Introduction: Predictive scoring systems are tools that assess the magnitude of a patient’s illness and forecast disease prognosis, usually in the form of mortality, in the ICU. We aimed to determine the mortality rate among patients admitted to ICU using the Acute Physiology and Chronic Health Evaluation II (APACHE II) scoring system correlating with lengths of stay in the ICU. Methodology: A cohort study using team approach to care was conducted from July 2021 through July 2022 at KRL Hospital. Five hundred fifty-two patients aged 18–40 years, admitted for medical or surgical reasons (other than cardiac) who stayed in the ICU for more than 24 h were included. The APACHE II score was determined using 12 physiological variables at the end of the first 24 h of ICU admission. Data were analyzed using IBM Corp. released in 2015 (IBM SPSS Statistics for Windows, Version 23.0, Armonk, New York). Results: The average age of study participants was 36.34±2.77, ranging from 18 to 40 years. Three hundred fifteen participants were males and 237 were females. Patients were categorized into four separate groups as per their respective APACHE II scores. Patients with an APACHE II score of 31–40 were assigned to group 1. Patients with an APACHE II score of 21–30 were assigned to group 2. Patients with an APACHE II score of 11–20 were assigned to group 3. Lastly, patients with an APACHE II score of 3–10 were assigned to group 4. All patients in group 1 and group 2 died and none survived. Groups 1 and 2 contained a sum of 228 patients. A total of 123 patients were assigned to group 3, out of which 88 patients (71.54%) survived and 35 patients (28.45%) died. From these observations, it is evident that a higher APACHE II score is correlated with increased mortality. Conclusion: APACHE II scoring serves as an early warning indication of death and prompts clinicians to upgrade their treatment protocol. This makes it a useful tool for the clinical prediction of ICU mortality.

Metronidazole is a widely used antibiotic against bacterial and protozoan infections. Even though the therapeutic use of the drug is high, it is associated with some severe side effects like neurotoxicity such as optic neuropathy, peripheral neuropathy, encephalopathy and cerebellar toxicity. We present a case of a 55-years male presented with dysarthria, who had positive cerebellar sign and magnetic resonance imaging findings suggestive of metronidazole induced cerebellar toxicity following metronidazole therapy for two months in a case of liver abscess. And, the symptoms resolved after cessation of metronidazole.

Central Nepal has long history in the field of botanical investigation in contrast with different parts of the nation. Nevertheless, the present study area (Manaslu Conservation Area) is still under-explored. The present floristic study was carried out with the aim of fulfilling this gap by giving particular attention on flowering plants and their documentation. Two field visits were directed in May-June 2012 and September-October 2012 in two unique seasons with a specific end goal to gather plant samples of both seasons. On the contrary, herbarium specimens were prepared and later identified at Tribhuvan University Central Herbarium (TUCH) and National Herbarium and Plant Laboratory (KATH). The present study uncovers the presence of 276 species of flowering plants belonging to 78 families and 200 genera of which 63 families belong to dicotyledons and 15 families belong to monocotyledons. Among these, 17 species (6.15%) of climbers, 178 species (64.49%) of herbs, 58 species (21.01%) of shrubs and 23 species (8.33%) of trees are found. Economically important flowering plants comprise about 156 species where 75 species are used as medicine, 29 species as fuel wood, 23 species as fodder, 29 species are edible, 6 species are for religious purpose, 5 specifically for construction purpose, 10 for ornamental and 13 species reported to have miscellaneous uses. MCA accounts to 9 flowering plant species for research and development and agro-technology development and 12 species are listed under IUCN and CAMP threatened categories. MCA and its affinity are likewise house to 10 endemic flowering plants. As from the study it can be inferred that Manaslu Conservation Area (MCA) is a treasure hub of flowering plants that not only represent its economic importance rather it is also a house to threaten and endemic flowering plants. Thus, proper management plans must be implemented for the conservation of resources in MCA.

Penile fracture is a rare condition with an incidence of 1 case per 175000 United States male population. It can be caused by vigorous sexual intercourse and masturbation. Patients usually present with pain and swelling of the penis and can be diagnosed clinically. It mostly occur as a result of rupture of tunica albuginea of corpora cavernosa. Ultrasound is the most reliable investigation to detect penile fractures. Patients need prompt treatment with exploration and repair of defects to prevent long-term sequelae. Here we present a case of 44 years male who developed a penile fracture following sexual intercourse and underwent surgical exploration and repair.