Modeling dosimetric benefits from daily adaptive RT for gynecological cancer patients with and without knowledge-based dose prediction.

Purpose: Daily online adaptive radiotherapy (ART) improves dose metrics for gynecological cancer patients, but the on-treatment process is resource-intensive requiring longer appointments and additional time from the entire adaptive team. To optimize resource allocation, we propose a model to identify high-priority patients.

Methods: For 49 retrospective cervical and endometrial cancer patients, we calculated two initial plans: the treated standard-of-care (Initial) and a reduced margin initial plan (Initial) for adapting with the Ethos treatment planning system.

Differential TLR-ERK1/2 Activity Promotes Viral ssRNA and dsRNA Mimic-Induced Dysregulated Immunity in Macrophages.

RNA virus-induced excessive inflammation and impaired antiviral interferon (IFN-I) responses are associated with severe disease. This innate immune response, also referred to as "dysregulated immunity" is caused by viral single-stranded RNA (ssRNA)- and double-stranded-RNA (dsRNA)-mediated exuberant inflammation and viral protein-induced IFN antagonism. However, key host factors and the underlying mechanism driving viral RNA-mediated dysregulated immunity are poorly defined.

Validation of the Updated Alternate Fistula Risk Score for Prediction of Postoperative Pancreatic Fistula After Pancreatoduodenectomy.

Background And Aim: Postoperative pancreatic fistula (POPF) remains a significant challenge following pancreatoduodenectomy (PD), contributing to morbidity and mortality. Various risk assessment models have been established to predict the likelihood of POPF. An updated alternate fistula risk score (ua-FRS) has been recently refined and validated within European cohorts.

Intraoperative Variations of the Gastrocolic Trunk of Henle noted in Gastrointestinal Surgeries.

Background: The gastro-colic trunk of Henle is a venous trunk that comprises the veins draining the stomach and colon and is an important landmark for various gastro-intestinal surgeries. Understanding the anatomy of these vessels may enhance the surgical outcome. The aim of this study is, to assess the Intraoperative variations of the Gastrocolic Trunk of Henle noted in gastrointestinal surgeries in a tertiary care center.

Anti-epileptic Drugs Use and Increased Risk of Stroke: A Systematic Review.

Background: Antiepileptic drugs (AEDs), the predominant treatment for epilepsy, are also utilised for migraine, neuropathic pain, and bipolar disorders, accounting for 1% of usage among the common population. There is a greater risk of stroke, heart attack, and arrhythmia among AED users particularly those with enzyme-inducing properties.

Summary: This systematic review aimed to look into the ischemic stroke risk among AED users, particularly in patients who had never had a cerebrovascular accident before.

Linalool and 1,8-Cineole as Constitutive Disease-Resistant Factors of Norway Spruce Against Necrotrophic Pathogen Heterobasidion Parviporum.

Norway spruce is an important coniferous species in boreal forests. Root and stem rot diseases caused by the necrotrophic pathogen Heterobasidion parviporum threaten the wood production of Norway spruce which necessitates the search for durable control and management strategies. Breeding for resistant traits is considered a viable long-term strategy.

Development of a welfare assessment tool for tourist camp elephants in Asia.

Background: Approximately one-third of Asian elephants are managed under human care, participating in educational, cultural, religious, and tourist activities. Management conditions vary considerably among venues, raising questions about whether welfare needs are consistently being met, particularly for Asian tourist camp elephants. To evaluate the well-being of elephants engaged in tourist activities, an evidence-based tool is needed for routine assessments to identify potential welfare risks, aid in the development of better camp standards, and enable caretakers to address specific concerns.

Indocyanine green fluorescence imaging: Assessment of perfusion at pancreatic resection margin during pancreatoduodenectomy: A cross sectional study.

Background: Clinically relevant-postoperative pancreatic fistula (CR-POPF) is one of the dreaded complications of pancreatoduodenectomy. Vascularity of the stump of the pancreas during pancreatico-enteric anastomosis is considered one of the major determinants of POPF. Indocyanine green (ICG) is one of the modality for vascular assessment; hence, we aimed to evaluate the role of ICG fluorescence imaging to assess the vascularity of the pancreatic stump during pancreatoduodenectomy.

Mutation of a highly conserved isoleucine residue in loop 2 of several β-coronavirus macrodomains indicates that enhanced ADP-ribose binding is detrimental for replication.

Unlabelled: All coronaviruses (CoVs) encode for a conserved macrodomain (Mac1) located in non-structural protein 3. Mac1 is an ADP-ribosylhydrolase that binds and hydrolyzes mono-ADP-ribose from target proteins. Previous work has shown that Mac1 is important for virus replication and pathogenesis.

Psychiatric Comorbidity among Type 2 Diabetes Mellitus Patients.

Background The co-occurrence of psychiatric conditions and diabetes mellitus is frequently observed. This coexistence manifests in various ways, leading to a diminished quality of life, heightened healthcare expenses, reduced treatment compliance, suboptimal blood sugar control, and an upsurge in visits to the emergency room. Objective To evaluate the prevalence of psychiatric comorbidity in patients with type 2 diabetes at a specialized medical center.

Role of Intraoperative Cholangiogram in Major Liver Resection and Complex Bilio-enteric Bypass Surgery.

Background Advances in surgery have decreased postoperative morbidities but bile leak is still a major issue. Intraoperative cholangiogram (IOC) is considered better in identifying bile leaks and anatomical delineation making its expanded use in hepato-biliary surgeries. Objective To assess the role of intraoperative cholangiogram in major hepatectomy and complex bilio-enteric bypass surgery.

Establishment of the First Institution-Based Poison Information Center in Nepal Through a Multilateral International Partnership.

Toxicological emergencies present a significant health challenge in Nepal. Despite the high burden, the country has inadequate formal toxicology training, medical toxicology expertise, and adequate poison control infrastructure. In recognition of this need, the Nepal Poison Information Center (PIC) was established as a collaborative effort involving local and international partners.

Pulmonary Actinomycosis in a 65-Year-Old Female with Poor Oral Dentition.

Pulmonary actinomycosis is an uncommon clinical entity that can be challenging to diagnose due to its non-specific symptomatology. Misdiagnosis and delayed treatment may result in invasive procedures and extended antimicrobial treatment courses. We report a case involving a 65-year-old female with poor oral dentition admitted for acute respiratory failure subsequently found to have a left-sided pleural effusion and perihepatic abscess formation.

Correlation of the Nutritional Risk Screening 2002 Score With Post-operative Complications in Gastrointestinal and Hepatopancreatobiliary Oncosurgeries.

Introduction The Nutritional Risk Screening 2002 (NRS 2002) is a reliable tool for assessing patients' nutritional status and for identifying those who may benefit from nutritional support before undergoing surgery. However, its application and correlation with post-operative outcomes for Nepalese patients undergoing gastrointestinal and hepatopancreatobiliary oncosurgeries remain unexplored. The objective of this study was to correlate the NRS 2002's nutritional risk with post-operative complications classified by the Clavien-Dindo Classification.

Occupational burnout and their determinants among schoolteachers in Nepal: a cross-sectional study.

Background: Burnout syndrome attributable to cumulative stressors is highly prevalent among teachers. Despite this, knowledge of burnout syndrome among schoolteachers in lower-middle-income countries are limited, therefore we aimed to investigate self-reported occupational burnout syndrome and associated factors among schoolteachers in Nepal.

Methods: A survey was conducted among randomly selected 37 community schools in Kathmandu, Nepal in 2022, with a total sample of 218 schoolteachers (70% male).

Central corneal thickness in new cases of dry eyes: A case-control study.

Significance: Loss of homeostasis and chronic inflammation result in ocular surface damage in dry eyes, which is also associated with corneal thinning in established cases. Yet, the correlation between corneal thickness and new cases of dry eyes remains inadequately supported by evidence.

Purpose: This study aimed to compare the central corneal thickness of new cases of dry eyes to that of age- and gender-matched controls.

Isolated visceral manifestation of Buerger's disease presenting as intestinal obstruction: a case report.

Introduction And Importance: Buerger's disease is an uncommon segmental nonatherosclerotic vasculitis essentially affecting small to medium-sized arteries and veins of upper and lower extremities and can lead to limb amputation. Visceral vessel involvement is quite rare accounting for 2% of cases presenting with acute abdomen due to mesenteric ischemia. Moreover, isolated visceral involvement is even rare.

Evaluating postoperative outcome assessment tools in hepato-pancreato-biliary surgery: A comparative analysis of the comprehensive complication index and Clavien-Dindo classification in a cohort of 1240 patients at a tertiary care center.

Introduction: The comprehensive complication index (CCI) has emerged as a new tool for reporting postoperative complications. The aim of this study is to evaluate and compare the efficacy of CCI and Clavien-Dindo Classification (CDC) in measuring postoperative outcomes in patients undergoing hepato-pancreato-biliary (HPB) surgery.

Materials And Methods: In this single-centered, prospective, comparative study conducted between January 2022 and March 2023, 1240 patients underwent HPB surgery, including laparoscopic cholecystectomies and complex HPB surgery.

Differential TLR-ERK1/2 activity promotes viral ssRNA and dsRNA mimic-induced dysregulated immunity in macrophages.

RNA virus induced excessive inflammation and impaired antiviral interferon (IFN-I) responses are associated with severe disease. This innate immune response, also referred to as 'dysregulated immunity,' is caused by viral single-stranded RNA (ssRNA) and double-stranded-RNA (dsRNA) mediated exuberant inflammation and viral protein-induced IFN antagonism. However, key host factors and the underlying mechanism driving viral RNA-mediated dysregulated immunity are poorly defined.

Introduction of enhanced weekend physiotherapy for patients with hip fracture is associated with improved early mobility outcomes.

Objective: To assess whether enhanced daily weekend physiotherapy (EWP) for patients with hip fracture was associated with improved clinical outcomes.

Methods: We retrospectively analysed all previously ambulatory adults admitted with hip fracture to our tertiary hospital, comparing 'usual' ('control') care (09/19-03/20) to EWP (09/20-03/21). Outcomes included Day-7 mobility ≥20 m (primary), additional mobility measures, specified postoperative complications, new residential facility placement, acute length-of-stay (LOS) and 30-day death.

Greenhouse gas mitigation and soil carbon stabilization potential of forest biochar varied with biochar type and characteristics.

Biochar is increasingly used in climate-smart agriculture, yet its impact on greenhouse gas (GHG) emissions and soil carbon (C) sequestration remains poorly understood. This study examined biochar-mediated changes in soil properties and their contribution to C stabilization and GHG mitigation by evaluating four types of biochar. Soil carbon dioxide (CO) and nitrous oxide (NO) emissions, soil chemical and biological properties, and soil organic carbon (SOC) mineralization kinetics were monitored using greenhouse, laboratory, and modeling experiments.

Economy of scale for green hydrogen-derived fuel production in Nepal.

Opportunity for future green hydrogen development in Nepal comes with end-use infrastructural challenges. The heavy reliance of industries on fossil fuels (63.4%) despite the abundance of hydroelectricity poses an additional challenge to the green transition of Nepal.

Modeling of gas sensor based on zinc oxide thin films by feedback loop using operational amplifier.

Nanostructured Zincoxide thin-film is widely used as a sensing material because of its tunable surface microstructure and wide optical bandgap but synthesizing a film with desired value of resistance and reproducibility of film is challenging, particularly by chemical method. In this work, we showed how a ZnO film of arbitrary resistance can be used as a sensor without application of heat using operational amplifier. Zinc oxide thin film was synthesized by using the Sol-gel method (Spin coating) and was characterized by XRD and SEM which revealed wurtzite polycrystalline nature of Zinc oxide film with average grain size 17-25 nm.

Acute paraquat poisoning in an adolescent with compromised outcome: A case report.

Paraquat, a highly toxic herbicide, accounts for a substantial number of poisoning-related fatalities, primarily prevalent in agricultural regions. The ingestion gives rise to severe complications affecting various organs, including the lungs, gastrointestinal tract, kidneys and liver. This report details the case of an 18-year-old male who had been using cannabis for a year and inadvertently ingested paraquat.