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ABSTRACT Introduction: Postoperative pain following percutaneous nephrolithotomy (PCNL) adds to the morbidity of patients requiring additional analgesia. Various modalities of pain control techniques, such as intercostal nerve block (ICNB) and peritract infiltration (PTI), are being studied for better pain management. This study compares the efficacy of ICNB with PTI for postoperative pain management. Methods: A double-blinded, prospective, randomized control study was conducted, in which 0.25% bupivacaine, either ICNB or PTI, was given at the puncture site at the end of PCNL. The primary outcome was a comparison of postoperative pain score measured with resting Visual analogue Scale (r-VAS) and dynamic VAS (D-VAS) recorded at 2 h, 4 h, 8 h, 10 h, 12 h, 24 h, and at discharge. Injection ketorolac was given as rescue analgesia. Secondary outcomes include time to first rescue analgesia and total analgesic requirement (TAR). Results: Sixty patients were randomized into two equal groups with 63.3% male and 36.6% female, with a mean age of 37.25 ± 13.09 years. In Group ICNB, 24 (40%) and 6 (10%) patients and in Group PTI, 21 (35%) and 9 (15%) patients underwent standard and mini PCNL, respectively, in each group. All cases were PCNL doen in prone position. The mean R-VAS and D-VAS scores at 2, 4, 8, 12, 24, and 48 h were similar in both groups. The mean TAR was 56.84 ± 0.33.00 mg and 55.54 ± 0.29.64 mg of injection ketorolac in Group ICNB and PTI, respectively (P < 0.894). The time to first rescue analgesic demand were 7.11 ± 4.898 h and 6.25 ± 3.354 h (P < 0.527). Both the groups were comparable in terms of length of hospital stay, stone clearance rate, and complication rate. Conclusion: The ICNB was as efficacious as PTI for postoperative pain control with 0.25% bupivacaine following PCNL.

Penetrating perineal trauma is rare but carries a high risk due to contamination, hidden tracts, and proximity to major vessels and viscera. Retained organic foreign bodies, particularly wood, are often radiolucent and can perpetuate infection or erode into vascular structures. Necrotizing soft tissue infection (NSTI) is a devastating complication with significant mortality. A 53‐year‐old woman from rural Nepal presented 8 days after falling onto a tree branch, sustaining a perineal impalement. Her wound had been sutured primarily at a local center. She developed severe pain, swelling, foul discharge, and rectal bleeding. On exploration, extensive necrotic tissue and foul collections were found. MRI revealed a pelvic extension of infection but missed the wooden fragments. During subsequent staged debridements, two retained wooden pieces were discovered. Their removal precipitated massive pelvic hemorrhage requiring ligation of the right internal iliac artery. A loop colostomy was fashioned to prevent fecal contamination. After multiple surgeries and 53 days of inpatient care, she was discharged in stable condition. Key Clinical Message Penetrating perineal injuries carry a high risk of occult infection and vascular damage, especially when contaminated wounds are closed primarily. Wooden fragments may be missed on imaging and cause necrotizing soft‐tissue infection. Avoid primary closure in contaminated perineal wounds, and early referral when deeper injury or contamination is suspected.

Waste biomass is mainly used conventionally, without being converted into valuable products in developing countries, e.g., Nepal, mainly due to a lack of proper conversion knowledge, infrastructure, and resource data. We assessed the amount of biomass at sub-national (geography, province, and district) levels in Nepal to explore its conversion possibilities and challenges. Our assessment includes waste biomass such as agriculture crop residues, municipal waste, livestock, and human waste. We identified their current utilization practices and discussed their conversion possibilities, focusing on fuel, feed, and fertilizers. We estimated that about 1.7–5.0 million tonnes (Mt) of pellet/briquette and biochar, 1.7–5.1 Mt of feed block, 129–387 million m3 of biogas, and 0.6–1.9 Mt of fertilizer can be produced in Nepal. The conversion of the waste biomass into valuable products can have significant environmental and economic benefits. Our findings can help authorities formulate appropriate policies and entrepreneurs to develop business plans for proper biomass utilization in Nepal at national and subnational levels.

Background Serum total cholesterol (TC) and LDL cholesterol (LDL-C) have been used as major laboratory measures in clinical practice to assess cardiovascular risk in the general population and disease management as well as prognosis in patients. However, some studies have also reported the use of non-HDL cholesterol (non-HDL-C). As non-HDL-C can be calculated by subtracting HDL-C from TC, both of which do not require fasting blood sample in contrast to LDL-C which requires fasting blood sample, we aimed to compare non-HDL-C with LDL-C as a predictor of myocardial infarction (MI). Methods This hospital based cross sectional study was undertaken among 51 cases of MI and equal number of controls. MI was diagnosed based on the clinical history, ECG changes and biochemical parameters. 5 mL of fasting blood sample was collected from each research participant for the analysis of lipid profile. Non-HDL-C was calculated by using the equation; Non-HDL-C = TC – HDL-C. Statistical analysis was performed using SPSS 14.0. Results 42 MI cases were dyslipidemic in contrast to 20 dyslipidemic subjects under control group. The differences in the median values of each lipid parameter were statistically significant between MI cases and controls. The lipid risk factors most strongly associated with MI were HDL-C (OR 5.85, 95% CI 2.41-14.23, P value = 0.000) followed by non-HDL-C (OR 3.77, 95% CI 1.64-8.66, P value = 0.002), LDL-C/HDL-C (OR 3.38, 95% CI 1.44-7.89, P value = 0.005), TC/HDL-C (OR 2.93, 95% CI 1.36-7.56, P value = 0.026), LDL-C (OR 2.70, 95% CI 1.20-6.10, P value = 0.017), TC (OR 2.68, 95% CI 1.04-6.97, P value = 0.042) and Tg (OR 2.54, 95% CI 1.01-6.39, P value = 0.047). Area under the receiver operating curve was greater for non-HDL-C than for LDL-C. Non-HDL-C was also found to be more sensitive and specific than LDL-C for MI. Conclusions HDL-C and non-HDL-C are better discriminating parameters than LDL-C for MI. Thus, we can simply perform test for HDL-C and non-HDL-C both of which do not require fasting blood sample rather than waiting for fasting blood sample to measure LDL-C.