Extragonadal Mixed Germ Cell Tumour of the Right Scapular Region: A Case Report

Extragonadal germ cell tumours are rare; to the best of our knowledge, a location in the soft tissue of the right scapular region has never been previously reported in the literature. We report a case of a 9-years-old girl who presented with swelling over the right scapular region, treated by a combination of surgery and cisplatin-based chemotherapy. Immunohistochemistry and serum tumour markers concluded it to be an extragonadal mixed germ cell tumour. Our patient had a complete response up to 2 years of follow-up. This case is being reported here due to a very rare site of presentation with a diagnostic dilemma. A multidisciplinary, combining systemic chemotherapy and surgery is the most appropriate treatment strategy for extragonadal germ cell tumours, to ensure both local and systemic control

of Struma Ovarii: A Rare Ovarian Tumor

Abstract Struma ovarii or monodermal teratoma is a specialized ovarian neoplasm which mainly constitutes mature thyroid tissue. It is a rare tumor which comprises 1% of all ovarian tumors and 2.7% of all dermoid tumors. Thyroid tissue can be observed in 5-15% of dermoid tumors but to designate the tumor as struma ovarii, it must comprise more than 50% of the ovarian tissue. This study was conducted in the Department of Pathology, Manipal Teaching Hospital in Pokhara, Nepal over a period of 10 years (Jan 2006 to Sep 2015. Age, clinical findings, preoperative imaging diagnosis, size and side of the tumor, gross and microscopic findings along with type of surgery performed are included in the study. During this 10 years period, there were 7 cases of struma ovarii with age ranging from 26 to 56 years. 2 cases had tumor on the right and 4 cases had tumor on the left side while 1 case had bilateral struma ovarii. Initial presenting symptom was palpable mass, abdominal pain and vaginal bleeding. The size of the tumor ranged from 4 to 15 cm. The capsule was smooth and cut surface shows multiloculated cyst filled with greenish to pale brown gelatinous thick fluid. Microscopic examination revealed well encapsulated tumor composed entirely of thyroid follicles. Diagnoses of struma ovarii were made in all cases. The preoperative imaging may not exactly give the diagnosis. Clinically, lesser age group was more affected and left side is more commonly involved in our series, in contrary to other literature. Out of 7 cases, bilateral struma ovarii was seen in 1 patient. No malignant features were seen in any of these cases

Irrigation management in vineyards Modeling water stress using hyperspectral imaging

Grapes, valued at nearly $6 billion annually, are one of the highest value fruit crops in the United States. They are commonly grown in Mediterranean climatic conditions with dry summers that are dependent upon irrigation for sustained fruit yield and quality. Although in-situ methods such as measurement of leaf water potential ([psi]L) are available for estimation of water stress, these methods are time, labor and cost-intensive. As climate change intensifies reducing the availability of water resources, development of a more robust, reliable water stress estimation technique in the vineyards is essential for irrigation management. In the past, research initiatives have been mostly focused on deriving linear relationships between physiological parameters and reflectance information from thermal and multispectral imagery. The current research focuses on the development of machine learning models for classification of vine water stress into three classes: no to mild water stress ([psi]L > −0.8 MPa), moderate water stress (–0.8 MPa < [psi]L < –1.2 MPa) and severe water stress ([psi]L < –1.2 MPa). First, optimal vegetation indices (VIs) derived from hyperspectral reflectance information and weather variables were identified for modeling plant water stress. Based on the comparison of linear relationships assessed between VIs and [psi]L and relative variable importance computed from random forest classifier (RFC) test models (RFC-Model 1, RFC-Model 2 and RFC-Model 3), Green Normalized Difference Vegetation Index (GNDVI), Photochemical Reflectance Index (PRI) and Anthocyanin Index (ANT) were found to have consistently good relationship with the data. Similarly, air relative humidity, evapotranspiration, minimum soil temperature and solar radiation demonstrated higher significance in model development. These spectral and weather variables were included in the final optimized RFC and artificial neural network (ANN) models. The study revealed that implementation of machine learning models with the inclusion of environmental variables substantially improved the capability of hyperspectral reflectance to detect water stress conditions in vineyards. The RFC and ANN models achieved accuracies of 73% and 70%, respectively, in classifying plant water condition into three classes. These results were promising for water stress prediction and monitoring, and for the development of decision support tools for precision irrigation in the future

Huntington\u27s Disease and Family Information Keeper

Our construct is family information keeper which is the ability for a family member to be able to take charge and help out with putting order in their loved one\u27s life. The presentation is to help you understand why a family information keeper is important with a person with Huntington\u27s disease

Pedalling Out of Sociocultural Precariousness: Religious Conversions amongst the Hindu Dalits to Christianity in Nepal

Christian conversion has become a major topic of discussion amongst academics, religious leaders, and policymakers alike in recent decades, especially in developing countries. Nepal has witnessed one of the highest rates of Hinduism to Christianity conversion in South Asia. Whilst there are no legal restrictions for religious conversion in Nepal, the conversion from Hinduism to Christianity appears to be disproportionately higher amongst Dalit communities in Nepal. However, religious conversion amongst Nepalese Dalits is yet to be fully understood. This research uses mixed methodologies of data collection and analysis to explore various issues related to religious conversion amongst Hindu Dalits into Christianity in Nepal. Results indicate whilst elderly and female Dalits tended to convert to Christianity, a range of factors specific to personal and communal biographies including social, cultural, emotional, and spiritual interplay together to shape the process of religious conversion amongst the Dalits. The paper concludes that the study of religious conversion should consider a range of sociocultural factors to fully understand the dynamics of religious conversion amongst Dalits

Biomass Carbon Content in Schima- Castanopsis Forest of Midhills of Nepal: A Case Study from Jaisikuna Community Forest, Kaski

Community forests of Nepal’s midhills have high potentiality to sequester carbon. This paper tries to analyze the biomass carbon stock in Schima-Castanopsis forest of Jaisikuna community forests of Kaski district, Nepal. Forest area was divided into two blocks and 18 sample plots (9 in each block) which were laid randomly. Diameter at Breast Height (DBH) and height of trees (DBH≥5cm) were measured using the DBH tape and clinometer. Leaf litter, herbs, grasses and seedlings were collected from 1*1m2 plot and fresh weight was taken. For calculating carbon biomass is multiplied by default value 0.47. The AGTB carbon content of Chilaune, Katus and other species were found 19.56 t/ha, 18.66 t/ha and 3.59 t/ha respectively. The AGTB of Chilaune dominated, Katus dominated and whole forest was found 43.78 t/ha, 39.83 t/ha and 41.81 t/ha respectively. Carbon content at leaf litter, herbs, grasses and seedlings was found 2.73 t/ha. Below ground biomass carbon at whole forest was found 6.27 t/ha. Total biomass and carbon of the forest was found 108.09 t/ha and 50.80 t/ha respectively. Difference in biomass and carbon content at Chilaune dominated block and Katus dominated block was found insignificant. This study record very low biomass carbon content than average of Nepal's forest but this variation in carbon stock is not necessarily due to dominant species present in the forest. Carbon estimation at forest of different elevation, aspect and location are recommended for further research. International Journal of EnvironmentVolume-6, Issue-4, Sep-Nov 2017, page: 72-84</p

Gynecologic surgery during the COVID-19 pandemic:patan hospital experience: Gynecologic surgery in COVID-19 pandemic

Introduction: The COVID-19 pandemic is a major challenge for health care services. Worldwide health systems were reorganized with the aim to both cope with the new disease and deliver surgical services safely and effectively. This study aims to audit &nbsp;gynecologic surgeries , complications, suspected , positive covid cases during covid -19 pandemic. &nbsp; Method: &nbsp;Data of gynecologic surgeries&nbsp; performed at patan hospital from 1st January to 31st December,2020 during prelockdown , lockdown and postlockdown&nbsp; period of the pandemic were collected from medical record . Patients’&nbsp; surgical&nbsp; procedures, blood transfusion, ICU stay,&nbsp; length of hospital stay , mortality, Covid-19 cases&nbsp; were descriptively analyzed . &nbsp; Result: There were&nbsp; total 413 surgeries among which major surgery was 155 (37.5%), minor&nbsp; 249 (60.3%), minimally invasive nine (2.2%) , 61 (14.8%)&nbsp; blood transfusion, mean length of hospital stay 3.75 with standard deviation of 3.711 ,15 (3.63%) cases stayed in ICU following procedure&nbsp; and one (0.2%) mortality.&nbsp; 149(36.1%) ,116(28.1%) and 148(28.1%) cases were done during &nbsp;prelockdown&nbsp; ,&nbsp; lockdown&nbsp; &nbsp;and &nbsp;postlockdown period respectively . Thirteen patients were suspected with COVID-19 infection and these surgeries were done in COVID operating room with full protective gear and 8 tested positive following a diagnostic PCR test . &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Conclusion: There was&nbsp; decrease in &nbsp;major procedures during lockdown period ,a result of travel restrictions, fear and postponement of elective surgeries prioritising the health care services. All the adequate protective measures taken &nbsp;in the setting of COVID-19&nbsp; enabled the continuity of&nbsp; surgery without significant compromise of the safety of patients and gynecologic surgery units. &nbsp

A Misdiagnosed Case of Hypertrophic Gastropathy

Hypertrophic gastropathy is a rare idiopathic hyperproliferative disorder which may present as Menetrier’s disease (MD) characterized by foveolar hyperplasia in the gastric fundus and body. It is often accompanied by a severe loss of plasma proteins (including albumin) from the altered gastric mucosa. The disease occurs in two forms, a childhood form due to cytomegalovirus infection and an adult form attributed to overexpression of transforming growth factor-alpha (TGF-α). The most common symptoms include epigastric pain with fullness and vomiting and generalized peripheral edema with hypoalbuminemia. We present a case of 75-year-old female presenting with epigastric pain and vomiting. Upper gastrointestinal endoscopy and computed tomography scan revealed an irregular mucosal fold at the body and antrum and thickening of the stomach wall, respectively. Though the endoscopic gastric mucosal biopsy was nonspecific, the patient underwent partial gastrectomy due to clinicoradiological suspicion of carcinoma. On histopathology, the case was reported as hypertrophic gastropathy, consistent with MD. Though there is a strong clinical and radiological suspicion of malignancy in the hypertrophied gastric mucosa, MD should be one of the important differential diagnoses

State-of-the-Art Smart and Intelligent Nanobiosensors for SARS-CoV-2 Diagnosis

The novel coronavirus appeared to be a milder infection initially, but the unexpected outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), commonly called COVID-19, was transmitted all over the world in late 2019 and caused a pandemic. Human health has been disastrously affected by SARS-CoV-2, which is still evolving and causing more serious concerns, leading to the innumerable loss of lives. Thus, this review provides an outline of SARS-CoV-2, of the traditional tools to diagnose SARS-CoV-2, and of the role of emerging nanomaterials with unique properties for fabricating biosensor devices to diagnose SARS-CoV-2. Smart and intelligent nanomaterial-enabled biosensors (nanobiosensors) have already proven their utility for the diagnosis of several viral infections, as various detection strategies based on nanobiosensor devices are already present, and several other methods are also being investigated by researchers for the determination of SARS-CoV-2 disease; however, considerably more is undetermined and yet to be explored. Hence, this review highlights the utility of various nanobiosensor devices for SARS-CoV-2 determination. Further, it also emphasizes the future outlook of nanobiosensing technologies for SARS-CoV-2 diagnosis

Clinico-pathological Study of Malignant Melanoma in A Tertiary Care Centre

Introduction: Malignant melanoma, which causes three fourth of all deaths related to skin cancer, is more common in Caucasian population compared to Asian population. There is no reliable information about malignant melanoma in Nepal hence an effort has been made to assess the clinical and pathological features of melanoma patients. Methods: This was a retrospective hospital based study done in the department of Pathology. All cases of malignant melanoma diagnosed on biopsy during a period of 13 years were retrieved, reviewed and collated. Results: We had 35 cases with age range from 15 to 84 years with the mean of 51.4 years and M: F of 1.3:1. The predominant site was lower extremities. Most cases were less than 3 cm. Majority of histologic subtypes were nodular melanoma 29 (82.8%) followed by mucosal lentiginous melanoma 3 (8.6%), superficial spreading melanoma 2 (5.7%) and acral lentiginous melanoma 1 (2.9%). Half (50%) of the excisional biopsies were at Clark’s level IV and 75% were at high Breslow thickness. Conclusions: The most frequent site in males and females were lower extremities and trunk respectively in contrast to Western studies where it is opposite. Nodular melanoma was the commonest histologic subtype while in other Asian studies and in Western studies majority were acral lentiginous melanoma and superficial spreading melanoma respectively. Keywords: Breslow thickness; Clark’s level; malignant melanoma; nodular melanoma