Effect of different doses of triacontanol on growth and yield of kohlrabi (Brassica oleracea L. var. gongylodes).

Triacontanol (TRIA), an endogenous plant growth regulator, promotes various metabolic activities in plants, resulting in improved growth and development in kohlrabi. The objective of this study was to assess the effect of different doses of triacontanol on the growth and yield of kohlrabi. This study was carried out in a randomized complete block design (RCBD) with five replications at Purkot Daha, Gulmi, Nepal, from October 2020 to January 2021. The treatments consisted of four doses of triacontanol (Niraculan 0.05% EC) diluted in water viz 0 mL L-1 (control), 1 mL L-1, 1.5 mL L-1 and 2 mL L-1. The results showed that triacontanol application significantly increased plant height, number of leaves, leaf length, and width of the large leaf at 40 days after transplanting (DAT). Plants treated with triacontanol at the dose of 1 mL L-1 produced the highest plant height (14.61 cm), which was statistically at par with 0 mL L-1 (12.76 cm) and 2 mL L-1 (14.26 cm). Similarly, at 40 DAT, plants treated with triacontanol at the dose of 2 mL L-1 produced the highest number of leaves (5.56), which was statistically at par with 1 mL L-1 (5.4) and 1.5 mL L-1 (4.96). Likewise, at 40 DAT, the highest length of large leaf (13.95 cm) and width of the large leaf (5.09 cm) were found in plants treated with triacontanol at the dose of 1 mL L-1, which was statistically similar with 2 mL L-1. The yield was found to be higher (6.75% to 40.4%) in plants treated with triacontanol as compared to plants treated with triacontanol at the dose of 0 mL L-1. A significant difference was found in the harvest index. The highest harvest index (0.39) was found in plants treated with triacontanol at the dose of 2 mL L-1, which was statistically similar with 1 mL L-1 (0.35) and 1.5 mL L-1 (0.39). The lowest harvest index (0.31) was found in plants treated with 0 mL-1. This study suggests that farmers can apply triacontanol at the dose of 1 mL L-1 to enhance the growth and yield of kohlrabi.

Perception and Practice among Community People and Health Service Providers on Care and Management of Burn Injuries in Nepal: A Qualitative Study.

BACKGROUND: According to WHO, burns are a serious public health problem and the second most common cause for injury in rural Nepal, accounting for 5% of disabilities. The overall objective of the study is to assess the prevailing perception and practice among community people and health service providers on care and management of burn injuries in Nepal. METHODS: This was a qualitative study conducted in 2016 representing all eco-development regions. A total of 40 key informants interviews with health personnel and 18 focus group discussions with the community people were conducted. RESULTS: There are very limited dedicated burn care facilities in Nepal. During discussion, the service providers and community people mentioned that a burn injury can affect any one irrespective of their age and socioeconomic status. The study showed that females are at higher risk for burn injury which is associated mostly with wood fire cooking.The burn cases in the hospitals were more during winter than insummer season. Among all the ethnic groups, Dalit and indigenous population were found more vulnerable towards burn injuries. Intentional burn injuries such as self-inflicted burns/suicidal attemptwere found to occur more in females.The community people had a good practice of taking the majority ofpatients having burn injury immediately to the hospital,if not, they at least provided them with a first aid treatment. CONCLUSIONS: Majority of burn injured cases are getting first aid treatment at the incident places and taking hospital immediately. Main reasons, who reached late, are unaware about seeking services and financial constraint. Overall, the community people are partially aware about the burn injury.

Perception of Community and Hospital Personnel on Burn Treatment and Outcome in Nepal.

INTRODUCTION: Globally, eleven million people sustain burn injuries every year enough to require medical attention. WHO has estimated Disability associated limited years of 84,000 per year just due to deformities and 2100 people die every year due to burn injuries in Nepal. The overall objective of the study is to explore the effectiveness of burn injuries treatment and management approach of hospitals. METHODS: This qualitative study approached to 40 Health Personnel for Key Informants Interviews and 18 Focus Group Discussions with community people at the ten referral hospitals of eight district from May-June 2016. Qualitative data were analyzed using AtLas.ti software. RESULTS: Female burn victims are brought late to the hospital compared to male patients and false reporting about incident is usually done by her attendants. More than three-fourth (80%) of the hospitals and about one-third male and female from FGD reported that the community people seek home remedy first rather than medical treatment. Majority of the medical doctors and nursing chiefs reported that first degree cases accounts for 50% of the total burn cases with a success rate of 80%. Medical and Nursing staff reported that deformities like hypertrophic scar, keloids, joint stiffness and compartment syndrome are mostly observed during the treatment. Hypothermia and sepsis were the major causes of death in most of the burn patients. CONCLUSIONS: Usually, people who engaged in house and agriculture works, have visited public health posts/hospitals more frequently due to financial constraints and transportation issues where quality of burn care services are unavailable.

Unexpected Effect of Propranolol and Prednisolone on Infantile Facial Rhabdomyosarcoma.

A 14-month-old Nepalese infant had developed a rapidly growing facial tumor originating from a dark spot on her upper eyelid. A cavernous hemangioma was suspected and treated with high doses of propranolol and prednisolone. Remission was dramatic. Histology confirmed alveolar rhabdomyosarcoma. Chemotherapy was planned but not carried out due to complicated logistics. The girl died at the age of 3. We present this case for discussion as to whether propranolol and prednisolone might be effective in rapidly growing rhabdomyosarcomas.

Familial adenomatous polyposis-related desmoids presenting with air-fluid level: a clinical review and management algorithm.

BACKGROUND: Familial adenomatous polyposis-related desmoid tumors can present with a liquefied center containing gas, accompanied by abdominal pain and sepsis. To date the optimal management of such patients has not been documented. OBJECTIVE: The aim of this study was to review our experience of managing these desmoids grouped together as "intra-abdominal desmoids with air-fluid level" and present a management algorithm. DESIGN: This is a retrospective study of prospectively maintained polyposis registry database. SETTING: This study was conducted at a tertiary referral center specializing in familial adenomatous polyposis and desmoid disease. PATIENTS: Nine patients with intra-abdominal desmoid and air-fluid level were analyzed for the purpose of this study. RESULTS: Two hundred and forty-six patients were identified with desmoid tumor. Of these, a total of 9 patients had an intra-abdominal desmoid with air-fluid level; 7 were women. Age range at diagnosis was 20 to 41 years. The median time from primary surgery to desmoid tumor development was 24 months (range, 0-48 months), and the median time for further progression to air-fluid level was 24 months (range, 0-226 months). Desmoid tumor size ranged from 10 cm to greater than 20 cm in diameter. Two patients were successfully managed with antibiotics alone, and 2 patients were managed with percutaneous drainage and antibiotics. The other 5 patients required surgical intervention involving either excision or drainage with or without proximal defunctioning/exclusion. There was a single 30-day mortality. LIMITATION: This study was limited by the small number of patients. CONCLUSIONS: The majority of intra-abdominal desmoids with an air-fluid level require surgical intervention. Antibiotics and percutaneous drainage are only successful in a limited number of patients. We present our current treatment algorithm based on this experience.

Diffusion tensor imaging (DTI) of desmoid tumours in familial adenomatous polyposis: initial experience.

PURPOSE: To assess the feasibility of diffusion tensor imaging (DTI) of desmoid tumours in familial adenomatous polyposis (FAP). MATERIALS AND METHODS: Following ethical approval and informed consent, FAP patients with desmoids underwent DTI. Fractional anisotropy (FA), relative anisotropy (RA) and apparent diffusion coefficient (ADC) were compared to control muscle using Mann-Whitney test; and to tumour site and signal intensity using one way analysis of variance (ANOVA). Imaging was repeated after 1 year. RESULTS: 15 desmoids (6 intra-abdominal; 6 abdominal wall, 3 extra-abdominal; size range: 1.6-22.9 cm) were evaluated in 9 patients. DTI was successful in 12/15 desmoid tumours. Median (range) of RA, FA and ADC were 0.23×10(-3) mm2/s (0.17-0.26); 0.27×10(-3) mm2/s (0.21-0.31); and 1.65×10(-3) mm2/s (1.39-1.91) for desmoids, significantly different from muscle: 0.27×10(-3) mm2/s (0.23-0.40), 0.32×10(-3) mm2/s (0.28-0.46), and 1.45×10(-3) mm2/s (0.92-1.63) (p=0.0001, p=0.0001, p=0.0016, respectively). There was no difference in RA, FA or ADC between tumour sites, or signal intensity (p>0.05). One year later, 2 patients had died. Tumour increased in size in 1 patient (+61%). DTI quantification was possible in only 8/13 tumours. FA, RA and ADC were not significantly different from baseline (p=0.77, 0.71 and 0.34, respectively). CONCLUSIONS: Assessment of water diffusion has the potential to provide insight into tumour microstructure and is feasible in desmoids. Desmoid tumours demonstrate anisotropy but diffusion is less restricted and less directional than in muscle.

Diagnostic accuracy of white cell count and C-reactive protein for assessing the severity of paediatric appendicitis.

OBJECTIVES: Simple investigations like white cell count (WCC) and C-reactive protein (CRP) may help to improve the accuracy of diagnosis in paediatric appendicitis. We evaluated the diagnostic accuracy of WCC and CRP for the severity of acute appendicitis in children. DESIGN: Cross-sectional study. SETTING: This study was conducted on all children who underwent open appendectomy from January 2007 to December 2008 at a District General Hospital. Data regarding demographics, WCC, CRP, histology and postoperative complications were analysed. PARTICIPANTS: All children who underwent open appendectomy during the study period. MAIN OUTCOME MEASURES: Diagnostic accuracy of WCC and CRP for simple acute appendicitis and a perforated appendix. RESULTS: Out of 204 patients, 112 (54.9%) were girls. At surgery, appendix was grossly inflamed in 175 of which 32 had perforation. Histology revealed simple acute appendicitis in 135 (66.2%) and gangrenous appendicitis in 32 (15.7%). The rest were normal. The duration of symptoms, temperature, length of stay, WCC and CRP were significantly worse in the perforated group (P value <0.05). Postoperative complications included wound infection (n = 18), pelvic collection (n = 5) and intestinal obstruction (n = 6); and were more common among patients with a perforated appendix (P value <0.05). WCC had a higher diagnostic accuracy and higher sensitivity than CRP in diagnosing simple acute appendicitis. The combined sensitivity of WCC and CRP increased to 95% and 100% for the diagnosis of simple acute appendicitis and a perforated appendix, respectively. CONCLUSION: Accuracy of WCC is higher than CRP for diagnosing simple acute appendicitis. The combined sensitivity of WCC and CRP increases for simple acute appendicitis as well as a perforated appendix.

Epstein-Barr virus (EBV) positive anal B cell lymphoma: a case report and review of literature.

This case report is on a very rare case of giant anal canal ulcer with rectal prolapse causing total faecal incontinence. An elderly patient in her eighties presented to the emergency department with complaints of a mass protruding thorough anus along with fresh rectal bleeding. Examination revealed a large ulcer measuring 6 cm x 8 cm involving the entire anal canal with rectal prolapse. Here, we discuss the management of this patient with a rare cause of giant anal canal ulceration.

Giant mesenteric lymphangioma: a rare cause of a life-threatening complication in an adult.

Mesenteric cyst lymphangiomas (MCLs) are rare benign tumours of unknown aetiology seen mostly in children. Clinical presentation can be diverse ranging from incidental abdominal cysts to an acute abdomen. A 24-year-old previously fit and healthy young man presented with a 2-week history of cramping, central abdominal pain and vomiting requiring acute hospital admission. He was a diagnostic conundrum despite extensive preoperative investigations. Recurring symptoms required urgent surgical exploration, resection and histological confirmation with a successful outcome. We review the literature and present here this rare case in an adult of MCL that has the potential to grow, invade and develop major life-threatening complications.