 cells/mm3. Twelve (70.58%) of total patients were under low risk of essential thrombocythemia while 3 (17.64%) of them were at high risk. Conclusions: The prevalence of essential thrombocythemia was similar to other studies done in similar settings.

Abstract Background Ganglioneuroblastoma is a tumor of peripheral neuroblastic tissue which occurs predominantly in the pediatric age group; it is a rare occurrence in the newborn period with only one case reported at birth to date. Case presentation We report the case of a newborn male baby of Brahmin ethnicity from Nepal who presented with respiratory distress and blueberry muffin skin lesions after birth. A computed tomography scan showed a mass lesion in the posterior mediastinum, which was diagnosed as ganglioneuroblastoma on fine-needle aspiration cytology. He also had metastases to multiple sites including heart, lungs, skin and brain. Conclusions Ganglioneuroblastoma is a rare tumor in newborns. Any newborn presenting with respiratory distress associated with blueberry muffin skin lesions should be evaluated for neuroblastic tumor.

Introduction: The role of high-resolution ultrasound in evaluation of cervical lymph nodes is well established. The aim of this study was to determine its accuracy in differentiating benign and malignant cervical lymphadenopathy. The objectives were to study various sonographic features applicable in routine clinical practice to identify and differentiate various types of cervical lymphadenopathy. Methods: The study was done at the Pathology and Radiology department of Manipal teaching hospital (MTH) from Jan 2015 to Dec 2015. Seventy cervical nodes in 70 patients (17-reactive, 23-tuberculous, 9-lymphoma and 21-metastatic) were evaluated by high resolution ultrasound (7.5- 10MHz). Shape (S:L ratio), (maximal short to maximal long axis ratio diameter) nodal margins, hilar echogenicity, vascular pattern, distribution, size, echogenicity, calcification, posterior enhancement, eccentric cortical hypertrophy, matting and soft tissue edema were assessed. Confirmed diagnosis was either made by USG guided FNAC on the largest node or by open biopsy. The first four parameters had the most significant differences between benign and malignant lymph nodes and were evaluated to calculate the accuracy of ultrasound in their differentiation. Individual groups were compared and optimal sonographic features in differential diagnosis were determined. Results: The common useful sonographic features to identify different types of cervical lymph nodes were S:L ratio, nodal margins, hilar echogenicity, vascular pattern, matting, soft tissue edema, echogeneity, intranodal necrosis, displaced hilar vascularity, eccentric cortical hypertrophy and posterior enhancement. Vascularity was the most accurate parameter (86%) when used in isolation and when combined parameters were used ultrasound had accuracy of 97% in diagnosing benign or malignant cervical lymphadenopathy. Conclusion: This study showed that high resolution ultrasound has a high degree of accuracy in differentiating benign and malignant cervical lymphadenopathy and assists in differentiating various causes of lymphadenopathy.

Nepal has approximately 1000 operational brick kilns, which contribute significantly to ambient air pollution. They also account for 1.81% of the total bricks produced in the South Asian region. Little is known about their emissions, which are consequently not represented in regional/global emission inventories. This study compared emissions from seven brick kilns. Four were Fixed Chimney Bull’s Trench Kilns (FCBTKs) and three were Induced-Draught Zigzag Kilns (IDZKs). The concentrations of carbon dioxide (CO2), sulfur dioxide (SO2), black carbon (BC), and particulate matter (PM) with a diameter less than 2.5 µm (PM2.5) were measured. The respective emission factors (EFs) were estimated using the carbon mass balance method. The average fuel-based EF for CO2, SO2, PM2.5, and BC were estimated as 1633 ± 134, 22 ± 22, 3.8 ± 2.6 and 0.6 ± 0.2 g per kg, respectively, for all FCBTKs. Those for IDZKs were 1981 ± 232, 24 ± 22, 3.1 ± 1, and 0.4 ± 0.2 g per kg, respectively. Overall, the study found that converting the technology from straight-line kilns to zigzag kilns can reduce PM2.5 emissions by ~20% and BC emissions by ~30%, based on emission factor estimates of per kilogram of fuel. While considering per kilogram of fired brick, emission reductions were approximately 40% for PM2.5 and 55% for BC, but this definitely depends on proper stacking and firing procedures.

Tracheoesophageal fistula (TEF) in adults occurs as a result of trauma, malignancy, cuff-induced tracheal necrosis from prolonged mechanical ventilation, traumatic endotracheal intubation, foreign body ingestion, prolonged presence of rigid nasogastric tube, and surgical complication. Anesthetic management for repair of TEF is a challenge. Challenges include difficulties in oxygenation or ventilation resulting from placement of endotracheal tube in or above the fistula; large fistula defect causing loss of tidal volume with subsequent gastric dilatation, atelactasis, and maintenance of one lung ventilation. The most common cause of acquired nonmalignant TEF is postintubation fistula, which develops after prolonged intubation for ventilatory support. Acquired TEF, which occurs after prolonged intubation, usually develops after 12-200 days of mechanical ventilation, with a mean of 42 days. We present a rare case of TEF that developed after 7 days of intubation. It was a difficult case to be diagnosed as patient had a history of polytrauma, followed by emergency intubation and both these conditions can contribute to tracheobronchial injury.

In the title compound, C24H21NO2, the residues at the central ethylene bridge are trans to each other. The dihedral angles between the pyridine and benzene rings are 67.09 (6) and 61.41 (5)°. In the crystal, centrosymmetrically related molecules are linked into dimers by pairs of C—H...O hydrogen bonds.

Central venous catheter (CVC) hub fracture is a rare complication of central venous cannulation. We report a case where catheter hub fracture was detected immediately after CVC insertion. Causes of catheter hub fracture and its complications are discussed.

Background The escalating impact of climate change underscores the critical need for advanced and sustainable climate forecasting techniques. This review examines the current state and future prospects of leveraging Artificial Intelligence (AI) for climate forecasting, focusing on enhancing accuracy and identifying complex patterns in large datasets. Methods A systematic bibliometric methodology was employed, analyzing peer-reviewed literature from the past two decades. The study screened 455 articles from Scopus and Web of Science databases using specific keywords related to AI and weather forecasting. After removing duplicates and irrelevant studies, 218 articles were selected for detailed analysis. Bibliometric analysis was conducted using RStudio software to examine publication trends, co-word co-occurrence, and thematic evolution. Results The findings indicate significant growth in AI applications for climate forecasting, particularly from 2014 to 2023. AI techniques such as machine learning, artificial neural networks, and deep learning have shown promise in improving the accuracy of weather forecasts and early warning systems. The thematic analysis identified key themes like numerical weather prediction, feature selection, and neural networks as fundamental areas of research. Additionally, AI-based early warning systems for extreme weather events were highlighted as a crucial application. Below Figure 1. shows the graphical abstract of research Conclusions AI has the potential to significantly enhance climate forecasting by analyzing vast amounts of data and identifying complex patterns. Future research should focus on developing universal AI models, increasing model accuracy with explainable AI techniques, and integrating region-specific forecasts to aid decision-making in various sectors. Addressing ethical concerns and ensuring sustainable AI applications are essential for the responsible deployment of AI in climate forecasting.

Central venous catheter (CVC) hub fracture is a rare complication of central venous cannulation. We report a case where catheter hub fracture was detected immediately after CVC insertion. Causes of catheter hub fracture and its complications are discussed.

We report on a 53-year-old male patient with malignant fibrous histiocytoma of the kidney. This malignant mesenchymal tumor presented as a large mass lesion arising from the upper pole of the right kidney. Indistinguishable clinically and radiologically from a renal cell carcinoma, a few unusual. features were the predominantly cystic areas interspersed with non-central calcification and complex cyst of the contralateral kidnei:. The dilenuna of adjuvant therapy after radical nephrectomy continues.