4 research outputs found
Moyamoya Disease in a 4‐Year‐Old Male Child: A Case Report From Nepal
No full textABSTRACT Moyamoya disease is a rare cerebrovascular disorder characterized by bilateral stenosis or occlusion of internal carotid arteries and abnormal vascular networks. We present a case of a 4‐year‐old child from Nepal with recurrent ischemic strokes, diagnosed with Moyamoya based on the clinical and imaging findings. Management involved conservative therapy with aspirin
High altitude pulmonary edema in a native highlander: A case report from Nepal
No full textBACKGROUND: High altitude pulmonary edema (HAPE) is a non-cardiogenic pulmonary edema, that usually occurs in unacclimatized lowlanders rapidly ascending above 2,500-3,000 m and in highlanders returning from lower altitudes, with both forms likely sharing the same pathophysiology. Its incidence among Himalayan trekkers and Alp’s climbers is approximately 4%, often varying with rate of ascent. It usually manifests within 2–4 days of arriving at altitudes exceeding 2,500 meters. The factors predisposing HAPE include prior respiratory infection, rapid ascent, prior history of HAPE, genetic predisposition. Patients with HAPE exhibit increased pulmonary artery pressures, normal left atrial pressure, heightened pulmonary vasoreactivity to hypoxia, and often benefit from treatments lowering pulmonary artery pressures.
THE CASE: A 41-year-old male of Rai ethnicity, born and raised in the Himalayan region of Nepal began experiencing shortness of breath during his ascent of Mount Everest at around 5,000 meters. The individual, currently employed as a trekking porter, had previously descended to an altitude of 3,420 meters for 2 weeks before commencing his ascent. He reported to have progressively worsening shortness of breath. After the onset of symptoms, he started to descend during which he fell unconscious and was brought to a hospital in Lukla. He had a low Glasgow Coma Scale score of 3/15 and SpO2 could not be determined by pulse oximetry. At the hospital, he quickly regained consciousness after receiving supplemental oxygen. He was then referred to the tertiary care center in Kathmandu for further evaluation and treatment. At the emergency department, he reported progressive shortness of breath, worsening from MMRC grade II to IV, and orthopnea. He had a similar episode three years prior and no known co-morbidities. Vital signs were stable with oxygen saturation (SpO2) of 81% in ambient air. Physical examination revealed bilateral wheezes and crackles on chest auscultation. Neurological and abdominal examinations were normal. Laboratory analysis revealed neutrophilia (80%), lymphocytopenia (15%), leukocytosis (14,900 cells/mm³), elevated serum urea (9.4 mmol/l), and high Alanine Transaminase (86 U/l). Liver and renal function tests were normal. Arterial blood gas (ABG) analysis revealed a low blood pH of 7.292. Sputum, blood, and urine cultures were negative for bacteria and fungi. He was transferred to the ICU for high-concentration oxygen therapy. ABG analysis was performed on a daily basis, with results illustrated in figure 1. He was intubated and mechanically ventilated for 4 days. Initially, chest x-ray was performed which shows pulmonary infiltrates in both lungs indicative of pulmonary edema as shown in figure 2. Throughout his ICU stay, he received iv antibiotics, CCBs and diuretics. By day 3, his crackles had significantly diminished, and a follow-up chest radiograph demonstrated notable improvement (Figure 3). After 8 days, he was transferred to the respiratory medicine ward for 2 days of observation before discharge.
CONCLUSION: Despite being physiologically adapted to high altitude conditions, native highlanders and people with prior history of HAPE may still be susceptible to developing high altitude pulmonary edema
Fuzzy Logic-Based Sprinkler Controller for a Precision Irrigation System: A Case Study of Semi-Arid Regions in India
No full textA sophisticated precision irrigation system was created to precisely determine the water requirements of crops and implement effective irrigation control strategies for automated, real-time, and targeted crop irrigation in the semi-arid regions of India. This system incorporates ZigBee technology, wireless sensor networks, and fuzzy logic-based control methodologies. This system discussed by the author actively gathers data for the most prominent parameters of the targeted area, such as soil water potential and meteorological conditions, encompassing ambient temperature, humidity, solar radiation, and wind speed. These data obtained from the sensors then processed with the fuzzy logic-based algorithms is utilized to transmit precise irrigation control instructions to the system. Moreover, this proposed system employs the Priestley and Taylor model (PTM) so as to calculate farmland evapotranspiration (ET). This algorithm has been chosen instead of the Penman & Monteith model (PMM) because of its better accuracy and simple calculations. Both field evapotranspiration and soil water potential serve as crucial inputs for the suggested fuzzy controller-based system. A comprehensive multi-factor control rule library is established, facilitating the implementation of fuzzy control mechanisms for regulating crop irrigation water requirements with enhanced performance. The testing results obtained from this proposed system demonstrate the system’s economic viability and practicality, underscoring its reliability in communication, high control accuracy, and suitability for precision irrigation in semi-arid regions in India that, in turn, enhances the crop yield
