A Short Note on Linkage of Climatic Records between Terai and Mid-mountain of Central Nepal

The steep North to South (N-S) gradient and complex topography markssignificant variations in the spatial and temporal patterns of climatic variation surrounding within a few distances in the Nepal Himalayas. Hence,to validate climatic linkages between the stations under two distinct topographic conditions, the study examines the observational climatic data from 106m a.s.l. and 1801m a.s.l., as a representative station from a plain and hilly area. Different statistical tools including Pearson correlation analysis and a best-fit regression model were applied to analyze climate data. The analysis of 13129 daily average temperature records and 13147 daily total precipitation records showed that the variation in their sum and average of daily, five days, ten days, and monthly values between the stations in the different elevations marked significantly.Despite these variations, temperature records are measured to be consistent in different altitudes and strongly correlated. The precipitation data showed a comparatively weaker correlation. The coefficients (0.85-1.6) with R2 >0.50 in the regression models for the lower elevation and higher elevation station in the mid-mountain region except for the monsoon season. It indicated a similar fluctuation of temperature between these two stations in the respective area. The strong degree of association and the change of climatic parameters in different range and elevations indicate the possibilities of using climatic data from Terai to represent the Mid-mountain region of central Nepal

Aneurysmal Bone Cyst of Talus

Aneurysmal bone cyst (ABC) of talus is rare benign, expansile and osteolytic bone growth. Cyst contains bloody fluid lined with variable amount of osteolytic giant cells. This is common in epiphyseal ends of long bone and rare in small bones like talus. Here a 20 years’ male with aneurysmal bone cyst of talus managed with wide intralesional curettage with autologous bone graft mixed with synthetic bone graft been presented

Barriers to Reproductive Health Services Among Female Youths of Suklagandaki Municipality in Western Part of Nepal

Background: Youths have specific sexual health needs, which vary according to their age, sex, marital and socioeconomic status. The study aimed to explore the barriers to reproductive health services among female youths of Suklagandaki Municipality, Nepal. Methods: A qualitative study was conducted through in-depth interviews among female youths aged 14 to 25 and two focus group discussions among FCHVs and health workers in health post. Snowball sampling technique was used for sample selection carried out by a same-sex researcher. Results: The barriers identified were poor sexual health knowledge, fear and embarrassment, poor youth friendly health services, misconceptions regarding contraceptives and negligence about the problems. Conclusions: Prejudice regarding utilization of reproductive health services by youths has been identified a major contributing factor or barrier, which requires integrated effort   from all sector to tackle this barrier

Is conservation agriculture a potential option for cereal-based sustainable farming system in the Eastern Indo-Gangetic Plains of Nepal?

A decline in land and water productivity, increase in the cost of cultivation, and labor-intensive practices are affecting the cereal-based farming system in Nepal, particularly in the Indo-Gangetic Plains (IGP). Conservation agriculture (CA) practices have been found to be the climate-, energy-, and labor-smart and sustainable agricultural production technologies. Sustainable and Resilient Farming System Intensification (SRFSI) has been working since 2014 in response to the sustainability of the cereal-based (rice–wheat and rice–maize) farming in Sunsari and Dhanusha districts of Nepal. This study was conducted to assess the adoption and scaling up of CA in addition to input usage, production, net profit, benefit to cost (B:C) ratio, and labor use of CA practice on average scale land holdings in Sunsari district. The study employed structured questionnaires and key informant surveys as the main data collection tools and project reports were used as secondary data. Results revealed that farmers had several tangible advantages: lower labor utilization per area (71 people day−1 ha−1 as compared to 106 for conventional), lower input cost (NRs. 78,395 ha−1 as compared to 102,727 ha−1), less irrigation with regards to ponding time (50%) as compared to conventional practice, and higher crop productivity (8.11 t ha−1 as compared to 8.08 t ha−1 in rice–wheat and 13.1 t ha−1 as compared to 11.75 t ha−1in conventional rice–maize) farming system through the adoption of CA practices. This study assessed the potential of CA-based practices in a cereal-based cropping system to improve the yields and net profit for sustainability

Is conservation agriculture a potential option for cereal-based sustainable farming system in the Eastern Indo-Gangetic Plains of Nepal?

A decline in land and water productivity, increase in the cost of cultivation, and labor-intensive practices are affecting the cereal-based farming system in Nepal, particularly in the Indo-Gangetic Plains (IGP). Conservation agriculture (CA) practices have been found to be the climate-, energy-, and labor-smart and sustainable agricultural production technologies. Sustainable and Resilient Farming System Intensification (SRFSI) has been working since 2014 in response to the sustainability of the cereal-based (rice–wheat and rice–maize) farming in Sunsari and Dhanusha districts of Nepal. This study was conducted to assess the adoption and scaling up of CA in addition to input usage, production, net profit, benefit to cost (B:C) ratio, and labor use of CA practice on average scale land holdings in Sunsari district. The study employed structured questionnaires and key informant surveys as the main data collection tools and project reports were used as secondary data. Results revealed that farmers had several tangible advantages: lower labor utilization per area (71 people day−1 ha−1 as compared to 106 for conventional), lower input cost (NRs. 78,395 ha−1 as compared to 102,727 ha−1), less irrigation with regards to ponding time (50%) as compared to conventional practice, and higher crop productivity (8.11 t ha−1 as compared to 8.08 t ha−1 in rice–wheat and 13.1 t ha−1 as compared to 11.75 t ha−1in conventional rice–maize) farming system through the adoption of CA practices. This study assessed the potential of CA-based practices in a cereal-based cropping system to improve the yields and net profit for sustainability

Foodborne Outbreak Investigation in a Festival at Panchkhal Municipality of Kavrepalanchok District in Central Nepal

Background: On September 2018, cluster of gastrointestinal cases following feast of Teej Festival was reported in Panchkhal Municipality of Kavrepalanchok, Nepal. The outbreak was investigated to identify the possible source of infection, causative agent and guide local control measures for prevention and control of the outbreak. Methods: Demographic and clinical details were collected from the cases, and the outbreak was described by time, place and person. Fourteen key informant interviews were conducted to assess the probable cause of infection, practice of food handling and preparation, source of drinking water. Semi-structured questionnaires were used to collect data from the cases. Blood examination, stool examination and culture and hepatitis serological test were done. Samples from wells and ponds were collected and microbiological tests were done in National Public Health Laboratory. Results: A total of 452 cases were identified with gastrointestinal illness and no reported deaths. All the affected population had taken food from the same place during the festival where children being more affected. Two stool samples detected Entamoeba Histolytica and some showed pus cells with no cyst or ova of organisms. Stool culture was negative. No definitive source of infection detected but was suspected to be due to improper food handling. Conclusion: This investigations confirmed the food borne outbreak in Panchkhal Municipality. The definitive causative agent of the foodborne outbreak was not identified. Proper and timely response to the outbreak is of utmost important, and can reduce the severity of the illness and halt further spread of the epidemics

Pre-operative Prediction of Difficult Laparoscopic Cholecystectomy

Introduction: Laparoscopic cholecystectomy is one of the most common operation performed. Though LC have become safer and easier at times it can be difficult. Difficult cases can result in prolonged operative time, bleeding, bile spillage, conversion to open technique and bile duct injury resulting in unplanned prolonged hospital stay, increase in estimated cost to the patients and for the surgeon it leads to increased stress during operation and time pressure to complete the operative list. . Identification of difficult cases has potential advantages for surgeons, patients and their relatives. We aim to develop and validate a scoring system to predict difficult LC preoperatively. Methods: Prospective study. History, physical examination, abdominal ultrasound and biochemical parameters were included to develop a scoring system. Hundred patients undergoing LC were included and preoperative scores were calculated preoperatively to predict difficult LC which was compared with operative assessment. Results: Sensitivity and specificity of the preoperative scoring for difficult case was 53.8 % and 89.2 % respectively with PPV of 63.64 % and NPV of 84.62%. Only three parameters (history of acute cholecystitis, gall bladder wall thickness and contracted gall bladder) were statistically significant to predict difficult LC individually. Area under ROC curve was 0.779 (95 % CI, 0.657-0.883). Conclusions: Preoperative scoring system can be used to predict difficult LC. Surgeons can plan operation based on predicted difficulty. Patients and relatives can be counselled preoperatively for the possibility of difficult operation, prolonged hospital stay and increased cost in predicted difficult case. Keywords: difficult cholecystectomy; laparoscopic cholecystectomy; symptomatic cholelithiasis

Feasibility of implementing public-private mix approach for tuberculosis case management in Pokhara Metropolitan City of western Nepal: a qualitative study

BackgroundThe Public-Private Mix (PPM) approach is a strategic initiative that involves engaging all private and public health care providers in the fight against tuberculosis using international health care standards. For tuberculosis control in Nepal, the PPM approach could be a milestone. This study aimed to explore the barriers to a public-private mix approach in the management of tuberculosis cases in Nepal.MethodsWe conducted key informant interviews with 20 participants, 14 of whom were from private clinics, polyclinics, and hospitals where the PPM approach was used, two from government hospitals, and four from policymakers. All data were audio-recorded, transcribed, and translated into English. The transcripts of the interviews were manually organized, and themes were generated and categorized into 1. TB case detection, 2. patient-related barriers, and 3. health-system-related barriers.ResultsA total of 20 respondents participated in the study. Barriers to PPM were identified into following three themes: (1) Obstacles related to TB case detection, (2) Obstacles related to patients, and (3) Obstacles related to health-care system. PPM implementation was challenged by following sub-themes that included staff turnover, low private sector participation in workshops, a lack of trainings, poor recording and reporting, insufficient joint monitoring and supervision, poor financial benefit, lack of coordination and collaboration, and non-supportive TB-related policies and strategies.ConclusionGovernment stakeholders can significantly benefit by applying a proactive role working with the private in monitoring and supervision. The joint efforts with private sector can then enable all stakeholders to follow the government policy, practice and protocols in case finding, holding and other preventive approaches. Future research are essential in exploring how PPM could be optimized

Routine Measurement of Serum Amylase in Acute Abdomen

Introduction: Acute abdominal pain is a common condition presenting to both the emergency department and surgical admission unit. Increase in serum amylase levels are found in much gastrointestinal pathology. Serum amylase level is consistently high in acute pancreatitis though high values are not pathognomonic of pancreatitis .The aim of this study to assess the level of serum amylase in various diseases presenting with acute abdominal pain and to evaluate the role of routine measurement of serum amylase in the screening of patient with acute abdominal pain for the diagnosis of acute pancreatitis in a prospective series. Methods: A prospective observational study was performed from 15th May 2014 – 15th Nov 2014 (6 months) at Department of Surgery of Kathmandu medical College Teaching Hospital; Kathmandu. All consecutive patients presented at emergency department and required admissions in surgical ward were included. A multivariate analysis was performed to assess the level of serum amylase in various diseases presenting with acute abdominal pain including acute pancreatitis. Results: Overall, 318 patients were included during a period of 6 months among them 48 patients were excluded. 34 cases (12.6 %) were diagnosed of acute pancreatitis. three cases (1.1%) of non pancreatic pathology with raised serum amylase level (> 1000 U\L). Conclusions: Routine assessment of serum amylase is helpful in excluding differential diagnosis of patient presenting with acute abdomen and this study identified serum amylase as a good screening tool if done in cases with clinical suspicion.  Keywords: acute abdominal pain; acute pancreatitis; serum amylase