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This article presents ideas on mentoring and professional development. It briefly describes the needs, practices and benefits of mentoring for the professional development of teachers. It discusses teaching as a profession and teacher development. Both mentoring and professional development go hand in hand to maximize teaching and learning process. In teaching profession, mentoring is a process in which a more experienced senior teacher supports the novice teachers by providing required guidance, counseling, ideas and information on carrying out the professional responsibilities successfully. The article concludes with the idea that mentoring helps novice teachers to grow and develop personally, professionally and institutionally. Mentoring is one of the great means to achieve professionalism in teaching.

Metallic (1T) molybdenum disulfide (MoS

Fabrication of hybrid trimetallic-organic framework-derived N, C co-doped Ni–Fe–Mn–P ultrathin nanosheet electrocatalyst demonstrating excellent performance with low overpotentials and cell voltage for HER, OER and overall water splitting.

In view of the increasing complexity of both cardiovascular implantable electronic devices (CIEDs) and patients in the current era, practice guidelines, by necessity, have become increasingly specific. This document is an expert consensus statement that has been developed to update and further delineate indications and management of CIEDs in pediatric patients, defined as ≤21 years of age, and is intended to focus primarily on the indications for CIEDs in the setting of specific disease categories. The document also highlights variations between previously published adult and pediatric CIED recommendations and provides rationale for underlying important differences. The document addresses some of the deterrents to CIED access in low- and middle-income countries and strategies to circumvent them. The document sections were divided up and drafted by the writing committee members according to their expertise. The recommendations represent the consensus opinion of the entire writing committee, graded by class of recommendation and level of evidence. Several questions addressed in this document either do not lend themselves to clinical trials or are rare disease entities, and in these instances recommendations are based on consensus expert opinion. Furthermore, specific recommendations, even when supported by substantial data, do not replace the need for clinical judgment and patient-specific decision-making. The recommendations were opened for public comment to Pediatric and Congenital Electrophysiology Society (PACES) members and underwent external review by the scientific and clinical document committee of the Heart Rhythm Society (HRS), the science advisory and coordinating committee of the American Heart Association (AHA), the American College of Cardiology (ACC), and the Association for European Paediatric and Congenital Cardiology (AEPC). The document received endorsement by all the collaborators and the Asia Pacific Heart Rhythm Society (APHRS), the Indian Heart Rhythm Society (IHRS), and the Latin American Heart Rhythm Society (LAHRS). This document is expected to provide support for clinicians and patients to allow for appropriate CIED use, appropriate CIED management, and appropriate CIED follow-up in pediatric patients.

Background & Objectives: Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation and inflammation. Mean platelet volume (MPV) may be used as a marker of inflammation. We aimed to study the association between MPV and COPD patients during acute attack and relationship of MPV with severity of COPD by FEV1 (%predicted), BODE Index, PaO2, mMRC grade and 6MWD test. Methods: 100 patients with COPD (50 with acute exacerbation and 50 with stable COPD) and 30 healthy controls were enrolled in the study. Mean platelet volume (MPV), spirometry, arterial blood gases, body mass index, renal function tests and BODE index (body mass index, airflow obstruction,dyspnoea and exercise) were assessed. Level of MPV was compared between cases and controls. Results: Of 100 COPD patients, 87(87%) were male and 13(13%)were female.MPV was significantly higher in COPD patients than control and also higher in acute exacerbation group than stable COPD (p=0.001). Interpretation & Conclusions: In the present study,MPV remain in normal range in all COPD patients, but MPV values were significantly higher in COPD cases compared with control.Increased MPV was associated with acute exacerbation and also increasing with severity of COPD.

The study was carried out during rabi season of 2015-16, 2016-17 and 2017-18 in 6 villages across 3 blocks (Rajsamand, Railmagra and Amet) of Rajsamand district. In all 225 front line demonstrations on chickpea crop were carried out in an area of 90.0 ha with the active participation of farmers with the objective to demonstrate the latest technology of chickpea production potential, technological gap, extension gap, technology index and economic benefit of improved technologies consisting suitable varieties GNG 1581, integrated nutrient management (20:40:0 NPK kg/ha + Rhizobium + PSB @ 20 g/kg seed) and integrated pest management (deep ploughing + seed treatment with Trichoderma viridae @ 6 g/kg seed +pheromone trap @ 10/ha + spray of Quinalphos @ 1.2 l/ha with 600 litres of water) at Rajsamand, Railmagra and Amet blocks of Rajsamand district during 2015-16 to 2017-18. The results revealed that FLD recorded higher yield as compared to farmers’ practices over the years of study. The improved technologies recorded average yield of 18.94 q ha-1 which was 27.97 per cent higher than that obtained with farmer’s practices of 14.81 q ha-1. In spite of increase in yield of chickpea, technological gap, extension gap and technology index existed which was 4.06, 4.13 q ha-1 and 17.67 per cent, respectively. The extension gap can be bridged by popularizing package of practices where in stress need to be laid on improved variety, use of proper seed rate, balanced nutrient application and proper plant protection measures. Improved technologies gave higher net return of Rs. 67727 ha-1 with benefit cost ratio 4.88 as compared to local check (Rs. 50487 ha-1, benefit cost ratio 4.22).

In view of the increasing complexity of both cardiovascular implantable electronic devices (CIEDs) and patients in the current era, practice guidelines, by necessity, have become increasingly specific. This document is an expert consensus statement that has been developed to update and further delineate indications and management of CIEDs in pediatric patients, defined as ≤21 years of age, and is intended to focus primarily on the indications for CIEDs in the setting of specific disease categories. The document also highlights variations between previously published adult and pediatric CIED recommendations and provides rationale for underlying important differences. The document addresses some of the deterrents to CIED access in low- and middle-income countries and strategies to circumvent them. The document sections were divided up and drafted by the writing committee members according to their expertise. The recommendations represent the consensus opinion of the entire writing committee, graded by class of recommendation and level of evidence. Several questions addressed in this document either do not lend themselves to clinical trials or are rare disease entities, and in these instances recommendations are based on consensus expert opinion. Furthermore, specific recommendations, even when supported by substantial data, do not replace the need for clinical judgment and patient-specific decision-making. The recommendations were opened for public comment to Pediatric and Congenital Electrophysiology Society (PACES) members and underwent external review by the scientific and clinical document committee of the Heart Rhythm Society (HRS), the science advisory and coordinating committee of the American Heart Association (AHA), the American College of Cardiology (ACC), and the Association for European Paediatric and Congenital Cardiology (AEPC). The document received endorsement by all the collaborators and the Asia Pacific Heart Rhythm Society (APHRS), the Indian Heart Rhythm Society (IHRS), and the Latin American Heart Rhythm Society (LAHRS). This document is expected to provide support for clinicians and patients to allow for appropriate CIED use, appropriate CIED management, and appropriate CIED follow-up in pediatric patients.

Dilated cardiomyopathy in infants could potentially be secondary to structural heart diseases such as LV outflow obstruction and ALCAPA. These conditions can be diagnosed by a dedicated echocardiogram. When such an evaluation was not possible, a postmortem echocardiogram could potentially provide clues about the possibility of a structural heart disease

This paper explores English language teachers’ perception of critical pedagogy and equity promotion in lingo-cultural diverse classroom. The study concerns how the teachers find multicultural students’ problems and address them in the classroom. The study further investigates how teachers use dimensions of equity (multicultural education, social justice education and culturally responsive pedagogy) to promote social harmony, critical awareness and independent learning. In the study, I have used narrative inquiry as a research method, selected six participants purposively from public schools of Kathmandu and collected information from in-depth semi-structured interviews. I have employed multiple layers of thematic analysis, interpreted narrative data and developed six different themes: facility and access, classroom management, language and behavior, classroom activities, feedback and reinforcement and evaluation procedures. On the basis of this study, what I found that school environment, classroom activities, evaluation procedures and feedback and reinforcement are the major factors for the influence of their students’ participation. The school management has major role to facilitate and encourage teachers for the promotion of students centered methods such as project based learning and collaborative learning. Along all these aforementioned themes, teachers have prominent role to run active participatory classroom activities through student friendly activities like language games and healthy academic debate. Not only that, teachers are equally responsible to identify at-risk students and address their issues immediately to promote independent learning. Furthermore, to evaluate students’ progress, intra-personal comparative evaluation procedure is found more effective than inter-personal comparative evaluation procedures to encourage them to strive ahead with self-respect. The study expects relevant recommendations in the field of content-based child-friendly teaching learning activities where students participate actively enjoy the activities and learn from self and others.

This research based article discusses on issues and practices of classroom management from the local perspectives. It is based on the context of public school of Nepal. The participant is an EFL teacher of public school in Kathmandu, teaching in middle school and secondary level there. The classroom management practices in the EFL teacher’s classes are seen using classroom observation tool, in her classes of both the levels for a week using qualitative framework. The findings show the traditional practice still dominating the classroom activities. Therefore the article is based on the issues of classroom management being specific to the seating arrangements, discipline, peer work, group work, space, presentation, and time management in the public school where classroom observation has been done.

The essence of so-called heterotaxy is the potential disharmony between the arrangement of the bronchuses, abdominal organs, and the atrial appendages. Accurate description of the heart, however, can only be provided by specific description of these features, all of which are readily discernible in the clinical setting. We argue that, when accurate description of the atrial and visceral arrangement is provided, along with appropriate description of the intracardiac findings, no further accuracy is gained by suggesting that an individual heart is “heterotaxic”.

Disorders of laterality are often associated with complex CHD. There is considerable debate about the appropriate terminology to describe these conditions. As our understanding of the genetic basis of these disorders improves, it is likely that terminology will be dictated by the genetic aetiology. The genetic basis of laterality disorders in the Indian population has not been studied. We report two families with autosomal recessive inheritance of isomerism and homozygous variants in the GDF1 gene in affected family members.

Background:The optimal management of symptomatic tetralogy of Fallot in neonates and younger infants with unfavourable anatomy is unclear and is further constrained by resource limitations in low and middle income countries.Methods:Retrospective medical record review of infants with tetralogy of Fallot undergoing corrective or palliative procedures between January 2016 and June 2019.Results:The study included 120 infants; of whom 83 underwent primary complete repair, four underwent surgical palliation, and 33 underwent catheter-based palliation, including balloon pulmonary valvuloplasty (n = 18), right ventricular outflow tract stenting (n = 14), and stenting of the patent arterial duct (n = 1). Infants undergoing catheter-based procedures were younger in age (median 32 days; inter-quartile range (IQR) 7–144 versus 210 days; IQR 158–250), with lower baseline saturation (65 ± 12% versus 87 ± 7%) and had smaller pulmonary artery z-scores compared to the complete repair cohort. Follow-up was available for 31/33 (94%) infants (median 7 months [IQR 4–11]) who underwent trans-catheter palliation; 12 underwent complete repair, 10 are well, awaiting repair, eight required further palliation (catheter: 6; surgical: 2), and one died post-discharge from non-cardiac causes.Conclusion:Catheter-based palliation is a safe and effective alternative in infants with tetralogy of Fallot who are at high risk for primary surgical repair.

Congenital heart disease (CHD) has been one of the most important contributors to neonatal mortality in the western world for the past 2 decades. With improvement in basic neonatal medical care in most parts of our country, the traditional contributors to neonatal mortality such as birth asphyxia and infections have reduced in numbers. This has hence thrust greater focus on CHD. Facilities with capability to diagnose and intervene on neonates with critical CHD are available in most states. Refinements in surgical techniques and advances in post-operative care have ensured that most neonates with critical CHD can undergo surgical or interventional procedures with very low mortality and can be expected to survive to adulthood with a reasonable quality of life. Unrecognized critical CHD could however result in death in the neonatal period. Focus has hence shifted towards sensitizing pediatricians about timely recognition of neonates with CHD. In this article, authors discuss the presentation and initial stabilization of neonates with CHD and attempt to provide practical solutions which can aid early diagnosis of CHD in the Indian scenario.

Background & Objectives:Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation and inflammation. Mean platelet volume (MPV) may be used as a marker of inflammation. We aimed to study the association between MPV and COPD patients during acute attack and relationship of MPV with severity of COPD by FEV1 (%predicted), BODE Index, PaO2, mMRC grade and 6MWD test. Methods:100 patients with COPD (50 with acute exacerbation and 50 with stable COPD) and 30 healthy controls were enrolled in the study. Mean platelet volume (MPV), spirometry, arterial blood gases, body mass index, renal function tests and BODE index (body mass index, airflow obstruction,dyspnoea and exercise) were assessed. Level of MPV was compared between cases and controls. Results:Of 100 COPD patients, 87(87%) were male and 13(13%)were female.MPV was significantly higher in COPD patients than control and also higher in acute exacerbation group than stable COPD (p=0.001). Interpretation & Conclusions:In the present study,MPV remain in normal range in all COPD patients, but MPV values were significantly higher in COPD cases compared with control.Increased MPV was associated with acute exacerbation and also increasing with severity of COPD.

In view of the increasing complexity of both cardiovascular implantable electronic devices (CIEDs) and patients in the current era, practice guidelines, by necessity, have become increasingly specific. This document is an expert consensus statement that has been developed to update and further delineate indications and management of CIEDs in pediatric patients, defined as ≤21 years of age, and is intended to focus primarily on the indications for CIEDs in the setting of specific disease categories. The document also highlights variations between previously published adult and pediatric CIED recommendations and provides rationale for underlying important differences. The document addresses some of the deterrents to CIED access in low- and middle-income countries and strategies to circumvent them. The document sections were divided up and drafted by the writing committee members according to their expertise. The recommendations represent the consensus opinion of the entire writing committee, graded by class of recommendation and level of evidence. Several questions addressed in this document either do not lend themselves to clinical trials or are rare disease entities, and in these instances recommendations are based on consenus expert opinion. Furthermore, specific recommendations, even when supported by substantial data, do not replace the need for clinical judgment and patient-specific decision-making. The recommendations were opened for public comment to Pediatric and Congenital Electrophysiology Society (PACES) members and underwent external review by the scientific and clinical document committee of the Heart Rhythm Society (HRS), the science advisory and coordinating committee of the American Heart Association (AHA), the American College of Cardiology, (ACC) and the Association for European Paediatric and Congenital Cardiology (AEPC). The document received endorsement by all the collaborators and the Asia Pacific Heart Rhythm Society (APHRS), the Indian Heart Rhythm Society (IHRS), and the Latin American Heart Rhythm Society (LAHRS). This document is expected to provide support for clinicians and patients to allow for appropriate CIED use, appropriate CIED management, and appropriate follow-up in pediatric patients.

Genetic diagnosis depends on having available tissue to test. This can be important for many reasons, such as related to familial diagnosis in the case of another pregnancy. When blood or DNA samples from affected family members are not available, accurate prenatal diagnosis may be much more difficult and hence additional effort may be needed to obtain a genetic diagnosis in such families. We report two families with suspected monogenic disorders where attempts were made to establish the genetic etiology in deceased offspring using dried umbilical cord remnants which had been preserved by the family.

This paper discusses on the mounting livelihoods challenges of high altitude region of Nepal driven largely by the growing conflict between pastoralists and community forestry (CF), and offers alternative pathways. The paper is based on a three-year action research using adap­tive learning as an approach to understanding conflicts between the herders and CF members and other challenges around high altitude herding. The paper also brings the case of Suspa- Kshamawati Kalinchowk region with pragmatic issues and concerns that need urgent action. In addition, we analyse information on CF and other pastureland, institutional arrangements of CFUG, analysis of herders’ livelihoods and review of policy process and relevant literature. The research shows that high altitude herding system has been facing several challenges with the con­flict between the CF and herders as the main challenge. The conflict with CF has posed extreme threats to the existence of herding system in the region. Similarly, challenges like declining avail­ability and access to quality pasture and hardship, and changing social values has contributed to decreasing herding number in recent years and has also put the unique transhumance livelihood activities in crisis. Finally, implications to policy and practice of CF and overall environmental governance are identified.

Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide, deteriorating approximately 1000,000 lives. Annually rising HCC to the third most common cause of cancer mortality. Liver cancer varies geographically depending on multimodality treatments available for this heterogeneous malignancy. Conglomeration of treatments has been exercised to manage this type of cancer across distinct geographic regions. Unprecedented rise of scientific knowledge mining from the published literature is a boon to develop novel treatment modalities. We aim to focus such pharmacological aspects in HCC treatment that could effectively display the improved therapies. Extrapolating the details of liver cancer (classification, diagnosis, adequate treatments, therapeutic engineering involved in the therapy, causes, epidemiology, and survival ratio) and the result obtained through this research could be a magnificent approach in the advancement of drug delivery systems that could assist in clinical trials and further betterment of survival rate and improved therapy from this deadly cancer.

Quadricuspid pulmonary valve is a rare abnormality which has been reported in isolation or with structural ehart diseases. We report a neonate who presented with supra-ventricular tachycardia and Wolff-Parkinson-White syndrome who had a structurally normal heart. The recognition of a phasic ejection click on clinical examination led to the identification of a normally functioning quadricuspid pulmonary valve

The authors aim to describe valuable information and experimental reviews that may help to develop and design different formulation, which can boost up the overall efficiency of the final product. Further, they explained the overall efficiency, method of preparation, target delivery approaches, drawbacks, and other characteristics in relation to lipids, peptides, polymers, and vaccines. In addition, they also propose to uncover the physico-chemical properties, in-process manufacturing issues, and external factors that influence the fate of a medicine. That major includes the excipients, method of preparation, dose, delivery route, chemical and biological properties, drug-drug interaction, drug-body interaction, patient compliance, modifications in lipid based nano-vectors, polymer-mediated delivery systems, conjugate delivery systems, and others. In conclusion, by the end of this chapter, the authors are able to explain a robust mode of delivering active constituents more safely and economically to the target site by showing maximum bioavailability.

Bangham was first to develop these spherical-shaped nano-vesicles called liposomes in the early 1960s. Today, liposomes have emerged as crucial tools for bettering the delivery of drugs that majorly includes-antifungal drug, peptide hormones, enzymes, vaccines antimicrobial agents, drugs against cancer, and genetic materials. Following the different manufacturing practices and versatile properties liposomes can be categorized in various parameters of size, charge, poly-dispersity index, encapsulation efficiency, solubility properties, and lamellarity. Alteration in such parameters elevates the loading and bioavailability of a drug by giving more clear target specification, desired or controlled release. This bibliographic chapter provides a comprehensive overview of methods for the preparation of liposomes with other perspectives that majorly includes—physio-chemical characteristics, dosage regimen, advantages over other delivery systems, approved liposomal based drugs and other ongoing drugs in clinical trials. It will help researchers to breakthrough more structurally successful delivery vehicles depending upon their various physic-chemical properties.

The focus of this research is on Makassar's linguistic landscape of food advertisements. The study's goals are to determine the language used in food advertisements in Makassar city and to describe the roles of the Makassar language employed in food advertisements. This study uses the descriptive qualitative method. The data are analyzed based on Canoz and Gorter’s theory (2006). The findings show that English is the most frequently used language in food advertisements in the city center of Makassar. The other languages utilized in advertisements include Indonesian, English, Makassar, and Mandarin. This study also found the function of using English in advertisements is a promotional medium and the identity of each store. Additionally, using a foreign language has a trendy and stylish impact, which improves product quality, intrigues buyers, and attracts their attention. Even though many offers in advertisements are not understood by consumers, all of the functions indicated by all informants allude to the benefits of utilizing English in their product advertisements, notably the increased sales value. Keywords: Linguistic Lanscape Analysis, Analysis Food Advertisement, Analysis Advertisement

Transcriptional dysregulation is a hallmark of prostate cancer (PCa). We mapped the RNA polymerase II-associated (RNA Pol II-associated) chromatin interactions in normal prostate cells and PCa cells. We discovered thousands of enhancer-promoter, enhancer-enhancer, as well as promoter-promoter chromatin interactions. These transcriptional hubs operate within the framework set by structural proteins - CTCF and cohesins - and are regulated by the cooperative action of master transcription factors, such as the androgen receptor (AR) and FOXA1. By combining analyses from metastatic castration-resistant PCa (mCRPC) specimens, we show that AR locus amplification contributes to the transcriptional upregulation of the AR gene by increasing the total number of chromatin interaction modules comprising the AR gene and its distal enhancer. We deconvoluted the transcription control modules of several PCa genes, notably the biomarker KLK3, lineage-restricted genes (KRT8, KRT18, HOXB13, FOXA1, ZBTB16), the drug target EZH2, and the oncogene MYC. By integrating clinical PCa data, we defined a germline-somatic interplay between the PCa risk allele rs684232 and the somatically acquired TMPRSS2-ERG gene fusion in the transcriptional regulation of multiple target genes - VPS53, FAM57A, and GEMIN4. Our studies implicate changes in genome organization as a critical determinant of aberrant transcriptional regulation in PCa.

Guidelines for the implantation of cardiac implantable electronic devices (CIEDs) have evolved since publication of the initial ACC/AHA pacemaker guidelines in 1984 [ 1 ]. CIEDs have evolved to include novel forms of cardiac pacing, the development of implantable cardioverter defibrillators (ICDs) and the introduction of devices for long term monitoring of heart rhythm and other physiologic parameters. In view of the increasing complexity of both devices and patients, practice guidelines, by necessity, have become increasingly specific. In 2018, the ACC/AHA/HRS published Guidelines on the Evaluation and Management of Patients with Bradycardia and Cardiac Conduction Delay [ 2 ], which were specific recommendations for patients >18 years of age. This age-specific threshold was established in view of the differing indications for CIEDs in young patients as well as size-specific technology factors. Therefore, the following document was developed to update and further delineate indications for the use and management of CIEDs in pediatric patients, defined as ≤21 years of age, with recognition that there is often overlap in the care of patents between 18 and 21 years of age. This document is an abbreviated expert consensus statement (ECS) intended to focus primarily on the indications for CIEDs in the setting of specific disease/diagnostic categories. This document will also provide guidance regarding the management of lead systems and follow-up evaluation for pediatric patients with CIEDs. The recommendations are presented in an abbreviated modular format, with each section including the complete table of recommendations along with a brief synopsis of supportive text and select references to provide some context for the recommendations. This document is not intended to provide an exhaustive discussion of the basis for each of the recommendations, which are further addressed in the comprehensive PACES-CIED document [ 3 ], with further data easily accessible in electronic searches or textbooks.

Paclitaxel (PTX) in its commercial products exhibits adverse effects owing to excipients and also has poor oral bioavailability. Present work is directed towards development of tocopheryl polyethylene glycol succinate-assisted self-nanoemulsifying system (SEDDS) for oral delivery of PTX. Box-Behnken design of experiment was employed to optimize PTX-SEDDS and was characterized for droplet size (29.76 ± 2.64 nm), zeta potential (-21.46 ± 2.52 mV), PDI (0.177 ± 0.012), drug content (4.97 ± 0.98 mg), entrapment efficiency (98.33 ± 0.54%) and in vitro drug release (51.03 ± 2.23% PTX at 72 h). PTX-SEDDS exhibited IC50; 1.58 ± 0.12 µM and a 52.46-folds higher cell uptake in MDA-MB-231 cells along with cellular and nuclear morphology changes. Significantly higher G2M cell cycle arrest, apoptosis, mitochondrial membrane potential disruption and ROS production was exhibited by PTX-SEDDS in comparison to Taxol. Up-regulation of Bax, p21, cleaved-caspase 3, -caspase 9 and down-regulation of Bcl2 and survivin suggested apoptosis via intrinsic pathways. Pharmacokinetic study showed approximately 4-folds higher oral bioavailability of PTX-SEDDS than Taxol. Significant reduction in tumour volume and weight was observed in syngeneic mammary tumour in SD rats. Tumour histopathology and TUNEL assay showed apoptosis in tumour tissue. PTX-SEDDS caused low lung metastasis, and was safe and stable. Conclusively, PTX-SEDDS could be suitable option for oral delivery of PTX.

Nepal’s community forestry has evolved from afforestation, forest conservation, social inclusion and equity to harnessing economic potentials. It has shown immense potential for forest sustainability by integrating ecological, social and economic dimensions but historically these dimensions received shifting focus hence one or more dimensions received inadequate attention. The donor priorities, discourses spanning from national and international arenas and shifting government policies had an effect on inflated treatment to one or the other dimensions of sustainability. We argue that by granting clear, strong and perpetual tenure rights to local communities would help better integrate ecological, social and economic dimensions of sustainability of forest commons.

Junctional ectopic tachycardia (JET) is the commonest tachyarrhythmia in the early post-operative period in children undergoing open-heart surgery. It frequently leads to hemodynamic instability and needs to be managed aggressively. Amiodarone is the first-line agent along with non-pharmacological interventions. We report our initial experience with the use of Ivabradine in post-operative JET. A retrospective case records review of children with post-operative JET during the period from June 2018 to May 2019 was performed. Eight patients with post-operative JET were treated with Ivabradine during this period. The first patient was initially treated with Amiodarone. All eight patients responded to Ivabradine. The initial response was rate control permitting overdrive pacing. One patient had recurrence of JET 10 h after Ivabradine and after return to sinus rhythm. Amiodarone was administered along with the second dose of Ivabradine resulting in remission to sinus rhythm. Ivabradine appears to be an effective alternative to Amiodarone in children with post-operative JET based on our initial clinical experience.

Right ventricular (RV) systolic function is an important determinant of clinical outcomes in patients with pulmonary arterial hypertension (PAH). However, RV function assessment is less well defined than left ventricle function and requires the use of multiple echocardiographic indices. We report a child with severe PAH and RV dysfunction in whom traditional measures of RV systolic function were deceptive.

Congenital Heart Diseases occur in close to 90% of children with Trisomy 18. A ventricular septal defect along with abnormalities of more than one cardiac valve is considered to be an imaging hallmark of Trisomy 18. We present echocardiographic images of an infant with Trisomy 18 who had a large ventricular septal defect and abnormalities of all cardiac valves.

Community forestry is an emerging success model of state–community partnership for forest management and poverty reduction. Bhutan's initial experience of forest management by user group is promising, but merits further study on how community forests have experienced with harvesting and income generation consistent with national forest policy. This study quantifies whether community forestry contribute to household income with equitable products and income distribution and gender inclusive participation; and community forests are managed applying the principles of sustainable harvest without compromising regeneration and productivity. We applied a combination of social and ecological methods using household interview and forest sampling plots. Our findings revealed that community forestry contributes to household income through harvesting and marketing of large trees, and non-wood forest products where markets are accessible. Household income, however, vary widely between rich and poor households with former capitalizing on commercial and latter on subsistence products. Timber harvesting is consistent with the principles of sustainable harvest without altering species composition, regeneration and productivity. To narrow income inequality, pro-poor approach to community forestry needs to target poor households with income diversification activities and market accessibility. The promising results are context-driven and warrant consolidation from other community forests experiencing harvest in Bhutan.