Climate-Smart Agriculture in Nepal: Champion technologies and their pathways for scaling up

This policy brief synthesises key findings and recommendations for decision-making under uncertainty in the agriculture sector in Nepal. This brief highlights the methodologies used for selection of champion climate-smart agriculture (CSA) practices for different agro-ecological regions of Nepal and recommendations for scaling up the champion CSA technologies and practices in Nepal. Adaptation to climate change in the agricultural sector and allied sectors is a major current and future challenge for Nepal. The majority of the population is still dependent on highly climate-sensitive agriculture. In recent years, long drought spells during the monsoon season and increased temperatures and unseasonal heavy rains during winter have caused serious distress to agriculture-dependent communities in many locations. If the Sustainable Development Goals (SDGs) of ending poverty, achieving food security and promoting sustainable agriculture are to be realised, climate change adaptation interventions need to be implemented in earnest

COVID-19 Pandemic, Climate Change, and Conflicts on Agriculture: A Trio of Challenges to Global Food Security

Global food security is a worldwide concern. Food insecurity is a significant threat to poverty and hunger eradication goals. Agriculture is one of the focal points in the global policy agenda. Increases in agricultural productivity through the incorporation of technological advances or expansion of cultivable land areas have been pushed forward. However, production growth has slowed in many parts of the world due to various endemic challenges, such as decreased investment in agricultural research, lack of infrastructure in rural areas, and increasing water scarcity. Climate change adversities in agriculture and food security are increasing. Recently, the COVID-19 pandemic has severely affected global food supply chains. Economic and social instability from the pandemic contribute to long-term disturbances. Additionally, conflicts such as war directly affect agriculture by environmental degradation, violence, and breaches of national and international trade agreements. A combination of food security and climate change challenges along with increased conflicts among nations and post-COVID-19 social and economic issues bring bigger and more serious threats to agriculture. This necessitates the strategic design of policies through multifaceted fields regarding food systems. In this comprehensive review, we explore how these three challenging factors, COVID-19, climate change, and conflicts, are interrelated, and how they affect food security. We discuss the impact of these issues on the agricultural sector, plus possible ways of preventing or overcoming such adverse effects

Occluded Coronary Artery among Non-ST Elevation Myocardial Infarction Patients in Department of Cardiology of a Tertiary Care Centre: A Descriptive Cross-sectional Study

Introduction: Non-ST elevation myocardial infarction is frequently thought to be caused by incomplete blockage of the culprit artery, whereas ST elevation myocardial infarction is frequently thought to be caused by total occlusion of the culprit artery. The objective of the study was to find out the prevalence of occluded coronary arteries among non-ST elevation myocardial infarction patients department of cardiology of a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among non-ST elevation myocardial infarction patients in a tertiary care centre from 22 June 2020 to 21 June 2021 after taking ethical approval from the Institutional Review Committee [Reference number: 4271 (6-11) E2 076/077]. A total of 196 patients were included in the study by simple randomized sampling. Data on the patient’s clinical profile, angiographic findings, and in-hospital complications were recorded. Point estimate and 95% Confidence Interval were calculated. Results: Among 126 non-ST elevation myocardial infarction patients included in the study, the prevalence of occluded coronary artery was 41 (32.54%) (24.36-40.72, 95% Confidence Interval). Conclusions: The prevalence of occluded coronary arteries was similar to the studies done in similar settings

McDonald-G Poisson Family of Distributions

In this article, we utilize the method proposed by Tahir and Cordeiro (2016) to study a new family of distributions called the McDonald Generalized Poisson (McGP) family. This family is defined by using the genesis of the McDonald distribution and the zero truncated Poisson (ZTP) distribution. We provide some mathematical properties and parameter estimation procedures of the McGP family. Three real-life data are analyzed to illustrate the potential applications of the McGP family. Our examples illustrate that the development of new probability distributions is of great interest to capture the nature of the data under study. However, one can’t guarantee a better fit just because a probability distribution possesses a larger number of parameters than its sub-model

Myocardial infarction with nonobstructive coronaries (MINOCA) following rabies postexposure prophylaxis: A case report

Key Clinical Message This case underscores the importance of considering myocardial infarction with nonobstructive coronary arteries (MINOCA) in patients experiencing acute chest pain following rabies vaccination, emphasizing the need for heightened awareness and further research into the association between MINOCA and Rabies vaccination. Abstract Rabies is a vaccine‐preventable deadly viral disease prevalent in Asia and Africa that causes thousands of deaths annually. Rabies pre (PrEP) and postexposure prophylaxis (PEP) is highly effective in annulling rabies‐associated deaths. The adverse reactions following rabies vaccination are typically mild. Myocardial infarction with non‐obstructive coronary arteries (MINOCA) is a rare condition, and its association with rabies vaccination is unprecedented. We present a case of a 43‐year‐old male with MINOCA following Rabies PEP. A 43‐year‐old male, nonsmoker and nonalcoholic, presented to the ER with complaints of acute onset left sided chest pain following the completion of the third dose of intradermal rabies vaccine, whose clinical features, ECG changes and lab reports were suggestive of acute presentation of inferior wall MI. Coronary angiography was performed, which however revealed normal coronaries with only slow flow being noted in the left anterior descending (LAD) artery. Echocardiography later showed a normal study with no other relevant diagnosis unveiled on further investigations. Hence a diagnosis of vaccine‐induced MINOCA was made. Treatment included antiplatelet therapy, statins, and beta‐blockers. MINOCA following rabies vaccination is an unprecedented finding. The clear etiology behind this couldn't be ascertained. The patient's treatment was conventional, emphasizing the need for further research and clinical trials in MINOCA diagnosis and management. This case highlights the need for clinicians to consider MINOCA in patients with acute chest pain post‐rabies vaccination. Further research is essential to unravel the association between MINOCA and rabies vaccination, paving the way for optimal management strategies

Arrhythmias: Its Occurrence, Risk Factors, Therapy, and Prognosis in Acute Coronary Syndrome

Background: Patients with acute coronary syndrome may lead to various metabolic and electrophysiological changes that induce both asymptomatic and symptomatic life-threatening arrhythmias, which increases morbidity and mortality. Methods: This observational retrospective study was conducted at Manmohan Cardiothoracic Vascular and Transplant Center, Institute of Medicine, Maharajgunj, Kathmandu, Nepal. Three hundred ninety-five patients with a diagnosis of acute coronary syndrome were enrolled in the study. Results: A total of 395 patients were included in the study with a mean age of patients 61.29± 13.5 years and with male predominance. A total number of 115 cases of arrhythmia were recorded among which the most common were atrioventricular block (10%), reperfusion arrhythmia (9.6%) followed by ventricular premature complex (8%), atrial fibrillation/flutter (6%), and ventricular tachycardia/fibrillation (5%). There was a significant difference in the incidence of arrhythmia in acute coronary syndrome group. STEMI (39.7%), NSTEMI 26(20.8%) and unstable angina11(14.8%) respectively (p=<0.001). Reperfusion arrhythmia was present in 89.47% of STEMI and 10.4 % of NSTEMI/ unstable angina and was statistically significant (p-value <0.001). A total of three patients (0.7%) needed permanent pacemaker insertion in the acute coronary syndrome group. All of these patients were STEMI which was 1.5% of total STEMI, two in inferior wall STEMI (2.6%) and 1 in anterior wall STEMI (0.8%). The total in-hospital mortality was 20 (5.06%), 17(8.6%) among STEMI and 3(2.4%) among NSTEMI, and none in unstable angina (P =<0.001). Pulmonary edema (12.9%) was the most common in-hospital outcome followed by cardiac arrest (7.6%). Conclusions: Arrhythmia in acute coronary syndrome is a common problem and may lead to structural and functional impairment of myocardial function. Keywords: Arrythmias; coronary artery disease; STEM

Percutaneous transluminal coronary angioplasty in a 52‐year‐old patient with porcelain aorta and calcified coronaries: A case report

Key Clinical Message Porcelain aorta, characterized by extensive calcification of the aortic wall is often associated with coronary calcification. It can pose an increased risk of thromboembolic complications during interventional and surgical procedures. We present a case of a 52‐year‐old female, a chronic smoker with dyslipidemia with complaints of exertional chest pain for past 6 months. She was diagnosed as a case of non‐ST elevation myocardial infarction (NSTEMI) with multivessel CAD, with porcelain aorta and calcified coronaries based on abnormal ECG, elevated troponin and coronary angiography findings. Percutaneous transluminal coronary angioplasty (PTCA) was the treatment modality chosen considering the risk of thromboembolism with aortic manipulation during coronary artery bypass grafting (CABG). Repeat ECG after the procedure showed resolution of ST segment depression. Her hospital stay was uneventful. She was discharged on dual antiplatelet therapy, statin and metoprolol. One‐week follow‐up revealed normal ECG and blood reports, with further outpatient department visits scheduled every 3 months. Porcelain aorta and coronary calcification is a challenging case for cardiologists. PTCA if done meticulously could be preferable to coronary‐artery by‐pass grafting (CABG) in such patients. Despite the risks like aortic rupture and thromboembolic complications, PTCA in a case of multivessel CAD with porcelain aorta and calcified coronaries could be a life‐saving procedure

Irrigation demands aggravate fishing threats to river dolphins in Nepal

Riverine species are adapted to natural habitat changes caused by seasonal flood-pulses. However, abrupt river channel changes following flooding events intersect with social systems of land and water management (e.g. agriculture,fisheries) and in turn generate significant consequences for conservation of endangered aquatic species. We investigated trade offs between changing river habitat availability and exposure to fishing intensity for a small population of Ganges River dolphins Platanista gangetica gangetica in the Karnali basin of Nepal. A major natural flooding event in the Karnali basin in 2010 caused the river channel to shift from the Geruwa (flows through a protected area where fishing is restricted) to the Karnali channel (high fishing activity, agriculture-dominated), where dolphins moved in response. Based on our survey data (2009–2015) and long-term hydrological trends in the basin, we found that irrigation diversions since 2012 had aggravated fishing impacts on dolphins, suggesting that their new habitat had become an ‘ecological trap’. Regression models showed that at low river depths, fishing intensity negatively affected dolphin abundance, but at higher depths no effect of fishing was observed. Two records of dolphin by catch in gill nets confirmed this, as both events corresponded with periods of sudden increase in water abstraction for irrigation. Overall, dolphin distribution shifted downstream and the population declined from 11 in 2012 to 6 in 2015. Effective protection of this river dolphin population from extinction will require the Government of Nepal to prioritize ecologically adequate river flow regimes for implementing efficient irrigation schemes and adaptive fisheries regulations in the Karnali basi