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The Forest Stewardship Council (FSC) principles and criteria have been implemented in over 80 community forests in Nepal over the last decade. However, the total size of community forests certified under the FSC certification is relatively small (0.1% of the total area of the country), which limits the overall benefits they can provide to the surrounding communities. The national government has instituted the Collaborative Forest Management (CFM) initiative to maintain forest connectivity and give local communities jurisdiction over the nearby forests that they and their ancestor have lived with and managed for many generations. The CFM policies strive to ensure the restoration of large and continuous patches of forest, equitable benefit sharing of forest products and good governance, yet these policies do not certify the forests as sustainably managed, and thus cannot provide increased prices on the international market for products from these forests. Two collaborative forests were assessed in the Tarai region of Nepal to understand how well these community managed forests already follow the FSC principles and where changes must be made for these forests to be certified in the future. Field observations were undertaken, focus group discussions held, and semi-structured interviews carried out in order to understand current management practices in these two collaborative managed forests. Findings showed that the CFM helped improve biodiversity and benefit sharing from the forest amongst the wide range of communities. Collaboratively managed forests and FSC principles were shown to have complementary objectives: to sustain forests, strengthen forest governance and conserve indigenous species and knowledge, and it is argued that these plans can be synchronized for the benefit of both forests and people.

Context The COVID-19 pandemic has been affecting health and economies across the world, although the nature of direct and indirect effects on Asian agrifood systems and food security has not yet been well understood. Objectives This paper assesses the initial responses of major farming and food systems to COVID-19 in 25 Asian countries, and considers the implications for resilience, food and nutrition security and recovery policies by the governments. Methods A conceptual systems model was specified including key pathways linking the direct and indirect effects of COVID-19 to the resilience and performance of the four principal Asian farming and food systems, viz, lowland rice based; irrigated wheat based; hill mixed; and dryland mixed systems. Based on this framework, a systematic survey of 2504 key informants (4% policy makers, 6% researchers or University staff, 6% extension workers, 65% farmers, and 19% others) in 20 Asian countries was conducted and the results assessed and analysed. Results and conclusion The principal Asian farming and food systems were moderately resilient to COVID-19, reinforced by government policies in many countries that prioritized food availability and affordability. Rural livelihoods and food security were affected primarily because of disruptions to local labour markets (especially for off-farm work), farm produce markets (notably for perishable foods) and input supply chains (i.e., seeds and fertilisers). The overall effects on system performance were most severe in the irrigated wheat based system and least severe in the hill mixed system, associated in the latter case with greater resilience and diversification and less dependence on external inputs and long market chains. Farming and food systems' resilience and sustainability are critical considerations for recovery policies and programmes, especially in relation to economic performance that initially recovered more slowly than productivity, natural resources status and social capital. Overall, the resilience of Asian farming and food systems was strong because of inherent systems characteristics reinforced by public policies that prioritized staple food production and distribution as well as complementary welfare programmes. With the substantial risks to plant- and animal-sourced food supplies from future zoonoses and the institutional vulnerabilities revealed by COVID-19, efforts to improve resilience should be central to recovery programmes. Significance This study was the first Asia-wide systems assessment of the effects of COVID-19 on agriculture and food systems, differentiating the effects of the pandemic across the four principal regional farming and food systems in the region.

SUMMARY The problem of food insecurity is growing, triggering global debates on the gap in understanding alternative ways of accessing foods, including those from forestlands. This paper aims to address this gap by demonstrating a variety of ways in which forests carry the potential to contribute to food security, drawing on the case study of community based forest management in Nepal. It shows that forests not only complement farms in providing foods in critical periods, but also provide an important platform for collective actions, which have the potential to enhance smallholders' entitlement to food. The paper, then, identifies barriers in the current policy framework to capitalize on the potential of forests to enhance food security. An important implication of this finding is that there is an urgent need to reframe forest governance to incorporate food security concerns, without necessarily compromising forests' role in biodiversity conservation.

This article examines Nepal's recently prepared Forestry Sector Strategy (FSS) (as of 2014) in terms of the use of scientific evidence and the quality of stakeholder participation. By reviewing the content and analyzing the context of its development during 2012–2014, we found that the transitional politics and overt influence of international development agencies dominated the process and content of the FSS. Although the FSS was developed through a significant stakeholder engagement, there was limited use of the available scientific evidence. The FSS was narrowly conceived as a deliverable of supporting aid programs, with limited demand for a politically meaningful policy processes. While civil society groups were consulted, they largely failed to present an independent voice due to their dependence on funding agencies. Our assessment calls for rethinking policy development in a way that facilitates assertive and independent participation by a range of actors and make better use of the available research.

Background Spinal anesthesia is widely used for caesarean section due to its rapid onset, low failure rate, complete analgesia. Addition of intrathecal ketamine and opioids to local anaesthetics seems to improve the quality of block and prolong the duration of analgesia.Objectives The purpose of this study was to compare the effect of intrathecal ketamine mixed with hyperbaric bupivacaine to intrathecal fentanyl mixed with hyperbaric bupivacaine.Methods One hundred parturients ASA Grade I scheduled for elective or semiurgent caesarean section under spinal anaesthesia were randomly divided into two groups. Group A received 2ml (10 mg) hyperbaric bupivacaine 0.5% plus 25 mg preservative free ketamine. Group B received 2ml (10mg) hyperbaric bupivacaine 0.5% plus 25?g fentanyl. The patients were observed intraoperatively for the onset of sensory block, degree of motor block and total duration of analgesia.Results The time to achieve Bromage scale 3 motor blockade was shorter in Group A than in Group B.(p= 0.445) whereas time to achieve highest dermatomal level of sensory block was shorter in Group A than in Group B (p= 0.143). The duration of spinal analgesia was longer in Group B than in Group A (p= 0.730). The frequency of side effect such as sedation score was higher in Group A compared to Group B (p= 0.048). The incidence of pruritus was significantly higher in Group B compared to Group A (p = 0.000).Conclusion Addition of preservative free ketamine lead to faster onset of sensory and motor blockade, although it did not prolong the duration of spinal analgesia compared to addition of fentanyl in parturients undergoing caesarean section with spinal anaesthesia.Kathmandu Univ Med J 2013; 11(4): 287-291

Post obstructive pulmonary edema (POPE) also known as Negative pressure pulmonary edema (NPPE)is potentially life threatening complication. It occurs in about 0.1% of anesthetics and is related to upper airway obstruction. Two types have been described in literature. Different etiology has been attributed to development of Negative pressure pulmonary edema. Early identification and treatment of predisposing factor along with proper monitoring of this complication early treatment should be instituted because resolution is also fast and in most cases without residual effects. DOI: http://dx.doi.org/10.3126/kumj.v9i4.6352 Kathmandu Univ Med J 2011;9(4):310-4

Background The ability of good glottis visualization during direct laryngoscopy is major determinant of easy tracheal intubation. Sniffing position for laryngoscopy is considered as gold standard and ideal position. Several studies have questioned the validation of sniffing potion. Objectives This study aims to compare relative efficacy of sniffing position and simple head extension for visualization of glottis during direct laryngoscopy. Methods Four hundred patients undergoing elective surgery under general anesthesia requiring endotracheal intubation were randomized into two groups and study was concluded. Glottic visualization was assessed using modified Cormack and Lehane classification. After laryngoscopy, tracheal intubation was performed and intubation difficulty scale was noted. Results Both the groups were comparable regarding glottis visualization. Both the groups were comparable in demographic profiles. All the intubation difficulty scale variables were comparable in both the groups except N3. Total Intubation Difficulty Score was better in sniffing position than in simple head extension group. Conclusion Glottic visualization and intubation difficulty score was better in sniffing position as compared to simple head extension. http://dx.doi.org/10.3126/kumj.v9i1.6265 Kathmandu Univ Med J 2011;9(1):58-63

Background Fentanyl, a synthetic opioid, is a popular choice amongst anaesthesiologists in the operating room. Pre induction intravenous fentanyl bolus is associated with coughing in 28 – 65% of patients. Fentanyl induced cough is not always benign and can be remarkably troublesome at the most critical moment of anaesthesia when airway reflex is lost. Objectives To study the effect of pre emptive use of minimal dose fentanyl through the peripheral venous cannulae on the incidence of cough by a larger bolus of intravenous fentanyl. Methods One hundred and fifty patients aged 18 -75 years undergoing elective surgical procedures were randomized into three groups of 50 each. The first group received 0.5 ml saline 0.9 % intravenously one minute prior to the administration of fentanyl 150μg (3 ml); the second group received pre emptive fentanyl 25μg(0.5ml) prior to the administration of fentanyl 125μg(2.5ml); and the third group received preemptive fentanyl 25 μg(0.5ml), followed by the administration of fentanyl 150μg(3ml).. Based on the number of coughs observed, cough severity was graded as mild(1-2), moderate (3-5),or severe (>5). Results The incidence of fentanyl induced cough was significantly lower in both pre emptive group 4(8%) for 125μg fentanyl and 7(14%) for 150μg than in the saline group 15(30%). Conclusion Pre- emptive use of minimal dose fentanyl 25μg administered one minute before a larger bolus dose of fentanyl (125 or 150μg ) can effectively suppress cough. DOI: http://dx.doi.org/10.3126/kumj.v10i4.10988 Kathmandu Univ Med J 2012;10(4):16-19

Background Anesthesiologists and anesthesia has been considered behind the scene. The image and status of anesthesiologist in the eyes of the medical and lay communities has always been a problem. Objectives This study was designed to assess the knowledge about the role of anesthesiologist among the paramedical staffs at Kathmandu University Hospital. Methods This prospective questionnaire based study was done at Kathmandu University School of Medical Science, Dhulikhel Hospital for 2nd January 2011 to 30th Jan 2011 among the paramedical staffs working in different department of the hospital. Results There were 150 questionnaire distributed out of which 120 responded. Mean Age was 23.33 and most of the respondents were female with majority having education qualification equivalent to intermediate level. Only 49.20 said it to be a different specialty and 72.5% said anaesthesiologist work differently in the theatre where as 70% knew anaesthesiologist did something in the post-operative period too. Conclusion Anesthesiologists have duty to visit patient’s pre operatively and post operatively. The role inside the theatre and expanding role outside the theatre is poorly known. The awareness about the role of anesthesiologist in operation theatre, in intensive care unit, acute and chronic pain management and emergency care areas should be highlighted to all the staffs. Kathmandu University Medical Journal | Vol.10 | No. 2 | Issue 38 | Apr – June 2012 | Page 51-54 DOI: http://dx.doi.org/10.3126/kumj.v10i2.7344

Background Ventilator associated pneumonia is a major cause of morbidity in the intensive care unit. Difficulties in identification of the risk factors, in diagnosing and in prevention, have intensified the problem. Objectives To measure the incidence of ventilator associated pneumonia in intensive care unit and to identify the risk factors associated. Methods A prospective observational cohort study of 69 patients who were mechanically ventilated for more than 48 hours were evaluated to find out the development of nosocomial pneumonia and presence or absence of risk factors. Data were subjected to univariate analysis using chi-square and t-test. Level of significance was set at 0.05. Results Twenty two (31.88%) out of 69 patients developed ventilator associated pneumonia, majority of them between four days to 14 days. Reintubation, invasive lines, H 2 blockers and low PaO 2 /FiO 2 were identified as major risk factors in our study. Enteral feeding via nasogastric tube and use of steroids was not associated with development of ventilator associated pneumonia. The patients with ventilator associated pneumonia had significantly longer duration of mechanical ventilation (18.88±7.7 days vs 7.36±4.19 days) and stay (29±17.8 days vs 9.22±5.14 days). The morality was similar for both the groups with or without ventilator associated pneumonia. Conclusion The incidence of ventilator pneumonia is high. Patients requiring prolonged ventilation, re-intubation, more invasive lines and H 2 blockers, are at high risk and need special attention towards prevention. http://dx.doi.org/10.3126/kumj.v9i1.6258 Kathmandu Univ Med J 2011;9(1):28-31

Background Hypertension is an important public health challenge worldwide and is most important modifiable risk factor for cardiovascular, cerebrovascular and renal disease. Blood pressure determination forms an integral part of anaesthesiologist’s evaluation of hispatient’s condition prior to and during surgery. Data are not available which indicate changes in blood pressure occurring preanaesthetically in hospitalized patients. There are several risks from untreated preoperative hypertension in perioperative and postoperative phase. Objective To know the incidence of hypertension in preoperative patients undergoing major surgery Methods This retrospective observational study was based on the data collected from preanaesthetic checkup record book from January 2010 to December 2010. Results A total of 955 patients were studied and analyzed in terms of hypertension and demographic characteristics. The total incidence of hypertension in preoperative phase was 10.16%. Among them 64.9% being male and 35.1% female. Maximum incidence was found in age group 50-59 years i.e. 26.6%. Among the case detected maximum patients i.e. 52% were patients with newly diagnosed hypertension and among those under medications 61.1% were using calcium channel blockers. Conclusion Knowing the incidence will help in proper preoperative optimization of the hypertensive patients and also help in decreasing the incidence of postoperative complications. DOI: http://dx.doi.org/10.3126/kumj.v9i2.6286 Kathmandu Univ Med J 2011;9(2):40-43

INTRODUCTION: Tracheal intubation is a foremost cause of trauma to the airway mucosa, resulting in postoperative sorethroat (POST). The aim of the study was to compare the effectiveness of ketamine gargle with placebo in preventing POST after endotracheal intubation. METHODS: Forty patients scheduled for elective surgery under general anaesthesia were enrolled in this randomized, control trial. Patients were randomly allocated into two groups of 20 patients each: Group C, gargling with drinking water 30 ml; Group K, gargling with ketamine 50 mg in drinking water 30 ml for 30 s, 5 min before induction of anaesthesia. POST was graded at 4, 8, and 24 hours respectively after operation on a four- point scale (0-3). RESULTS: POST occurred more frequently in Group C, when compared with Group K at 4, 8, and 24 hours. CONCLUSIONS: Ketamine gargle reduces the incidence of POST after endotracheal intubation.

Contains fulltext : 70372.pdf (Publisher’s version ) (Open Access) INTRODUCTION: Erythema nodosum leprosum (ENL) is an inflammatory reaction, which may occur in the course of leprosy and may result in nerve function impairment and subsequent disability. METHODS: This retrospective study explores demographic and disease specific parameters. Severity of ENL was assessed using the Reaction Severity Scale (RSS). Records of 94 patients were reviewed. The study reports also on the treatment of 76 of these patients who were treated with prednisolone alone or thalidomide in addition to prednisolone. RESULTS Thirty percent of patients presented with ENL at time of diagnosis; 41% developed ENL-reaction in the first year of MDT. Forty-eight percent of patients were treated for ENL-reaction for less than 12 months; 13% for more than 5 years. High RSS-scores correlated with a longer duration of treatment. In group A (prednisolone) 51.7% and in group B (prednisolone and thalidomide) 76.6% of patients were male. Age, leprosy classification, delay of multidrug treatment (MDT) and interval between MDT and first ENL-symptoms did not differ significantly in both groups. Median duration of ENL-treatment was 15 months in group A versus 38 months in group B (P < 0.001). At the start of treatment, ENL-reaction was less severe in group A (RSS = 12) than in group B (RSS = 18; P = 0.003). DISCUSSION: ENL-symptoms may be of help in the early diagnosis and adequate treatment of ENL. Characterisation of (sub) groups of patients with ENL based on presence and severity of symptoms is important for future prospective studies to better evaluate the efficacy of interventions.

Summary Leprosy type 1 reactions (T1R) are immune-mediated events with inflammation of peripheral nerves and skin. We report the clinical outcomes of a closely monitored open prospective trial in which eight Nepali and 33 Ethiopian patients with T1Rs were treated with an Indian generic formulation of ciclosporin (Cn; 5–7.5 mg/kg/day) for 12 weeks and followed up for 24 weeks after starting treatment. Outcomes were measured using a clinical severity score. Among the Nepalis, 75–100% improved in all acute clinical parameters; 67–100% patients maintained improvement, except for those with acute sensory nerve impairment among whom 67% relapsed after stopping treatment. The skin lesions of all Ethiopians on 5 mg/kg/day of Cn improved and 50–60% had peripheral nerve function improvement. Most Ethiopians needed a higher dose of Cn to improve nerve impairment and neuritis, and 50–78% of them developed worse clinical severity scores when Cn was stopped. Four Ethiopians and two Nepalis developed elevated serum creatinine levels on 7.5 mg/kg/day Cn, and three (9%) Ethiopians developed treatable hypertension. This suggests that Cn monotherapy is an effective treatment for severe T1R with few adverse effects. A dose of 5 mg/kg/day seems efficacious in Nepalis, but a higher dose may be required in Ethiopian patients.