Disseminated appendicular lymphoma presenting as acute appendicitis: a case report.

Introduction and importance: Acute appendicitis is a common surgical emergency marked by appendix inflammation, presenting as acute abdominal pain and typically treated with appendectomy. The authors report a rare case of disseminated appendicular lymphoma presenting as acute appendicitis. Acute appendicitis is a common surgical emergency. Case presentation: This case involved a 75-year-old male patient who underwent appendectomy, revealing an enlarged appendix with lymphomatous nodules. Clinical discussion: Lymphoma involvement in the appendix is extremely rare, and lymphomas presenting as acute appendicitis are even more exceptional. Imaging investigations, including ultrasound and CECT scan of the abdomen, are recommended to aid in diagnosis. On computed tomography, appendiceal lymphoma is characterized by markedly diffuse mural soft-tissue thickening with preserved vermiform morphology and occasional aneurysmal dilatation of the lumen. Conclusion: This case underscores the importance of considering unusual etiologies in atypical appendicitis presentations.

Adenosquamous Carcinoma of Gallbladder with Unusual Prognosis: A Case Report.

The adenosquamous carcinoma of the gallbladder is a rare variant accounting for only 1-4% of all primary gallbladder carcinoma. Regardless of the histological types, all gallbladder carcinomas have silent and rapid progression resulting in delayed diagnosis and poor prognosis. Even with medical and/or surgical interventions, the median survival of patients with adenosquamous carcinoma, one of the histological variants, is less than a year. However, we present a case of adenosquamous carcinoma with an unusually better prognosis. A 70-year-old female patient, after being diagnosed with gallbladder carcinoma was suggested for surgical resection but was lost to follow-up since then. Two years later, the patient presented and was managed with extended cholecystectomy. The slow progression and non-recurrence of the tumour during follow-up for two years after the surgery indicates a better prognosis in this case. Keywords: carcinoma; case reports; cholecystectomy; prognosis.

Performance evaluation and genetic parameters estimation of multi-companies maize hybrids in Lamahi Dang, Nepal.

Selection, a basic and crucial step of breeding, can be made efficient through the estimates of genetic parameters. Ten multi-company's maize hybrids and two Nepalese maize hybrids were used as standard checks and evaluated in a randomized complete block design with three replications. Analysis of variance for different characters revealed significant differences for most of the characters among the genotypes used. The phenotypic coefficient of variation (PCV) was observed to be higher than the genotypic coefficient of variation (GCV) for all traits studied suggesting those traits interacted with the environment. The traits under study showed a wide range of heritability estimates (24%-90%). Among the characters, highest heritability and genetic advance were recorded for grain yield. Path coefficient analysis showed that the plant height, ear weight, number of kernel rows cob-1 and number of kernel row-1 and thousand kernel weight showed positive direct effect on grain yield. Ear weight and number of kernels row-1 had significant and positive correlation with grain yield. Therefore, much attention should be given to ear weight and number of kernels row-1 as these traits are helpful for indirect selection. Star 9, 10V10, and Shrestha were observed as superior and yielded higher than Rampur Hybrid 10 and Khumal Hybrid 2 in terms of grain yield.

Retrorectal schwannoma in a middle-aged female: A case report.

INTRODUCTION AND IMPORTANCE: Primary sacral and presacral lesions are uncommon and pose a significant diagnostic dilemma. Retrorectal schwannoma is a benign primary presacral lesion that is extremely rare and presents with non-specific symptoms. CASE PRESENTATION: A 42-years-old, female patient was admitted for lower-back pain for seven days. The retrorectal mass was detected on imaging, and she underwent laparoscopic excision. Pathological examination revealed a rare retrorectal schwannoma. CLINICAL DISCUSSION: Retrorectal location of schwannomas is rare and the preoperative diagnosis is very difficult as the clinical features and the radiological features are non-specific. In addition, these tumors can be found incidentally on routine rectal or pelvic examinations. As these tumors are benign, encapsulated, and non-invasive, this entity has an excellent prognosis. Despite the tumors' rarity and variety, we concur with the literature that surgical management is required to obtain a clear diagnosis and avoid consequences such as malignant transformation. CONCLUSION: Retrorectal Schwannoma presents a diagnostic and therapeutic challenge. Identification is important because surgical excision, either open or laparoscopic, is curative.

Importance of world high altitude Jumli Marshi rice with cultivation practices.

Geographically, Jumla is a Himalayan mountainous region located in the Karnali Province of Nepal. It has a beautiful landscape with abundant plant and animal species and is rich in biodiversity. Jumli Marshi has been cultivated since prehistoric times. Marshi has nutritional, religious, and cultural significance. The Chumchaur of Jumla, a place where rice cultivation is carried out at the highest elevation (3050 m) of the world. In the past, the field at the bank of the Tila river was filled with Jumli Marshi rice; however, its cultivation is currently decreasing day by day due to low productivity and blast susceptibility. Farmers prefer to grow improved varieties such as Chandannath-1 and Chandannath-3 rather than Marshi. Jumla's peasant worked very hard to produce this local variety and the role of women in producing this variety is crucial. The cultivation practice for Marshi production is unique compared with other rice production practices in Nepal. Due to it's richness in fiber (2.01 %), proteins (9.86 %), minerals such as 0.57 mg/100 â€‹g iron, 66.70 â€‹mg/100 â€‹g calcium, and 57.54 â€‹mg/100 â€‹g phosphorous, and low carbohydrates (72.74 %), it is regarded as suitable food for diabetes patients. Furthermore, it contains more nutrients than other rice varieties commonly grown in Nepal. Therefore, conservation and cultivation of Jumli Marshi should be promoted to preserve local diversity and contribute to sustainable local food production systems, agro-ecotourism, and crop improvement programs.

Presacral dermoid cyst in a young female patient: A case report.

Presacral dermoid cysts are rare, benign tumors of developmental origin that primarily affect women. Surgical resection is the mainstay of treatment for these cysts, even if asymptomatic, with the laparoscopic approach being safer and more efficient.

Incidental finding of jejunal diverticula during laparotomy for suspected adhesive small bowel obstruction: A case report.

INTRODUCTION AND IMPORTANCE: Jejunal diverticula are usually asymptomatic and are discovered incidentally. While rare, their complications may be life-threatening. They should be considered as differential diagnoses in undiagnosed complaints of chronic abdominal pain, malabsorption, anemia, gastrointestinal bleed and intestinal obstruction. CASE PRESENTATION: A 66-year lady, known hypertensive and hypothyroidism with history of hysterectomy presented with symptoms suggestive of small bowel obstruction. Intraoperatively adhesions between loops of the small intestine, multiple diverticula with two of them impending perforation were found. Resection of 10 cm of jejunum containing diverticula with end-to-end anastomosis was performed. She had uneventful recovery and on 2 months of follow-up she was doing well. CLINICAL DISCUSSION: Although diverticula can be found anywhere along the gastrointestinal tract, jejunal diverticula are rare. Most patients are asymptomatic, symptoms if present is non-specific that delay diagnosis causing patients to land up with complications. They are diagnosed incidentally on endoscopy or imaging rather than through clinical suspicion. Asymptomatic cases do not mandate treatment while symptomatic cases can be managed conservatively with surgery being reserved for those with complications. CONCLUSION: Small bowel obstruction due to jejunal diverticula is a rare entity, a diagnosis of which can be confirmed only intra-operatively. So it must be borne as a differential in small bowel obstruction. Timely diagnosis and management will prevent life-threatening complications of it.

Morgagni hernia in adult: A case report.

INTRODUCTION AND IMPORTANCE: Morgagni Hernia is a congenital diaphragmatic hernia but can rarely present in adults. It occurs due to a congenital defect in the development of the diaphragm. Here we present a case of symptomatic Morgagni hernia diagnosed in a 53 years' female. CASE PRESENTATION: A 53 years' female presented with recurrent chest symptoms and was found to have bowel contents herniated into the right hemithorax on chest X-ray and CECT. Reduction of hernia was done laparoscopically and the hernia was repaired with non-absorbable suture in an interrupted manner. CLINICAL DISCUSSION: Morgagni hernias are mostly diagnosed incidentally on a chest radiograph or can present with cardiorespiratory or abdominal symptoms. Our case was an adult who was diagnosed to have Morgagni hernia presenting with chest symptoms. The investigation of choice to diagnose and evaluate this condition is CECT of chest and repair of hernia without the use mesh is advised in asymptomatic cases also due to feared complications like strangulation and incarceration. CONCLUSION: The treatment of Morgagni Hernia is primary surgical repair which can be done either transthoracically or transabdominally. It is advised that surgical repair should be done even in asymptomatic cases.

Cecal gastrointestinal stromal tumor causing ileocolic intussusception in an adult: A rare case report.

INTRODUCTION AND IMPORTANCE: Cecal gastrointestinal stromal tumors (GIST) constitute a rarer subtype of all GISTs. Rarely, it can present with ileocolic intussusception in adults making it a challenging diagnosis due to non-specific clinical features. CASE PRESENTATION: A 30-year previously healthy woman presented with lower abdominal pain and a distended abdomen who was subsequently diagnosed with ileocolic intussusception on a CT scan. Intraoperatively, a pedunculated polypoid hard mass was identified in the cecum and thus, a standard right hemicolectomy was performed with the suspicion of malignancy. Histopathology of the resected mass confirmed CD117 negative, spindle type GIST. DISCUSSION: Cecal GIST presenting in the form of ileocolic intussusception is rare. Contrast-enhanced CT scan is the preferred imaging modality for the evaluation of patients with suspected GIST to determine the extent of the tumor, the presence or absence of metastatic disease alongside evaluation of the possibility of complete resection. Adjuvant imatinib therapy following complete resection decreases the disease recurrence. CONCLUSION: Intussusception in an adult can be the first manifestation of underlying malignancy like GIST. Complete surgical resection of the tumor with a negative margin offers long-term survival.

Common hepatic artery pseudoaneurysm: A rare complication following total gastrectomy: A case report.

INTRODUCTION AND IMPORTANCE: Common Hepatic Artery (CHA) Pseudoaneurysm is a rare entity, attributed to infections, trauma, and upper abdominal surgery. Most cases occur after biliary and pancreatic surgery. CHA pseudoaneurysm after total gastrectomy is uncommon and can be devastating. CASE PRESENTATION: A 58-years male who underwent D2 total gastrectomy for gastric carcinoma ten days ago, presented with hematemesis, epigastric pain, and a history of melaena. After admission, upper gastrointestinal endoscopy showed a clot at the jejunojejunostomy site. Computed tomography with angiography was diagnostic of pseudoaneurysm of CHA located inferiorly. Coil embolization of CHA was done and the patient improved. CLINICAL DISCUSSION: Pseudoaneurysm of the common hepatic artery is a serious complication after abdominal surgery. Only a few cases have been reported with similar symptoms related to gastrointestinal bleeding following various upper abdominal surgeries. Coil embolization is a gold standard technique with a high success rate. CONCLUSION: CHA pseudoaneurysm is a dreadful potential complication of abdominal surgery including gastrectomy. Early recognition and emergency management of CHA pseudoaneurysm are crucial for a favorable outcome for patients with bleeding from CHA aneurysm.

Performance evaluation of maize hybrids in inner-plains of Nepal.

Hybridization plays a vital role in increasing the production and productivity of maize. Evaluating maize hybrids in a specific environment is a key task for the hybrid maize program. The objective of this study was to identify a promising maize hybrid for winter planting in inner terai regions. Ten maize hybrids were evaluated in a randomized complete block design (RCBD) with three replications during the winter season of 2018 and 2019 at the research field of Purwanchal Agriculture Campus, Jhapa, Nepal. The results suggested that among tested hybrids, P3396 (11.18 tons ha-1), Shresta (10.67 tons ha-1), and Rampur Hybrid 6 (10.37 tons ha-1) produced significantly higher yield in 2018 whereas P3396 (11.10 tons ha-1), Shresta (10.20 tons ha-1), and Ganga Kaveri (10.03 tons ha-1) were the ones with the highest grain yield in 2019. Comparing both years, P3396 and Shresta consistently outperform the other hybrids in terms of grain yield, which is an important traits for the farmers. Correlation studies suggested that ear weight and thousand-grain weight showed a positive significant correlation with grain yield. Therefore, we suggest P3396 and Shresta as promising hybrids for the maize growers in the inner terai regions of Nepal.

Congenital Partial Intercostal Liver Herniation.

Congenital intercostal liver herniation is a rare entity. The exact etiology of congenital intercostal liver herniation is unknown. Left sided intercostal herniation is even rarer. We present a case report of an eight-day old female who presented to the emergency department of Kanti Children's Hospital with tissue mass protruding through a defect in the left side of anterior chest wall since birth. Sonographic and radiological investigation revealed the tissue to be an extension of the part of the left lobe of the liver with decreased vascularity. There were no other congenital anomalies. Laparotomy with thoracotomy with resection of the non-viable herniated part and closure of defect was done. During postoperative period patient developed surgical site infection and wound dehiscence for which daily dressing and later secondary suturing was done. Keywords: Intercostal liver herniation.

Spad value varies with age and leaf of maize plant and its relationship with grain yield.

OBJECTIVES: A field experiment was conducted to evaluate Soil Plant Analysis Development (SPAD) value in different age and leaf of maize hybrid and correlating with grain yield. Ten maize hybrids were replicated thricely under Randomized Complete Block Design (RCBD) during winter of 2018. SPAD value was measured by SPAD 502 plus meter. At 30 days interval during vegetative stage SPAD measurement were taken from T1 (top most leaf) and T3 (2nd leaf from top leaf) leaves of five randomly selected plants from one plot and they were averaged. For reproductive phase data taken from eo (leaf attached to ear) and e2 (2nd leaf from eo leaf) leaves at 10 days intervals. Same leaves were used for entire data collection. RESULTS: Significantly different SPAD value was observed for different age and leaves of maize during pre and post anthesis. SPAD value increase with increase in age and decrease at the time of maturity. During vegetative phase T3 leaves has more SPAD value than T1. During reproductive stage eo leaves had more SPAD than e2 leaves, so center leaf of maize contributes more to grain yield. Correlation showed that there is strong positive correlation between different stage of SPAD with grain yield.

Assessment of productivity and profitabilty of wheat using Nutrient Expert®-Wheat model in Jhapa district of Nepal.

Wheat is the third most important cereal crop in Nepal after rice and maize both in area and production, but its productivity of 2.3 tonne ha- 1 is very less compared to other developed countries (6 tonne ha-1 for Switzerland and China) in the world. The main cause of low wheat yield in Nepal is the improper and inadequate use of fertilizer devoid of site specific nutrient management practices. Therefore, a farmers' field experiment was conducted during November 2015 to April 2016 to rectify the best fertilizer management options at two sites of Damak and Gauradaha in Jhapa district in eastern-Terai of Nepal using Nutrient Expert®-Wheat model. The research was accomplished in Randomized Complete Block Design with 2 treatments and 20 replications, considering farmers' field as replication. Two treatments included in the experimentation were NE® (Nutrient Expert Recommendation) and FFP (Farmer's Fertilizer Practices). The statistical result revealed the highly significant difference in terms of number of effective tiller m-2, plant height, filled grain per spike, spike length, grain, straw and biological yields and harvest index. The highest yield (4.71 tonne ha-1) was obtained from NE field than FFP (2.99 tonne ha-1). On an average, NE based practices produced 58 % higher yield in comparison to FFP. NE based treatment produced significantly higher biomass yield, yield attributes and cost-benefit ratio than FFP treatments. Field experiment validation confirmed that the Nutrient Expert® Wheat model could be used as the most adoptable and practical precision decision support system tool to make a more authentic fertilizer recommendation in eastern-Terai of Nepal.

Unique Features of Gastric Cancer in Young Patients: Experience from a General Hospital in Nepal.

BACKGROUND: Gastric cancer, the fifth most common malignancy in the world, usually affects older individuals but can occur in younger age groups. In this study we compared the clinicopathological profile of young patients of gastric cancer with that of older patients. MATERIALS AND METHODS: It is a prospective study of gastric cancer patients treated over three year period (January 2012 to December 2014). Data of patients were obtained from the medical record. Clinical and pathological characters of younger patients (age 40 years or less) were compared with older patients (age more than 40 years). RESULTS: There were total of 152 patients treated during the study period. Twenty patients (13.2%) were less than 40 years of age and 132 (86.8%) were older. The male to female ratio in younger patients was 1:1.5 whereas in older patients it was 1:0.6. In the younger age group 14 patients (70%) had poorly differentiated adenocarcinoma in contrast to 45% in the older age group (<0.01). Some 55% of younger and 42% of older patients had stage IV disease at presentation and curative surgery was not possible. Palliative surgery for gastric outlet obstruction or bleeding from the tumor was performed on 25% and 21% respectively. CONCLUSIONS: Gastric cancer in young people aged less than 40 years has unique characters like female predominance, unfavorable tumor biology, and advanced stage at presentation. There should be a high index of suspicion of gastric cancer even in young patients.

Dietary intake patterns and nutritional status of women of reproductive age in Nepal: findings from a health survey.

BACKGROUND: Improper dietary intake pattern in women of reproductive age in Nepal has resulted in the deficiency of essential nutrients. Adequate nutritional status and proper dietary intake pattern of women improves maternal and child health. The objective of this study was to assess the nutritional status and dietary intake pattern among the women and associated factors. METHODS: Data collection at households and health check-up camps were conducted in selected Village Development Committees of nine districts in three ecological regions (Mountain, Hill and Terai) of Nepal from September 2011 to August 2012. Women of reproductive age (15 to 49 years) were the study subjects. At the household interview, structured questionnaires were used to obtain information on socio-demographic characteristics, anthropometric measurements, dietary intake pattern, consumption of junk foods, animal rearing, agricultural products, possession of kitchen garden, pregnancy status and anemia. Dietary intake pattern was determined by information collected through the structured questionnaires comprising of food items-cereals, pulses/legumes, vegetables, meat, fruits and milk and milk products. Health check-up camps were conducted in the local health facilities where qualified doctors, nurses and laboratory technicians performed physical examination of the women, confirmed their pregnancy and conducted hematocrit tests. The data was entered and analyzed using SPSS. RESULTS: Altogether 21,111 women were interviewed. More than a quarter of the women in Terai were malnourished as indicated by low body mass index (BMI < 18.5 Kg/m(2)). Among the dietary intake pattern, the majority of women consumed cereals at least once a day in all three ecological regions. The majority of women in Mountain consumed pulses/legumes thrice a week. In Terai, the majority of women consumed vegetables thrice a week. In all three ecological regions, the majority of women consumed meat and meat products and fruits once a week. About thirty percent of women consumed milk and milk products once a day in all three ecological regions. The non-use of iodized salt by Terai women was the highest (5.3 %, n = 303). In all the ecological regions, cereals and vegetables were produced in the majority of the participants' households in comparison of fruits, poultry and goat/sheep. The women of age 15 to 24 years were 2.7 times more likely to be malnourished than women of 35 to 49 years age (aOR = 2.7, CI = 2.5,3.0). The unemployed women had nearly two times more chances of being malnourished than women doing manual work (aOR = 1.9, 95 % CI = 1.5,2.2). In Terai, women were five times more likely to be malnourished (aOR = 0.2, CI = 0.1,0.2) and 20 times more likely to be anemic (aOR = 0.05, CI = 0.04,0.07) than women in Mountain. The pregnant women were five times more likely to be anemic than non-pregnant women (aOR = 0.2, CI = 0.2,0.3). CONCLUSIONS: The nutritional status of women of reproductive age is still poor especially in Terai and the dietary intake pattern is not adequate. It suggests improving nutritional status and feeding habits especially intake of meat, fruits and vegetables focusing on reproductive aged women.

Gastric cancer perforation: experience from a tertiary care hospital.

INTRODUCTION: Gastric cancer perforation can occurs in advanced stage of the disease and is often associated with a high morbidity and mortality. Peritonitis due to perforation needs emergency laparotomy and different surgical procedures can be performed for definitive treatment. Surgical procedures largely depend on the stage of the disease and general condition of the patient. This study was carried out to evaluate the outcome and role of different surgical procedures in gastric cancer perforation. METHODS: Medical record of patients with gastric perforation, who were treated during ten years period, was reviewed retrospectively. Data regarding clinical presentation, surgical procedures, staging and survival of patients were obtained. RESULTS: Features suggestive of diffuse peritonitis were evident in all cases. The majority of the patients underwent emergency surgery except one who died during resuscitation. The majority of patients were in stage III and stage IV. Surgical procedure includes simple closure and omental patch in five patients, simple closure and gastrojejunostomy in nine patients, gastrectomy in six patients and Devine's antral exclusion in one patient. Surgical site infection was the most common (45.5%) postoperative complication. Four patients died within one month of the surgery. Three patients who underwent gastrectomy survived for one year and one patient survived for five years. CONCLUSIONS: Although gastric cancer perforation usually occurs in advanced stage of the disease, curative resection should be considered as far as possible.