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Background and Objectives: Health care-associated infections (HAI) are one of the most common adverse events in health-care delivery and an endemic burden as major health-care problem. Carbapenems have broad-spectrum antibacterial activity and thus known as Extended-spectrum β-lactamases. Therefore, the emergence of carbapenem-resistant bacteria poses great significance in HAI. Methods: The study was undertaken to see the prevalence of carbapenem-resistant Acinetobacter baumannii (CRAB) and carbapenem-resistant enterobacteriaceae (CRE) in patient samples and surrounding environment. During the study, all the patients' clinical samples sent to the microbiology department for culture sensitivity were considered. All isolates were processed according to standard microbiological protocols and reported according to the Clinical and Laboratory Standards Institute guidelines. Environmental swabs were taken from HI-touch areas from all intensive care unit (ICU)-admitted patients' rooms. Results: Around 290 isolates were reported during the study from concerned ICUs. Out of which 80 samples were carbapenemase producers. Environmental samples were collected from ICUs from Hi-Touch areas showed growth in 23 samples out of a total of 270. Carbapenem-resistant isolates identified in the study belonged equally to Enterobacteriaceae (most common-Klebsiella pneumoniae and Escherichia coli) and nonfermenters classes (CRAB and Pseudomonas aeruginosa), were of similar concern and also difficult to treat, and further compounds the morbidity and mortality of associated infections. The majority of carbapenem-resistant pathogens in this study were resistant to extended-spectrum cephalosporins, fluoroquinolones, and piperacillin-tazobactam (multidrug-resistant [MDR]). Interpretation and Conclusions: In a setting where CRE and CRAB persist, environmental contamination is common. Screening of patients, ensuring strict contact precautions, and strictly following decontamination guidelines in ICUs can be a powerful tool in discerning HAI caused due to CRE and CRAB.

Key Clinical Message Pituitary apoplexy is a rare entity, which is characterized by severe neurological, ophthalmological, and endocrinological complications, with acute adrenal crisis being a major concern. The diagnosis of pituitary apoplexy is challenging, particularly in cases where it coexists with bacterial meningitis, leading to a diagnostic dilemma and delay in treatment. We report a case of a 23‐year‐old female diagnosed with pituitary apoplexy with concurrent bacterial meningitis.

Key Clinical Message Clinicians should be mindful of the rare occurrence of spontaneous bacterial peritonitis in essential thrombocythemia with extensive splanchnic vein thrombosis, especially when patients with ascites exhibit fever and abdominal pain. Abstract Spontaneous bacterial peritonitis (SBP) complicating extensive splanchnic vein thrombosis (SVT) is a rare manifestation of essential thrombocythemia (ET). In the absence of any hypercoagulable state, JAK2 mutation can be an important risk factor for extensive SVT. Evaluation for SBP is crucial when non‐cirrhotic patient exhibits fever, abdominal pain and tenderness in the background of ascites after ruling out common pathologies such as tubercular peritonitis, acute pancreatitis, Budd‐Chiari syndrome and ovarian malignancy. We present a case of SBP complicating pre‐hepatic portal hypertension with ascites in a 44‐years‐old female. On further evaluation, extensive SVT with portal cavernoma in the setting of ET was identified. She was managed with cytoreductive therapy and anticoagulation, resulting in symptom resolution.

**Background**: Unique challenges posed by caring for patients of geriatric age, require concurrent management of chronic comorbidities and strategies to avoid or minimize complications related to the injury and/or hospitalization. The presentation in this population of two or more rib fractures is associated higher morbidity and mortality compared to a younger age group. A lack of guidelines regarding the management of multiple rib fractures in the elderly for primary care providers in the community and the complexity of rib fracture management led to reviewing available evidence regarding various approaches to rib fracture management. **Methods**: Online databases (PubMed and MEDLINE) were used to identify 57 publications between 2000 and 2022 regarding the management of multiple rib fractures. **Results**: The majority of publications were retrospective studies and observational cohort studies (56%). 32% of studies were review articles, meta-analyses, and guidelines. Three articles (5.3%) were randomized control studies. Four articles (7%) cited statistics from a national resource. **Conclusions**: The management of rib fractures is predominantly non-surgical, managed with pain control and respiratory rehabilitation. Triaging protocols, available to healthcare providers in outpatient clinics, urgent care centers, and emergency departments, to identify the most vulnerable patients with rib fractures in a timely fashion likely help expedite the level of care they need. A comprehensive treatment team includes not only the primary trauma team (consisting of emergency physicians/trauma surgeons, trauma nurses, and mid-level practitioners) but also incorporates a multidisciplinary team with the early involvement of a geriatrician, physical therapist, anesthesiologist, social worker, and respiratory therapist when required to improve ventilation, breathing and patient comfort.

BackgroundThe Coronavirus Disease 2019 (COVID-19) pandemic and associated mitigation policies created a global economic and health crisis of unprecedented depth and scale, raising the estimated prevalence of depression by more than a quarter in high-income countries. Low- and middle-income countries (LMICs) suffered the negative effects on living standards the most severely. However, the consequences of the pandemic for mental health in LMICs have received less attention. Therefore, this study assesses the association between the COVID-19 crisis and mental health in 8 LMICs.Methods and findingsWe conducted a prospective cohort study to examine the correlation between the COVID-19 pandemic and mental health in 10 populations from 8 LMICs in Asia, Africa, and South America. The analysis included 21,162 individuals (mean age 38.01 years, 64% female) who were interviewed at least once pre- as well as post-pandemic. The total number of survey waves ranged from 2 to 17 (mean 7.1). Our individual-level primary outcome measure was based on validated screening tools for depression and a weighted index of depression questions, dependent on the sample. Sample-specific estimates and 95% confidence intervals (CIs) for the association between COVID-19 periods and mental health were estimated using linear regressions with individual fixed effects, controlling for independent time trends and seasonal variation in mental health where possible. In addition, a regression discontinuity design was used for the samples with multiple surveys conducted just before and after the onset of the pandemic. We aggregated sample-specific coefficients using a random-effects model, distinguishing between estimates for the short (0 to 4 months) and longer term (4+ months). The random-effects aggregation showed that depression symptoms are associated with a increase by 0.29 standard deviations (SDs) (95% CI [-.47, -.11], p-value = 0.002) in the 4 months following the onset of the pandemic. This change was equivalent to moving from the 50th to the 63rd percentile in our median sample. Although aggregate depression is correlated with a decline to 0.21 SD (95% CI [-0.07, -.34], p-value = 0.003) in the period thereafter, the average recovery of 0.07 SD (95% CI [-0.09, .22], p-value = 0.41) was not statistically significant. The observed trends were consistent across countries and robust to alternative specifications. Two limitations of our study are that not all samples are representative of the national population, and the mental health measures differ across samples.ConclusionsControlling for seasonality, we documented a large, significant, negative association of the pandemic on mental health, especially during the early months of lockdown. The magnitude is comparable (but opposite) to the effects of cash transfers and multifaceted antipoverty programs on mental health in LMICs. Absent policy interventions, the pandemic could be associated with a lasting legacy of depression, particularly in settings with limited mental health support services, such as in many LMICs. We also demonstrated that mental health fluctuates with agricultural crop cycles, deteriorating during "lean", pre-harvest periods and recovering thereafter. Ignoring such seasonal variations in mental health may lead to unreliable inferences about the association between the pandemic and mental health.

Abstract Stiff Person Syndrome (SPS), a progressive Central Nervous System disorder is accompanied by progressive muscle rigidity, hyperreflexia, and spasms mainly in truncal and proximal leg muscles mainly associated with autoimmune disorders. Here, we report a rare case of SPS in a middle‐aged Nepalese man with uncontrolled diabetes mellitus and ketonuria.

Abstract Systems-level studies aimed at determining how soil properties are linked to plant production and ultimately animal response spatially are lacking. This study aims to identify if grazing pressure is linked to soil properties, terrain attributes, and above-ground plant accumulation and nutritive value in a silvopastoral (or integrated tree-livestock) system. Overall, cattle prefer grazing native grasses (2.81 vs. 1.24 h ha−1 AU−1) and udic (dry) landscape positions compared to aquic (wet) areas (2.07 vs. 1.60 h ha−1 AU−1). Greater grazing frequency occurs in udic soils with greater phosphorus and potassium contents and with accumulated forage with less lignin (P ≤ 0.05), which correspond to reduced elevation and greater tree height and diameter (shade) during summer mob grazing. Combining spatial monitoring technologies (both soil and animal) with forage allowance can optimize grazing systems management and sustainability spatially and temporally.

Kenya is a rapidly developing country with a growing economy and evolving health care system. In the decade since the last publication on the state of emergency care in Kenya, significant developments have occurred in the country's approach to emergency care. Importantly, the country decentralized most health care functions to county governments in 2013. Despite the triple burden of traumatic, communicable, and non-communicable diseases, the structure of the health care system in the Republic of Kenya is evolving to adapt to the important role for the care of emergent medical conditions. This report provides a ten-year interval update on the current state of the development of emergency medical care and training in Kenya, and looks ahead towards areas for growth and development. Of particular focus is the role emergency care plays in Universal Health Coverage, and adapting to challenges from the devolution of health care.

We reported that gamma-hydroxybutyrate (GHB) is released upon Herpes Simplex Virus Type-1 (HSV-1) acute infection. However, the cellular biochemical processes involved in the production of GHB in infected cells are unclear. This study aims to shed light on the biochemical pathway and the stage within the viral life cycle responsible for the release of GHB in infected cells. UV-inactivation, acyclovir (ACV), and cycloheximide (CHX) treatments were used to inhibit HSV-1 replication at various stages. Vero cells treated with UV-inactivated HSV-1 significantly decreased GHB production. However, ACV or CHX treatments did not affect GHB production. We also showed that inhibition of glycolytic enzyme enolase by sodium fluoride (NaF) significantly reduces GHB production upon infection. This finding suggests that suppression of glycolytic activity negatively affects cellular GHB production. Our data also indicated that succinic semialdehyde dehydrogenase, an enzyme involved in the shunt of the tricarboxylic acid (TCA) cycle to generate succinic acid, was decreased upon infection, suggesting that infection may trigger the accumulation of succinic semialdehyde, causing the production of GHB. Although the precise mechanism has yet to be defined, our results suggest that early events following infection modulates the release of GHB, which is generated through the metabolic pathways of glycolysis and TCA cycle.

An operational research study was conducted in 2019 to assess the quality of data submitted by antimicrobial resistance (AMR) surveillance sites in the Bagmati Province of Nepal to the National Public Health Laboratory for Global Antimicrobial Resistance and Use Surveillance System (GLASS). Measures were implemented to enhance the quality of AMR surveillance by strengthening capacity, improving infrastructure, implementing data sharing guidelines, and supervision. The current study examined reports submitted by surveillance sites in the same province in 2022 to assess whether the data quality had improved since 2019. The availability of infrastructure at the sites was assessed. Of the nine surveillance sites in the province, seven submitted reports in 2022 versus five in 2019. Completeness in reporting improved significantly from 19% in 2019 to 100% in 2022 (p < 0.001). Timely reports were received from two sites in 2019 and only one site in 2022. Specimen–pathogen consistency in accordance with the GLASS guidelines for urine, feces, and genital swab specimens improved, with ≥90% consistency at all sites. Overall, the pathogen–antibacterial consistency improved significantly for each GLASS priority pathogen. The study highlights the importance of dedicated infrastructure and institutional arrangements for AMR surveillance. Similar assessments covering all provinces of the country can provide a more complete country-wide picture.

Graft-versus-host disease (GVHD), manifesting as either acute (aGVHD) or chronic (cGVHD), presents significant life-threatening complications following allogeneic hematopoietic cell transplantation. Here, we investigated Friend virus leukemia integration 1 (Fli-1) in GVHD pathogenesis and validated Fli-1 as a therapeutic target. Using genetic approaches, we found that Fli-1 dynamically regulated different T cell subsets in allogeneic responses and pathogenicity in the development of aGVHD and cGVHD. Compared with homozygous Fli1-deficient or WT T cells, heterozygous Fli1-deficient T cells induced the mildest GVHD, as evidenced by the lowest Th1 and Th17 cell differentiation. Single-cell RNA-Seq analysis revealed that Fli-1 differentially regulated CD4+ and CD8+ T cell responses. Fli-1 promoted the transcription of Th1/Th17 pathways and T cell receptor–inducible (TCR-inducible) transcription factors in CD4+ T cells, while suppressing activation- and function-related gene pathways in CD8+ T cells. Importantly, a low dose of camptothecin, topotecan, or etoposide acted as a potent Fli-1 inhibitor and significantly attenuated GVHD severity, while preserving the graft-versus-leukemia (GVL) effect. This observation was extended to a xenograft model, in which GVHD was induced by human T cells. In conclusion, we provide evidence that Fli-1 plays a crucial role in alloreactive CD4+ T cell activation and differentiation and that targeting Fli-1 may be an attractive strategy for treating GVHD without compromising the GVL effect.

Introduction Neck space infection in the pediatric age group is common but can be life-threatening if not diagnosed properly. Since it is a polymicrobial disease, antibiotic usage should be guided by culture sensitivity pattern. Objectives To assess the microbiology, antibiotic resistance pattern and the outcome of the medical and surgical management of deep neck space infection in children. Methods This was a prospective study of children admitted for management of neck space infection from August 2017 to August 2018. The age, gender, organisms isolated, sensitivity and resistance to antibiotics, length of hospital stay, complications, and recurrence were noted. The descriptive data were analyzed. Results Out of 108 cases, there were 51 males (47.2%) and 57 females (52.8%) ranging from 1 month to 15 years, with a mean age of 5.32 +/− 4.35 years. The mean period of hospitalization was 6.98 days. Staphylococcus aureus was the most common organism isolated with less coagulase-negative staphylococci and streptococci. Clindamycin was the most sensitive drug (82.35%) followed by vancomycin and cloxcillin, while amoxicillin/ampicillin, a commonly used drug, was the least sensitive (20.58%). The abscess recurrence rate was 9.28%. The outcomes of either medical treatment or a combined medical or surgical treatment in properly selected cases were comparable. Conclusion Clindamycin or cloxacillin can be used as a first-line option for neck infection in children. Ampicillin/amoxicillin alone has a small role in neck abscess because of high resistance to this type of antibiotic.

Abstract Primary breast liposarcoma is an extraordinarily rare breast malignancy. Histological subtypes including dedifferentiated are confirmed after a thorough histopathological and immunohistochemistry analysis. Liposarcoma of the breast can mimic other breast lesions. Long‐term follow‐up is needed due to the risk of local recurrence and delayed dedifferentiation.

Abstract Giant ovarian tumors are rare in the present day due to the early diagnosis and treatment. However, owing to the large size, it can often compress the inferior vena cava and sudden decompression of it during the removal can lead to hemodynamic instability with disastrous outcomes.

Abstract Creutzfeldt‐Jakob disease (CJD) can also be diagnosed in a resource‐limited setting through good clinical analysis. The diagnosis of CJD should be considered in patients with rapidly evolving neurological signs associated with cognitive disturbances even in countries with limited available sophisticated tools and where CJD was never reported before.

Introduction Fine needle aspiration cytopathology (FNAC) is widely used for the stratification of thyroid nodules. Objective The objective of the present study is to validate FNAC reporting based on The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) at our institution and to calculate the risk of malignancy in each category. Methods This was a descriptive cross-sectional study conducted jointly at the Department of Ear, Nose and Throat and at the Department of Pathology for a period of 1.5 years (May 2018 to November 2018). All cases presenting with thyroid swelling in the outpatient department were investigated with ultrasonography (USG) of the neck, thyroid function test, and FNAC. All FNAC reporting was done according to TBSRTC. Results A total of 134 thyroidectomies were performed during the study period. The female to male ratio was 5.3:1. The age ranged from 11 to 74 years old. with a mean age of 51 years old. The FNAC has a specificity of 84.9%, a sensitivity of 89.4%, a positive predictive value of 86.4%, a negative predictive value of 88.2%, and an accuracy of 87.3% in detecting thyroid cancer. The implied risk of malignancy (ROM) in Bethesda II, III, IV, V and VI is 11.7%, 25%,40%,76.6% & 96%, respectively. Conclusion The four studied categories had a ROM comparable to other studies, except for the Bethesda III category. Further studies with larger sample sizes and with the use of USG guidance for the aspiration from the thyroid swelling may give better results by reducing the number of false negative and false positive cases.

Abstract A blunt trauma to a phthisical eye may elicit sympathetic ophthalmia. Non invasive imaging such as use of optical coherence tomography and angiography metrics of the retinal and choroidal vasculature can help monitor response to the treatment.

Abstract Heterotaxy syndrome is associated with asplenia/polysplenia and complex congenital heart disease. Facial palsy in heterotaxy is very rare. The management is still challenging with a poor prognosis. Proper counseling to the family about the disease course, treatment modalities, and outcomes is essential.

Evidence-based decision-making to combat antimicrobial resistance (AMR) mandates a well-built community-based surveillance system for assessing resistance patterns among commensals and pathogenic organisms. As there is no such surveillance system in Nepal, we attempted to describe the antimicrobial resistance pattern in E. coli isolated from the fecal samples of apparently healthy individuals in Dhulikhel municipality and also explored the local drivers of AMR. We used a mixed-method design with a cross-sectional quantitative component and a descriptive qualitative component, with focus group discussion and key informant interviews as the data collection method. Fecal samples were collected from 424 individuals randomly selected for the study. E. coli was isolated from 85.9% of human fecal samples, of which 14% were resistant to ≥3 class of antimicrobials (multidrug resistant). Of the 368 isolates, resistance to ampicillin (40.0%), tetracycline (20.7%) and cefotaxime (15.5%) were most prevalent. The major drivers of AMR were: lack of awareness of AMR, weak regulations on sales of antimicrobials, poor adherence to prescribed medications, and incomplete dosage due to financial constraints. These findings indicate the need for strict implementation of a national drug act to limit the over-the-counter sales of antimicrobials. Additionally, awareness campaigns with a multimedia mix are essential for educating people on AMR.

Abstract Evans syndrome and tuberculosis could be predisposing factors for one another, or there may be a common pathophysiological denominator for the co‐occurrence. Further research is needed for a better understanding of pathophysiology and treatment.

Abstract Primary squamous cell carcinoma of the breast is an extremely rare invasive breast carcinoma with rapid progression and worse prognosis. Careful assessment and diagnosis of the entity should also be considered in a rapidly progressing breast tumor.

[This corrects the article DOI: 10.1371/journal.pone.0245873.].

Ventilator-associated pneumonia (VAP) is one of the most frequent ICU-acquired infections and a leading cause of death among patients in Intensive Care Unit (ICU). The South East Asian Region is a part of the world with limited health resources where infectious diseases are still underestimated. We aimed to review the literature in this part of the world to describe incidence, mortality and microbiological evidence of VAP and explore preventive and control strategies. We selected 24 peer-reviewed articles published from January 1, 2000 to September 1, 2020 from electronic databases and manual searching for observational studies among adult patients diagnosed with VAP expressed per thousand days admitted in ICU. The VAP rates ranged from 2.13 to 116 per thousand days, varying among different countries of this region. A significant rate of mortality was observed in 13 studies ranging from 16.2% to 74.1%. Gram negative organisms like Acinetobacter spp., Pseudomonas aeruginosa and Klebsiella pneumoniae and Gram-positive organisms like Staphylococcus aureus and Enterococcus species were frequently found. Our findings suggest an alarming situation of VAP among patients of most of the countries of this region with increasing incidence, mortality and antibiotic resistance. Thus, there is an urgent need for cost effective control and preventive measures like interventional studies and educational programs on staff training, hand hygiene, awareness on antibiotic resistance, implementation of antibiotic stewardship programs and appropriate use of ventilator bundle approach.

BackgroundEmergency Medical Services (EMS) systems exist to reduce death and disability from life-threatening medical emergencies. Less than 9% of the African population is serviced by an emergency medical services transportation system, and nearly two-thirds of African countries do not have any known EMS system in place. One of the leading reasons for EMS utilization in Africa is for obstetric emergencies. The purpose of this systematic review is to provide a qualitative description and summation of previously described interventions to improve access to care for patients with maternal obstetric emergencies in Africa with the intent of identifying interventions that can innovatively be translated to a broader emergency context.MethodsThe protocol was registered in the PROSPERO database (International Prospective Register of Systematic Reviews) under the number CRD42018105371. We searched the following electronic databases for all abstracts up to 10/19/2020 in accordance to PRISMA guidelines: PubMed/MEDLINE, Embase, CINAHL, Scopus and African Index Medicus. Articles were included if they were focused on a specific mode of transportation or an access-to-care solution for hospital or outpatient clinic care in Africa for maternal or traumatic emergency conditions. Exclusion criteria included in-hospital solutions intended to address a lack of access. Reference and citation analyses were performed, and a data quality assessment was conducted. Data analysis was performed using a qualitative metasynthesis approach.FindingsA total of 6,457 references were imported for screening and 1,757 duplicates were removed. Of the 4,700 studies that were screened against title and abstract, 4,485 studies were excluded. Finally, 215 studies were assessed for full-text eligibility and 152 studies were excluded. A final count of 63 studies were included in the systematic review. In the 63 studies that were included, there was representation from 20 countries in Africa. The three most common interventions included specific transportation solutions (n = 39), community engagement (n = 28) and education or training initiatives (n = 27). Over half of the studies included more than one category of intervention.InterpretationEmergency care systems across Africa are understudied and interventions to improve access to care for obstetric emergencies provides important insight into existing solutions for other types of emergency conditions. Physical access to means of transportation, efforts to increase layperson knowledge and recognition of emergent conditions, and community engagement hold the most promise for future efforts at improving emergency access to care.

Sewing professionals are engaged in extensive near work in a small and intensely condensed workspaces, thereby exposing themselves to different ocular and vision-related problems. In a cross-sectional study, 305 sewing professionals of garment factories were included and assessed for ocular and vision-related problems. The assessment included detailed anterior and posterior segment examination and vision assessment comprising of visual acuity, static refraction, dynamic refraction, eye alignment, convergence, fusional vergence, amplitude of accommodation, accommodative facility, color vision, and stereopsis. The findings were recorded on preset proforma and data were analyzed in SPSS version 20. Ocular and Vision-related problems were reported for all participants by descriptive data (number, frequency, median, IQR). The median age of the sewing professional was 30 (24–39) years with male predominance (65.2%). On anterior segment assessment, meibomitis (24.26%) was the most prevalent anterior segment disorder. Prevalence of refractive error was seen in 79.7% of the subjects of which hyperopia (44.5%) was the most prevalent form of refractive error. In participants of age group less than 40 years, 79.5% of the population were found to be consistent with some form of vergence and accommodative disorder; 44.5% manifesting convergence excess with accommodative insufficiency. These participants reported ocular, visual, and asthenopic symptoms at a higher rate as compared to other dysfunctions. Association between vision-related problems and symptoms was analyzed using a Chi-square test. A significance level of 0.05 was applied for a 95% confidence interval. Ocular, visual, and asthenopic symptoms were significantly associated with binocular and accommodative disorders (r = 18.726, p = 0.04). Ocular morbidity and binocular vision anomalies were significantly prevalent in sewing professionals of garment factories.

Best management practices (BMPs) are commonly used to reduce sediment loadings. In this study, we modeled the Fort Cobb Reservoir watershed located in southwestern Oklahoma, USA using the Soil and Water Assessment Tool (SWAT) and evaluated the impacts of five agricultural BMP scenarios on surface runoff, sediment yield, and crop yield. The hydrological model, with 43 sub-basins and 15,217 hydrological response units, was calibrated (1991–2000) and validated (2001–2010) against the monthly observations of streamflow, sediment grab samples, and crop-yields. The coefficient of determination (R2), Nash-Sutcliffe efficiency (NS) and percentage bias (PB) were used to determine model performance with satisfactory values of R2 (0.64 and 0.79) and NS (0.61 and 0.62) in the calibration and validation period respectively for streamflow. We found that contouring practice reduced surface runoff by more than 18% in both conservation tillage and no-till practices for all crops used in this modeling study. In addition, contour farming with either conservation tillage or no-till practice reduced sediment yield by almost half. Compared to the conservation tillage practice, no-till practice decreased sediment yield by 25.3% and 9.0% for cotton and grain sorghum, respectively. Using wheat as cover crop for grain sorghum generated the lowest runoff followed by its rotation with canola and cotton regardless of contouring. Converting all the crops in the watershed into Bermuda grass resulted in significant reduction in sediment yield (72.5–96.3%) and surface runoff (6.8–38.5%). The model can be used to provide useful information for stakeholders to prioritize ecologically sound and feasible BMPs at fields that are capable of reducing sediment yield while increasing crop yield.

Pre-harvest contamination of produce has been a major food safety focus. Insight into the behavior of enteric pathogens on produce in pre-harvest conditions will aid in developing pre-harvest and post-harvest risk management strategies. In this study, the attachment strength (SR) and die-off rate of E. coli on the surface of watermelon fruits and the efficacy of aqueous chlorine treatment against strongly attached E. coli population were investigated. Watermelon seedlings were transplanted into eighteen plots. Prior to harvesting, a cocktail of generic E. coli (ATCC 23716, 25922 and 11775) was inoculated on the surface of the watermelon fruits (n = 162) and the attachment strength (SR) values and the daily die-off rates were examined up to 6 days by attachment assay. After 120 h, watermelon samples were treated with aqueous chlorine (150 ppm free chlorine for 3 min). The SR value of the E. coli cells on watermelon surfaces significantly increased (P

Background Water level fluctuations in endorheic lakes are highly susceptible to even slight changes in climate and land use. Devils Lake (DL) in North Dakota, USA is an endorheic system that has undergone multi-decade flooding driven by changes in regional climate. Flooding mitigation strategies have centered on the release of lake water to a nearby river system through artificial outlets, resulting in legal challenges and environmental concerns related to water quality, downstream flooding, species migration, stakeholder opposition, and transboundary water conflicts between the US and Canada. Despite these drawbacks, running outlets would result in low overspill risks in the next 30 years. Methods In this study we evaluated the efficacy of this outlet-based mitigation strategy under scenarios based on the latest IPCC future climate projections. We used the Coupled Model Intercomparison Project CMIP-5 weather patterns from 17 general circulation models (GCMs) obtained under four representative concentration pathways (RCP) scenarios and downscaled to the DL region. Then, we simulated the changes in lake water levels using the soil and water assessment tool based hydrological model of the watershed. We estimated the probability of future flood risks under those scenarios and compared those with previously estimated overspill risks under the CMIP-3 climate. Results The CMIP-5 ensemble projected a mean annual temperature of 5.78 °C and mean daily precipitation of 1.42 mm/day; both are higher than the existing CMIP-3 future estimates of 4.98 °C and 1.40 mm/day, respectively. The increased precipitation and higher temperature resulted in a significant increase of DL’s overspill risks: 24.4–47.1% without release from outlets and 3.5–14.4% even if the outlets are operated at their combined full 17 m3/s capacity. Discussion The modeled increases in overspill risks indicate a greater frequency of water releases through the artificial outlets. Future risk mitigation management should include providing a flood warning signal to local resource managers, and tasking policy makers to identify additional solution measures such as land use management in the upper watershed to mitigate DL’s flooding.

Bortezomib, a proteasome inhibitor, is an established therapy against multiple myeloma. Bortezomib-induced lung injury, although not appreciated during the introductory time of the medication, has now been highlighted in multiple case reports. The objective of this study is to report a case of bortezomib-induced lung injury, review current literature, and perform exploratory analysis.

Despite its widespread recognition as a successful model of participatory forest management, the community forestry program in Nepal is often criticized for its protection-oriented emphasis. Recognizing the need for more active timber management, the government of Nepal recently adopted a scientific forest management (SFM) policy in the lowland tropical region. In this study, strength, weakness, opportunity, and threat analytical hierarchical process criteria were employed to understand stakeholder perceptions concerning SFM implementation in Nepal. The overall perception was prioritized in the order of strengths (35%), threats (28%), opportunities (22%), and weaknesses (16%). The study results suggest that there is agreement among stakeholders regarding the need for active management of forests in the tropical lowland region. However, the perceptions of academic researchers and non-government organization professionals differed from those of the other stakeholders in that those two groups were more concerned about potential corruption and uncertainties surrounding policy and legal issues. The findings suggest that the long-term success of SFM may depend on the ability of the government to develop a mechanism that is transparent and capable of ensuring equitable benefit sharing among stakeholders. While the stakeholder perception analysis performed in this study was focused on SFM implementation in Nepal, the results could have implications for other countries that practice the participatory model of forest governance as well.

Successful medicinal chemistry campaigns to discover and optimize sphingosine kinase inhibitors require a robust assay for screening chemical libraries and for determining rank order potencies. Existing assays for these enzymes are laborious, expensive and/or low throughput. The toxicity of excessive levels of phosphorylated sphingoid bases for the budding yeast, Saccharomyces cerevisiae, affords an assay wherein inhibitors added to the culture media rescue growth in a dose-dependent fashion. Herein, we describe our adaptation of a simple, inexpensive, and high throughput assay for assessing inhibitors of sphingosine kinase types 1 and 2 as well as ceramide kinase and for testing enzymatic activity of sphingosine kinase type 2 mutants. The assay was validated using recombinant enzymes and generally agrees with the rank order of potencies of existing inhibitors.

Purpose: To evaluate the pattern of presumed tuberculous uveitis and its various clinical presentation. Methods: This hospital based, cross-sectional descriptive study was conducted in B.P. Koirala Lions Centre for Ophthalmic Studies, Kathmandu, Nepal from January 2013 to June 2014. All uveitis patients presenting to uveitis clinic were included in the study. A complete ophthalmic examination, systemic evaluation and tailored investigations were done for each individual patient and the findings were recorded. Results: Out of 1140 uveitis patients evaluated, 12 patients (1.05%) had presumed tuberculous uveitis. Panuveitis (five patients, 41.7%) was the most common form of uveitis, followed by posterior (four patients, 33.3%) and anterior uveitis (three patients, 25%). All patients showed signs of clinical resolution after the institution of anti-tuberculous therapy along with drugs for the control of intraocular inflammation. Conclusion: Panuveitis and posterior uveitis were the common forms of clinical presentation of presumed tuberculous uveitis in this study. Treatment with anti-tuberculous therapy along with drugs to control intraocular inflammation resolves presumed tuberculous uveitis.

Herpes Simplex Virus Type -1 (HSV-1) infections can cause serious complications such as keratitis and encephalitis. The goal of this study was to identify any changes in the concentrations of volatile organic compounds (VOCs) produced during HSV-1 infection of epithelial cells that could potentially be used as an indicator of a response to stress. An additional objective was to study if any VOCs released from acute epithelial infection may influence subsequent neuronal infection to facilitate latency. To investigate these hypotheses, Vero cells were infected with HSV-1 and the emission of VOCs was analyzed using two-dimensional gas chromatograph/mass spectrometry (2D GC/MS). It was observed that the concentrations of gamma-butyrolactone (GBL) in particular changed significantly after a 24-hour infection. Since HSV-1 may establish latency in neurons after the acute infection, GBL was tested to determine if it exerts neuronal regulation of infection. The results indicated that GBL altered the resting membrane potential of differentiated LNCaP cells and promoted a non-permissive state of HSV-1 infection by repressing viral replication. These observations may provide useful clues towards understanding the complex signaling pathways that occur during the HSV-1 primary infection and establishment of viral latency.

Introduction: Ear disease in children is a major public health concern in developing countries. In spite of availability of potent antibiotics, severe life threatening complications of ear diseases can occur. Objective: This study was done to find out the prevalence of different types of otological disease in school going children of Kathmandu valley. Method: This is prospective study among 1245 school children aged between 5-12 years in the time period of June 2007 - May 2008. Students were randomly selected from 4 different schools of Kathmandu valley. All these children were interviewed, examined otoscopically and findings were noted in the performa. Informed consent was taken from guardians to participate in this study. Statistical analysis was done using frequency and percentage. Results: Out of 1245 children, 64.0% were male and 36.0% female children. The most common otological diseases were wax (60.6%), followed by chronic suppurative otitis media (5.7%) and otitis media with effusion (3.7%). In CSOM, there was 85.9% tubotympanic type. Overall otological diseases were present in 75.7% children. Conclusion: There is a high prevalence of otological diseases in school going children of Kathmandu valley. Health education, improvement of socioeconomic status and health facilities will be helpful in reducing the prevalence of otological diseases.