First Line Treatment of Meniere’s Disease

Introduction: There is no consensus on the first line medical treatment of Meniere disease to produce symptomatic improvement and slow the disease progress. Dietary salt restriction, diuretics, and vasodilators like betahistine are among the first line drugs that have been used for long. There is lack of evidence due to paucity of quality studies to support their effectiveness and advocate their use. This study is done to evaluate the effectiveness of three first line treatment of Meniere disease i.e. salt restriction, oral diuretics, and betahistine. Methods: Double blind randomized controlled trial was carried out in out-patient clinic of Ear Nose and Throat department of Lumbini Medical College Teaching Hospital. Cases were randomized into three groups; dietary salt restriction, diuretics as amiloride and furosemide, and vasodilator as betahistine. Pre and post treatment evaluation was done in terms of number and severity of vertigo, tinnitus, and hearing outcome. Results: There were a total of 97 cases with F:M ratio of 1.1:1. Mean age of patients was 47.86 yr (SD=12.7). Twenty-nine (30%) were treated with dietary sodium restriction alone (Group A), 35 (36%) were treated with diuretics (Group B) and the rest 33 (34%) were treated with vasodilator (betahistine, Group C). There was no significant difference in hearing outcome in any group. Tinnitus was significantly improved in Group B. Number of vertigo attack was significantly decreased in Group B and Group C. Severity of vertigo was significantly decreased in Group B. Conclusion: Dietary salt restriction alone was not effective in controlling any aspect of the disease whereas diuretics were effective in reducing tinnitus and number and severity of vertigo. Betahistine was effective in reducing the number of vertigo attacks but not effective on other aspects of the disease

Endoscopic Management of Epistaxis in Lumbini Medical College

Introduction: Epistaxis is one of the commonest Ear Nose Throat (ENT) emergency. Proper guidelines for its management are lacking; on the other hand, the management is mostly done by the junior health service providers which has invited non-standardized practice of epistaxis management. Thereby this study was much inclined towards assessment of the effectiveness of endoscopic management of epistaxis.   Methods: This prospective study included patients above 16 years who were diagnosed with idiopathic epistaxis visiting Out Patient of ENT Department or in the Emergency Department of Lumbini Medical College from 1st of July 2014 to 30th of June 2015. ENT examination was done to find the cause and site of bleeding. Thereafter different epistaxis management interventions were done depending on the bleeding condition. The data were collected, entered and then analyzed using SPSS version 21. The descriptive statistics were applied.   Results: Of the total 116 patients, 53 (45.69%) were male and 63 (54.31%) were female showing no gender preponderance with epistaxis in our study. Majority (49%) of the patients were managed with cauterization with silver nitrate or electrocautery in out-patient clinic. Second most common (18%) procedure was endoscopic sphenopalatine artery cauterization. Nasal packing was done only in three cases with zero posterior pack.   Conclusion: Endoscopic intervention of epistaxis seems to be safe, simple, fast, and effective for the management of epistaxis with low rates of morbidity and complications. Thereby it can be preferred over the conservative nasal packing and considered as immediate second-line management

Effect of scion varieties and wrapping materials on success of tongue grafting in Kiwifruit (Actinidia deliciosa) in Dolakha, Nepal

This study was conducted at Boch, Bhimeshwor-8, Dolakha, Nepal from January to May, 2019 to study the effect of scion variety and wrapping materials on growth performance of kiwi seedling rootstock. The field experiment was carried out in Factorial Randomized Complete Block Design using four replications. The treatments consisted of four scion varieties (Monty, Bruno, Hayward, Allison) grafted onto one year old kiwi seedling (Actinidia deliciosa) and two types of wrapping material (Grafting tape and Polyethylene plastic). The measured traits included sprout length, diameter, number of leaves, and number of sprouted bud per graft, graft success, mortality and survival percentage of grafts. The success rate of kiwi grafting was significantly affected by the scion variety and the wrapping materials. Allison variety showed the minimum days (61.72 days) to first sprouting and the maximum length of sprouts, diameter, number of leaves and number of sprouted bud per graft at the final observation. Monty variety showed the lowest growth performance. The maximum graft success (96.87%) and survival percentage of grafts (93.75%) was observed in Allison variety statistically at par with Bruno and Hayward and the lowest graft success(73.44%) and survivability(64.21%) was observed in Monty due to high mortality of the sprouted grafts. Grafting tape was superior to polyethylene plastic in terms of days to first sprouting (64.08 days), number of sprouted buds per grafts, number of leaves, graft success (92.18%) and survival of the grafts (87.01%) at the final observation. Interactive effect was found non-significant. In a nutshell, Allison is the best scion variety for grafting under the climatic condition of Dolakha and the grafting tape was the suitable tying material

Ear Nose Throat (ENT) disorders in Government Schools of Far-Western Nepal

Background: ENT disorders specially hearing impairment negatively impacts students’ development of academic, language and social skills. If left undiagnosed, these conditions may result in significant irreversible damage such as varying degree of hearing loss that can affect the social or professional performance of the individuals in later stages of life. Students going to government school in our country generally come from under privileged society. We investigated the occurrence of ENT diseases among various government school students in Kailali district. Methods: Nine government school of Kailai district were chosen at random. All students of those school present on the day of examination went routine ENT examinations. Brief history, if any, was recorded and findings were noted. The study was done throughout the month of September, 2013. Results: There were a total of 2256 students enrolled in the study. There were 1126 male and 1130 female students. Mean age of the students was 9.88 years. Forty One percent of students had ENT problems. Ear wax was the most common (17%) findings followed by suppurative ear diseases, otittis media with effusion as so on in decreasing frequency. Conclusions: ENT diseases and specially ear diseases are important health problems among school children of Nepal. Regular school health services, screening program, public awareness, improvement of socioeconomic status, timely referral to a specialist doctor can help to reduce the disease-related burden

Knowledge and attitude towards pharmacovigilance among healthcare students at a medical college in Nepal

Background: Pharmacovigilance is the science and activities relating to the detection, assessment, understanding, and prevention of adverse drug reactions (ADRs) and any other possible drug-related problems. Under reporting of adverse drugs reactions are the global health problem. The adequate knowledge and skills towards pharmacovigilance and adverse drugs reactions reporting are crucial for the health care students to ensure patients’ medication safety. This study aims to assess the knowledge and attitude of the health care students towards pharmacovigilance and ADRs. Methods: A closed ended, structured, self-administered questionnaire was administered to 204 undergraduate health care students to collect the data. Data were analyzed using SPSS version 21. Non-parametric tests (Mann Whitney U test and Kruskal Wallis test) were used for analysis. Results: Among 204 respondents, the majority of them had a poor knowledge (91.18%) and positive attitude (87.25%) towards Pharmacovigilance. The inter quartile range (median) score of the respondents’ knowledge was 5.0±2.211 and attitude was 27.0±2.88 towards Pharmacovigilance and ADRs reporting. The main reason for under reporting of ADRs was difficulty to decide whether ADR has occurred or not (32.4%) due to the lack of appropriate knowledge and training. There is a poor knowledge and positive attitude towards Pharmacovigilance. Conclusions: Adequate coverage of Pharmacovigilance and ADRs reporting issues should be covered in the curriculum as well as hand on training and workshop should be conducted to increase the knowledge and confidence in detecting, monitoring and reporting ADR in their clinical posting

Drought risk assessment in central Nepal: temporal and spatial analysis

This paper presents temporal and spatial pattern of drought phenomena in central Nepal using standardized precipitation index (SPI) at multiple time scales. The study is based on 32 years of monthly precipitation data from 40 meteorological stations from 1981 to 2012. Results indicate that, while there is no distinct trend in regional precipitation, interannual variation is large. Trend analysis of drought index shows that most stations are characterized by increases in both severity and frequency of drought and trend is stronger for longer drought time scales. Over the study period, the summer season of 2004, 2005, 2006, 2009 and winters 2006, 2008 and 2009 were the worst widespread droughts. These dry periods have a serious impact on agriculture–livestock production of central Nepal. Better understanding of these SPI dynamics could help in understanding the characteristics of droughts and also to develop effective mitigation strategies

Effects of different rates of nitrogen and pinching on yield and yield attributes of African marigold (Tagetes erecta L.)

Proper pinching practice and the optimum rate of nitrogen (N) enhance the production of marigold. An experiment was conducted at a farmer’s field in Gadawa-4, Gangaparaspur, Dang, Nepal from July 2018 to November 2018 to investigate the effects of different rates of nitrogen and pinching on yield and yield attributes of African marigold (cv. Kolkata Local). Two factorial experiment was laid in the Randomized Complete Block Design (RCBD) with three replications. There were eight treatments, consist of four rates of nitrogen (0, 50, 100 and 150 kg/ha) and two levels of pinching (pinching and non-pinching). The maximum plant height (89.70 cm), the diameter of flower (4.29 cm) and the fresh weight per flower (4.32 g) and early days to 50% flowering (61.58) were obtained at non- pinching. The highest number of flowers (60.66), yield per plant (237.49 g) and yield per hectare (9.89 t/ha) were obtained with pinching. The highest plant height (92.20 cm) was recorded at 150 kg/ha of N but the highest yield per plant (238.18 g) and yield per ha (9.91 t/ha) was obtained at 50 kg/ha of nitrogen application. No significant effect was noted on the days to 50% flowering, number of flowers per plant, fresh weight per flower and diameter of flowers by different rates of nitrogen. The interaction of pinching and different rates of nitrogen showed non- significant effect on yield per plant and yield per ha. But, the combination of pinching and nitrogen rates at 50 kg/ha recorded the maximum yield per plant (249.20 g) and yield per ha (10.36 t/ha). Hence it is suggested to use pinching practice with optimum application of nitrogen @ 50 kg/ha to obtain high yield of marigold

Economics of potato (Solanum tuberosum L.) production and marketing in Darchula district of Nepal

The potato (Solanum tuberosum) is a popular root vegetable that is grown all over the world. Potato production is popular in Nepal because of its greater adaptability, high yield potential, and high demand, contributing 6.57 percent to AGDP and 2.17 percent to GDP. In Nepal, it is grown on 197,037 hectares (ha) with a yield of 13.13 metric tons per hectare and a total production of 2,586,287 metric tons. The major objective of our research was to analyze the economics and marketing state of potatoes in Api-Himal rural municipality Darchula, Nepal where a survey on potato production and marketing was conducted. A total of 60 households were randomly sampled and interviewed as the primary source of information for the research. For the residents of Api-Himal RM, there are few options for sustenance and revenue generation. The area is ideal for potato farming, and potato trading has a direct impact on rural communities' livelihoods. The B/C ratio was found to be 1.62 in the research area. The average cost of potato production was Rs. 2,67,319 while the average return was Rs. 4,32,804. The research focuses on the marketing and production of potatoes from the growers to the final customers. Low yield, insect and disease infestation, and a lack of government support are among the issues. To promote the production and marketing of potatoes, availability of improved technology, an extension of technical knowledge, efficient management of marketing channels and substantial financial support by the government as well as local bodies are recommended

Improving decision support system in identifying vulnerability rating and prioritizing the best interventions for sustainable watersheds in Pakistan, Nepal, and Sri Lanka

Quantification of watershed vulnerability rating and prioritization of the best watershed management intervention is always a challenge for multidisciplinary experts in developing consensus. Consequently, the lack of a decision support system (DSS) negatively affects the adoption of promising interventions leading to reduced watershed communities’ resilience to climate change. Therefore, a DSS has been developed to integrate local multi-disciplinary knowledge in identifying the watershed vulnerability ratings and prioritizing the best site-specific watershed management interventions. The DSS developed was applied to selected watersheds using 25 local experts each in Pakistan, Nepal, and Sri Lanka. The results showed the DSS is conveniently applicable and effective in developing consensus among multidisciplinary experts. The DSS recommended that the best interventions for the selected watersheds should primarily reduce the existing accelerated land and water degradation through engineering and biological actions, namely the control the rainwater run-off losses through appropriate harvesting systems and their subsequent efficient utilization for improving food security, climate change resilience and livelihood of vulnerable watershed communities. The DSS developed can be helpful in developing local adaptation plans and strengthening the policy support for promoting sustainable watersheds in Pakistan, Nepal, and Sri Lanka. However, the system needs further refinement through the incorporation of the design, specifications and costing of the interventions and making the data acquisition and analysis automatic using an online electronic system for quicker results and appropriate resource allocation for stimulated adoption.Quantification of watershed vulnerability rating and prioritization of the best watershed management intervention is always a challenge for multidisciplinary experts in developing consensus. Consequently, the lack of a decision support system (DSS) negatively affects the adoption of promising interventions leading to reduced watershed communities’ resilience to climate change. Therefore, a DSS has been developed to integrate local multi-disciplinary knowledge in identifying the watershed vulnerability ratings and prioritizing the best site-specific watershed management interventions. The DSS developed was applied to selected watersheds using 25 local experts in Pakistan, Nepal, and Sri Lanka. Results showed that DSS is conveniently applicable and effective in developing consensus among multidisciplinary experts. The DSS recommended that the best interventions for the selected watersheds should primarily reduce the existing accelerated land and water degradation through engineering and biological actions. These actions may include controlling the rainwater run-off losses through appropriate harvesting systems and their subsequent efficient utilization for improving food security, climate change resilience and livelihood of vulnerable watershed communities. The DSS developed can be helpful in developing local adaptation plans and strengthening the policy support for promoting sustainable watersheds in Pakistan, Nepal, and Sri Lanka. However, the system needs further refinement through the incorporation of the design, specifications and costing of the interventions and making the data acquisition and analysis automatic using an online electronic system for quicker results and appropriate resource allocation for stimulated adoption

Spatial and temporal variability of rainfall in the Gandaki River Basin of Nepal Himalaya

Landslides, floods, and droughts are recurring natural disasters in Nepal related to too much or too little water. The summer monsoon contributes more than 80% of annual rainfall, and rainfall spatial and inter-annual variation is very high. The Gandaki River, one of the three major rivers of Nepal and one of the major tributaries of the Ganges River, covers all agro-ecological zones in the central part of Nepal. Time series tests were applied for different agro-ecological zones of the Gandaki River Basin (GRB) for rainfall trends of four seasons (pre-monsoon, monsoon, post-monsoon and winter) from 1981 to 2012. The non-parametric Mann-Kendall and Sen’s methods were used to determine the trends. Decadal anomalies relative to the long-term average were analyzed using the APHRODITE precipitation product. Trends in number of rainy days and timing of the monsoon were also analyzed. We found that the post-monsoon, pre-monsoon and winter rainfalls are decreasing significantly in most of the zones but monsoon rainfall is increasing throughout the basin. In the hill region, the annual rainfall is increasing but the rainy days do not show any trend. There is a tendency toward later departure of monsoon from Nepal, indicating an increase in its duration. These seasonally and topographically variable trends may have significant impacts for the agriculture and livestock smallholders that form the majority of the population in the GRB