Suchergebnisse

Cover -- Half Title -- Title Page -- Copyright Page -- Contents -- Preface -- New Dimensions in Agroecology for Developing a Biological Approach to Crop Production -- Education in Agroecology and Integrated Systems -- Redesigning Industrial Agroecosystems: Incorporating More Ecological Processes and Reducing Pollution -- Integrating Agroecological Processes into Cropping Systems Research -- An Agroecological Basis for Designing Diversified Cropping Systems in the Tropics -- Soil Ecosystem Changes During the Transition to No-Till Cropping -- The Ecology of Crop-Weed Interactions: Towards a More Complete Model of Weed Communities in Agroecosystems -- Research and Extension Supporting Ecologically Based IPM Systems -- Effects of Key Soil Organisms on Nutrient Dynamics in Temperate Agroecsosystems -- Nutrient Dynamics: Utilizing Biotic-Abiotic Interactions for Improved Management of Agricultural Soils -- Microbial and Genetic Diversity in Soil Environments -- Impact of Global Change on Biological Processes in Soil: Implications for Agroecosystem Management -- The Importance of Biodiversity in Agroecosystems -- Biophysical and Ecological Interactions in a Temperate Tree-Based Intercropping System -- Agricultural Landscapes: Field Margin Habitats and Their Interaction with Crop Production -- Benefits of Re-Integrating Livestock and Forages in Crop Production Systems -- Nitrogen Efficiency in Mixed Farming Systems -- Ecological Context for Examining the Effects of Transgenic Crops in Production Systems -- Redesigning Pest Management: A Social Ecology Approach -- Research Priorities in Natural Systems Agriculture -- Index.

Background: Nephrolithiais is a recurrent disease. Recent advances have enabled stone surgeries to be performed by minimal invasive techniques; but still a large number of patients present with history of ipsilateral open renal stone surgery. Previous scar to the kidney and overlying muscles are fraught with possibility of increased complications. This study was conducted to evaluate the perioperative results of percutaneous nephrolithotomy in patients with a history of open stone surgery and to compare with those undergoing percutaneous nephrolithotomy for the first time.Methods: A retrospective study of all the percutaneous nephrolithotomy performed by standard technique within four years at Bir Hospital was made. Patients were divided into those undergoing percutaneous nephrolithotomy for the first time and those who had undergone open renal stone surgery in the past. Preoperative and intraoperative variables were recorded and postoperative stone free status and complications were evaluated. Results: Six hundred and twenty seven patients; out of 691, who had undergone percutaneous nephrolithotomy were included. Demographic variables and stone characteristics were similar in the two study groups. percutaneous nephrolithotomy was found to be statistically similar in the two groups in terms of the number of tracts made (p= 0.1642) and operative time (0.9197). Exit strategies were similar in both groups. Stone free rate was 83.33% in patients undergoing percutaneous nephrolithotomy for first time and 82.08% in those with history of open surgery. Average hospital stay was 3 days in both groups. Although the group with history of previous surgery had significantly more complications (p= 0.0207), Clavien grading was similar in the two groups.Conclusions: This study shows that the rate of complications is more in patients with history of open surgery, most complications are minor, not requiring intensive management. percutaneous nephrolithotomy is efficient and safe in patients with history of open renal stone surgery. Keywords: Complications; open renal stone surgery; percutaneous nephrolithotomy

Background: To identify the perioperative factors associated with complications after percutaneous nephrolithotomy by classification of complications according to the modified Clavien scoring system and evaluation of the minor and major complications related to the procedure.Methods: A prospective study of all the percutaneous nephrolithotomy performed by standard technique within 1.5 years at Bir Hospital was made. Possible demographic, preoperative and intraoperative variables were included in the study and patients were followed up postoperatively for any complications. All complications were classified according to modified Clavien scoring system and analyzed to identify the prognostic variables.Results: Two hundred and forty six percutaneous nephrolithotomy done within the study period were analyzed. Although 41.06 % of the study population developed complications, only 9.35 % had major complications. Age, body mass index, gender, clinical presentation, history of previous surgery and ASA score did not correlate with complications. Diabetes was the only comorbidity associated (p = 0.0482). Preoperatively estimated stone burden (p = 0.0023), number of calyces involved by the stones (p = 0.0002), and presence of staghorn calculi were significantly associated with development of postoperative complications. Multiple tracts were required (p = 0.0151) and operative time was longer (p < 0001) in the patients who developed complications.Conclusions: Percutaneous nephrolithotomy has lesser complications. Diabetic patients are more prone to develop complications. Larger stone burden, involvement of multiple calyces by stones and staghorn calculi are associated with need of multiple tracts and longer operative time, thus predisposing to higher incidence of complications.

Background: Urinary stone disease has high prevalence in our belt. The end stage complication of this disease turns out to be a non-functioning kidney, which in fact could be prevented by means of appropriate treatment and follow up.Methods: This is retrospective study of the nephrectomy cases of last 8 years retrieved from the hospital database. Variables like age, sex, indications for nephrectomy, modalities of nephrectomy and morbidities among the primary and recurrent disease were taken into consideration. Analysis were done using Microsoft Excel 2016.Results: Five hundred and twenty-nine nephrectomies were performed in last 8 years at our hospital. Female were more prone for nephrectomies. Age at third and fourth decade were most to be affected. Ninety percentage of nephrectomies were done for benign causes, 65% for the stone disease. The recurrent renal stone disease without any past surgical interventions were more prone to undergo nephrectomies. The conventional open technique of nephrectomy has largely been replaced by laparoscopic means in recent years.Conclusions: The main contributor for nephrectomy in our context is urinary stone disease, which is considered to be the preventable factorKeywords: Nephrectomy; renal stone; urinary stone disease.

Background: The purpose of this study was to determine the optimal pillow height for the best laryngoscopic view in adult patients scheduled for elective surgery under general anaesthesia.Methods: 150 adult patients undergoing surgery under general anaesthesia with endotracheal intubation with no features suggestive of difficult airway were enrolled for the study. After induction of anaesthesia the assessment of direct laryngoscopic views was done at head positions without a pillow and with non-compressible pillows of heights 5cm and 10cm.Results: The laryngoscopic view with the 5cm pillow was significantly superior to other head position (p<0.01). The incidence of difficult laryngoscopy (Cormack and Lehane grade III) was 32.7% without a pillow which improved to (Cormack and Lehane grade III) 4% with 10cm pillow and there were no cases of difficult laryngoscopy with 5cm pillow.Conclusions: The use of 5cm pillow in the 'sniffing' position obtains the best laryngoscopic view during direct laryngoscopy.Keywords: Direct laryngoscopy; head elevation; laryngoscopicview; pillow height.

Background: The aim of the study is the compare efficacy and safety of percutaneous nephrolithotomy in supine and prone positions. Percutaneous nephrolithotomy is conventionally performed in prone position but in recent years numbers of supine percutaneous nephrolithotomies is increasing globally.Methods: The hospital based cross-sectional observational study was conducted in the Department of Urology, Bir Hospital from July 2018 to January 2020. A total of 81 consecutive patients undergoing percutaneous nephrolithotomy were divided into two groups, with 38 patients in Supine (Group 1) and 43 patients in Prone (Group 2) positions, respectively. Patient's demographics, access time, operative duration, stone free rate, radiation dose and duration, irrigation fluid volume, post-operative hemoglobin drop and complications were compared.Results: Demographic and stone characteristics were comparable in both groups. Supine Group (Group 1) had significantly shorter operative duration than Prone Group (Group 2), 44.63 ± 12.44minsvs 53.02 ±12.67mins (p< 0.04). The mean radiation duration was 99.11 ± 61.17secs in Group 1 and 108.40 ± 51.65 secs in Group 2 (p=0.46), respectively. Although the mean radiation dose was lower in Group 1 (375.1µGym2) than in Group 2 (465.7 µGym2), it was not statistically significant(p=0.24). The stone free rate at 1 month duration were comparable with 92.1% and 93.02% in Group 1 and Group 2 respectively (p=0.16). Overall complication rates were similar in both groups (15.7% in Group 1 vs 16.2% in Group 2), respectively. None of the patients in both groups had complications higher than Clavien IIIa.Conclusions: PCNL in supine position has significantly shorter operative time with similar complications and stone free rates as compared to prone position.Keywords: percutaneous nephrolithotomy; prone position; supine position

Anaesthetic management of patients with Corona Virus Disease (COVID-19) posses multiple challenges. In the low-income nation like Nepal, factors like suboptimal infrastructure and resource limitations may add on to the existing challenges. Proper planning and preparedness can help to overcome the challenges and enhance safety of both the patients undergoing surgery and of the health care workers involved in patient management.Keywords: Anaesthetic management; COVID-19; Nepal

Mountain farming systems rely on both empirical and academic knowledge. Their sustainability depends on how effectively diverse knowledge is used for solution-oriented decision making. For mountains, decisions must be conducive to rural farmers whose livelihoods depend on agriculture and related activities. Adopting transdisciplinary research approach, we define a composite Sustainability Space indicator that will help decision makers better understand the ingredients for sustainability, and formulate policy and management decisions to reinforce on-the-ground sustainability. Sustainability Space was derived through analysis of the positive and negative impact factors co-defined by community and disciplinary experts, and visualized through a radar diagram. We used Principal Component Analysis to understand relationships between factors. The results on Sustainability Spaces for eight cases of farming systems from the far-Eastern Himalayas indicated that the sustainability of farming systems is strengthened if decisions holistically cater to (i) geophysical pre-requisites, (ii) ecological foundations, (iii) integrated processes and practices, (iv) resources, knowledge, and value systems, (v) stakeholders' development and economic aspirations, (vi) well-being of farming communities, and (vii) government support mechanisms. More equitable the attention to these seven components, the higher the sustainability of farming systems in this region could be.

Funding: Stop TB Partnership/UNOPS – TB REACH project (grant number: 5–31); European Union, Horizon 2020 – IMPACT TB project (grant number: 733174). ; This study compared the yield of tuberculosis (TB) active case finding (ACF) interventions applied under TB REACH funding. Between June 2017 to November 2018, Birat Nepal Medical Trust identified presumptive cases using simple verbal screening from three interventions: door-to-door screening of social contacts of known index cases, TB camps in remote areas, and screening for hospital out-patient department (OPD) attendees. Symptomatic individuals were then tested using smear microscopy or GeneXpert MTB/RIF as first diagnostic test. Yield rates were compared for each intervention and diagnostic method. We evaluated additional cases notified from ACF interventions by comparing case notifications of the intervention and control districts using standard TB REACH methodology. The project identified 1092 TB cases. The highest yield was obtained from OPD screening at hospitals (n = 566/1092; 52%). The proportion of positive tests using GeneXpert (5.5%, n = 859/15,637) was significantly higher than from microscopy testing 2% (n = 120/6309). (OR = 1.4; 95%CI = 1.12–1.72; p = 0.0026). The project achieved 29% additionality in case notifications in the intervention districts demonstrating that GeneXpert achieved substantially higher case-finding yields. Therefore, to increase national case notification for TB, Nepal should integrate OPD screening using GeneXpert testing in every district hospital and scale up of community-based ACF of TB patient contacts nationally. ; Publisher PDF ; Peer reviewed