Methane release from enteric fermentation and manure management of domestic water buffalo in Nepal.

Methane (CH4) emission in livestock arises from enteric fermentation (EnF) and manure management (MM). This study develops the country-specific CH4 emission factors (EFs) in both EnF and MM for domestic water buffalo (Bubalus bubalis) and estimates total CH4 emission in Nepal using Intergovernmental Panel on Climate Change (IPCC) Tier 2 methodology. Seasonal field data were collected on morphological characteristics, feed characteristics, and manure management practices of the buffalo. The buffalo population was divided into five age groups, and at least 35 buffalo individuals were measured from each age group in the Hilly and Plain regions of Nepal in the winter and summer seasons. Buffalo adult male (BAM) had the highest body weight of 530 ± 53 kg in the plain region and 514 ± 65 kg in the Hill region. Similarly, the weight of buffalo calf (BC) was 91 ± 25 kg in the plain region and 77 ± 26 kg in the Hill region. For different age groups of buffalo, EnF EFs ranged from 34 ± 8 to 90 ± 10 kg CH4 head-1 year-1 and MM EFs ranged from 2.5 ± 0.5 to 7.5 ± 0.5 kg CH4 head-1 year-1. The estimated EnF and MM EFs of buffalo were not statistically different by region (p > 0 .05). The total CH4 flux from buffalo was 347.8 Gg year-1 in Nepal, contributing 322.2 Gg year-1 from EnF and 25.6 Gg year-1 from MM. The country-specific EFs are highly recommended for precise computing of the national emissions and carrying out mitigation action.

Association of preoperative pain catastrophizing with postoperative pain after lower limb trauma surgery.

OBJECTIVES: To evaluate an association between preoperative Nepali pain catastrophizing scale (N-PCS) scores and postoperative pain intensity and total opioid consumption. METHODS: In this prospective cohort study we enrolled 135 patients with an American Society of Anaesthesiologists physical status I or II, aged between 18 and 65 years, and scheduled for surgery for lower-extremity fracture under spinal anaesthesia. Maximum postoperative pain reported during the 24 h was classified into two groups, no-mild pain group (Numeric rating scale [NRS] scores 1-3) and a moderate-severe pain group (NRS 4-10). The Pearson's correlation coefficient was used to compare the association between the baseline N-PCS scores and outcome variables, i.e., the maximum NRS pain score and the total tramadol consumption within the first 24 h after surgery. Logistic regression models were used to identify the predictors for the intensity of postoperative pain. RESULTS: As four patients violated the protocol, the data of 131 patients were analyzed. Mean N-PCS scores reported by the moderate-severe pain group was 27.39 ± 9.50 compared to 18.64 ± 10 mean N-PCS scores by the no-mild pain group (p < 0.001). Preoperative PCS scores correlated positively with postoperative pain intensity (r = 0.43, [95% CI 0.28-0.56], p < 0.001) and total tramadol consumption (r = 0.36, [95% CI 0.20-0.50], p < 0.001). Preoperative pain catastrophizing was associated with postoperative moderate-severe pain (odds ratio, 1.08 [95% confidence interval, 1.02-1.15], p = 0.006) after adjusting for gender, ethnicity and preoperative anxiety. CONCLUSION: Patients who reported higher pain catastrophizing preoperatively were at increased risk of experiencing moderate-severe postoperative pain. CLINICAL TRIAL REGISTRATION: www.clinicaltrials.gov Identifier: NCT03758560.

Functional outcome of patients of tibial fracture treated with solid nail (SIGN nail) versus conventional hollow nail - A randomized trial.

BACKGROUND: Trauma related disabilities disproportionately affects low and middle income countries due to lack of resources, skills and optimal implants. Despite adequate animal studies, biomechanical studies, cohort studies and comparison studies we are not aware of any randomized trial to compare the functional outcome of SIGN (Surgical Implant Generation Network, US) solid nailing with a hollow nailing for tibial shaft fracture. METHODS: Sixty patients (≥16 years) of closed and Gustilo grade I traumatic fractures of the leg were randomized into SIGN solid nailing or hollow nailing group. Cases with compromised soft tissue and grossly deformed medullary canal were excluded. Functional outcome and need for resurgery were the primary outcomes while the secondary outcomes were duration of surgery, intraoperative blood loss, overall pain (VAS), radiological union (RUST), surgery related complications (infection, malalignment, shortening, nonunion) and pain/range of motion (ROM) of knee/ankle. All SIGN surgery related data were entered and retrieved online from www.signsurgery.org. RESULT: The demographical parameters were symmetrically distributed between the groups (p > 0.05). 2 cases in SIGN nailing and 4 cases in hollow nailing needed open reduction. The functional outcome, as assessed by blinded physiotherapist using Johner and Wruh criteria, was excellent in 18 (62.06%), good in 6 (20.68%), fair in 3 (10.34%) and poor in 2 (6.89%) for SIGN nail whereas it was 16 (57.14%), 8 (28.57%), 3 (10.71%) and 1 (3.57%) respectively for hollow nail. There was 1 case of implant failure and 1 case of infection. Intraoperative blood loss (397 ± 94.47 ml versus 350 ± 75.43 ml, p = 0.037) and duration of surgery (94.8 ± 14.57 min versus 82.0 ± 12.36 min, p = 0.001) were significantly more in hollow nailing group. At final follow up, overall pain on weight bearing (VAS score) and radiological union (RUST score) were 2.1 and 11.7 for SIGN nailing while they were 2.7 and 11.3 respectively for hollow nailing.(p = 0.41 and 0.45 respectively) The malrotation (p = 1.000), shortening (p = 1.000), varus-valgus angulation (p = 0.511), AP angulation (p = 0.706), ROM ankle (p = 0.239) and ROM knee (p = 0.086) were similar. CONCLUSION: Solid SIGN nailing gives comparable functional outcome as conventional hollow nailing for tibia shaft fracture. For developing world with limited resources, SIGN nail is useful which is supplied freely and is designed to be used without image intensifier and fracture table.

Outcome of Proximal Femoral Nail Antirotation II fixation of Peritrochanteric Fracture of Femur.

BACKGROUND: Intramedullary fixation is biomechanically superior to extramedullary fixation for fracture of peritrochanteric region of femur in elderly which is often complicated due to associated osteoporosis. Helical blade of proximal femoral nail antirotation II has stronger purchase in the head of femur preventing rotation and cutout. This study was done to evaluate the outcome of Proximal Femoral Nail Antirotation II fixation in B.P. Koirala Institute of Health Sciences. METHODS: Retrospective review of the data of 100 traumatic peritrochanteric fracture cases operated between March 2017 and March 2018 was done for study. Cases lost to follow-up, deaths and incomplete functional outcome (VAS, HHS), intraoperative and postoperative data were excluded. Total of 71 cases were included in the study. RESULTS: Mean age of patients was 65 (+14) (range:19 to 86) years and were operated for intertrochanteric (54), subtrochanteric (16) and neck of femur (1) fractures. Trivial fall on ground was the commonest mechanism of injury (43 of 71). Mean injury to surgery time was 7 (+7) days and mean duration of hospital stay was 5.92 (+4) days. Mean blood loss during surgery was 132.61 (+21) ml and mean surgical time was 56 (+8) minutes. Mean visual analogue scale (VAS) Score was 7 at 2 weeks, 3 at 6 weeks and 1 at 12 weeks. Mean harris hip score was 80 (+10) at 6 months. CONCLUSIONS: Proximal femoral nail antirotation II is a reliable implant system to use for fixation of proximal femoral fractures with a good functional outcome and low complication rates.

Methane emission factors and carbon fluxes from enteric fermentation in cattle of Nepal Himalaya.

This study presents a first estimate of the country-specific enteric methane (CH4) emission factors (EFs) and the net CH4 fluxes for the local and improved cattle breeds (LCB and ICB) in Nepal using the IPCC Tier 2 methodology. The country-specific herd structure, morphological and feed characteristics data of cattle were collected from the field survey. In LCB, adult males had the highest mean live body weights (BWs) ranging from 222 ± 42 kg in the Hill to 237 ± 36 kg in the Plain region, while for improved cattle, adult females had the highest BW of 334 ± 45 kg in the Hill to 308 ± 38 kg in the Plain regions. Weight gains of ICB were higher than the LCB. Local calves gained BWs of 97 ± 20 g day-1, while improved calves gained a weight of 202 ± 41 g day-1. The CH4 EFs ranged from 13 ± 3 to 46 ± 9 kg CH4 head-1 yr-1 for different age-groups of the LCB, while for the ICB, the EFs ranged from 14 ± 3 to 75 ± 15 kg CH4 head-1 yr-1. Overall, the EFs were 33 ± 7 and 46 ± 9 kg CH4 head-1 yr-1 for LCB and ICB, respectively. The estimated enteric EFs of cattle in the Hill and Plain regions were not statistically different (p > 0.05), but a significant difference existed between the breeds (LCB and ICB; p < 0.05). The net CH4 flux was 254 ± 51 Gg yr-1 from enteric fermentation in cattle of Nepal using the country-specific EFs, about 15% higher than using the default EFs (221 ± 66 Gg yr-1). We underline that the emission estimation, deploying the country-specific EFs, will be more accurate, contributing to reduce the uncertainties in the national GHG inventories and supporting the mitigation actions.

Comparison of Functional and Radiological Outcomes of Olecranon Fractures Treated with Tension Band Wiring with Kirschner Wires to Transcortical Screw Fixation-A Randomised Controlled Study.

AIM: To compare the clinical and radiological outcomes of fixation of olecranon fractures by a transcortical screw with conventional tension band wiring (TBW) using a Kirschner wire (K-wire). MATERIALS AND METHODS: This is a non-blinded randomised controlled trial comprising two groups (n = 30 each) with Mayo type A olecranon fractures fixed with either TBW or transcortical cancellous screws (CCS). Outcomes included the Mayo elbow performance index (MEPI), time to union, range of motion (ROM), and rates of complication among these two groups. RESULTS: Most of the patients showed excellent scoring as per MEPI in both the groups at 6 weeks (90% in TBW group and 76.7% in CCS group) and were not significant (p = 0.719). Signs of the radiological union were noted in 80% of the cases at 6 weeks and complete at 6 months. Hardware-related complications (8.3% symptomatic hardware and 6.7% implant back-out), infection, and mean ROM were similar between the two groups (elbow flexion was 142.33 ± 24.67° in TBW group and 143.1 ± 10.19° in transcortical screw group, p = 0.246) at the end of the study. CONCLUSION: There were no statistically significant differences in the clinical-radiological outcomes and complications fixing the non-comminuted olecranon fractures with either transcortical screw or TBW. CLINICAL SIGNIFICANCE: Transcortical screw fixation is an acceptable alternative to TBW for non-comminuted olecranon fractures in terms of union and functional outcome. HOW TO CITE THIS ARTICLE: Sinha S, Maharjan R, Khanal GP, et al. Comparison of Functional and Radiological Outcomes of Olecranon Fractures Treated with Tension Band Wiring with Kirschner Wires to Transcortical Screw Fixation-A Randomised Controlled Study. Strategies Trauma Limb Reconstr 2020;15(3):131-137.

A Case of Surgically Intervened Chronic Tophaceous Gout and Review of Literature.

BACKGROUND: Gout is a disease of deposition of monosodium urate crystal in the body which commonly presents as an acute arthritis of the peripheral joints but can have varied presentation. It is mostly managed by dietary modifications and drugs, but surgery is rarely required for the management of urate crystals. CASE REPORT: We present a case of a 66-year-old male who intermittently presented to the outpatient with multiple tophi which was managed with lifestyle changes and medically; initially, the patient eventually required surgical excision for tophi in fingers and heel which improved the pain and morbidity of the patient. CONCLUSION: Gout can be managed by lifestyle changes, medically by drugs, and in extreme cases surgically and requires the utmost compliance by the patient. Such surgical intervention is rare with the advent of uricosuric medication now.

Diversity and use of wild and non-cultivated edible plants in the Western Himalaya.

BACKGROUND: Local people in the Himalayan region use a wide range of wild and non-cultivated edible plants (WNEPs) for food, spice, medicinal, and cultural purposes. However, their availability, use, status and contribution to livelihood security are poorly documented, and they have been generally overlooked in recent agro-biodiversity conservation and management programmes. The study aimed to investigate WNEP diversity and current status in a part of the Kailash Sacred Landscape-a transboundary landscape shared by Nepal, India and PR China-in terms of collection, use, management and conservation initiatives. METHODS: Multiple methodologies and tools were used for data collection. A series of participatory tools (45 key informant interviews, 10 focus group discussions, a crop diversity fair, direct observation of species through a transect walk and rapid market assessments) was followed by a household survey (195 respondents) and complemented by a literature review. RESULTS: The study recorded 99 WNEPs belonging to 59 families of which 96 were angiosperms, one gymnosperm and two pteridophytes. Species were used for food, spice, medicine, rituals and income generation. Thirty-five species had multiple uses, including these: 40 species were used for fruit and 31 for vegetables. WNEPs contribute significantly to daily food requirements, especially the vegetables. The use value of Dryopteris cochleata was found highest (0.98) among frequently used vegetable species. The values of informant consensus factor were found maximum for worms in the stomach (0.99) and minimum for skin disease treatment (0.67). Nearly 85% of households depended exclusively on WNEPs for at least more than a month per year. Results on the importance and use of different species, gender roles in WNEP activities and conservation approaches are presented. CONCLUSIONS: People living in the Kailash Sacred Landscape depend significantly on WNEPs, and this is especially critical in times of food shortage. The WNEPs have considerable potential as an important supplement to cultivated food crops. Farmers prioritise species with multiple use values and popular vegetables. However, there are numerous challenges and interventions needed to ensure conservation and management of species and their continued availability to support food security and local livelihoods.

From food security to food wellbeing: examining food security through the lens of food wellbeing in Nepal's rapidly changing agrarian landscape.

This paper argues that existing food security and food sovereignty approaches are inadequate to fully understand contradictory human development, nutrition, and productivity trends in Nepalese small-scale agriculture. In an attempt to bridge this gap, we developed a new food wellbeing approach that combines insights from food security, food sovereignty, and social wellbeing perspectives. We used the approach to frame 65 semi-structured interviews in a cluster of villages in Kaski district in the mid-hills of Nepal on various aspects of food security, agriculture, off-farm livelihood opportunities, and women's wellbeing. Our results indicate that context-specific subjective and social relational factors highlighted by the food wellbeing approach are key to understanding a paradox of increased food security, yet decreasing sustainability of small-scale agriculture. Increased levels of male out-migration and opportunities for local off-farm work have increased local capacity to purchase food. The positive consequences for food security are indicated by evidence that households with non-farm income sources had better food sufficiency, absorption capacity, nutritional quality, and stability of food supply. These off-farm employment opportunities have also led to the greater involvement of low caste groups and women in small-scale agriculture. This has been empowering for both groups and led to an increase in wellbeing, particularly for those women who have become de facto heads of household. Yet, small landholdings, persistent patterns of unequal and absentee land ownership, sharecropping, women's overwork, and the aspirations of low caste farmers and women away from agriculture are simultaneously driving the erosion of local small-scale agricultural productivity and ecological sustainability.

Local perceptions of climate change validated by scientific evidence in the Himalayas.

The Himalayas are assumed to be undergoing rapid climate change, with serious environmental, social and economic consequences for more than two billion people. However, data on the extent of climate change or its impact on the region are meagre. Based on local knowledge, we report perceived changes in climate and consequences of such changes for biodiversity and agriculture. Our analyses are based on 250 household interviews administered in 18 villages, and focused group discussions conducted in 10 additional villages in Darjeeling Hills, West Bengal, India and Ilam district of Nepal. There is a widespread feeling that weather is getting warmer, the water sources are drying up, the onset of summer and monsoon has advanced during last 10 years and there is less snow on mountains than before. Local perceptions of the impact of climate change on biodiversity included early budburst and flowering, new agricultural pests and weeds and appearance of mosquitoes. People at high altitudes appear more sensitive to climate change than those at low altitudes. Most local perceptions conform to scientific data. Local knowledge can be rapidly and efficiently gathered using systematic tools. Such knowledge can allow scientists to test specific hypotheses, and policy makers to design mitigation and adaptation strategies for climate change, especially in an extraordinarily important part of our world that is experiencing considerable change.

Management of trochanteric fractures of the femur with external fixation in high-risk patients.

The aim of this prospective study was to assess the outcome of trochanteric fractures of the femur after external fixation in a group of elderly patients with high surgical risk. The study population consisted of 50 patients with trochanteric fractures of the femur and a mean age of 87 years who were classified by an anaesthetist as ASA 3 or 4 and considered not suitable for conventional fractures fixation. The fracture was fixed with an external fixator under spinal anaesthesia. The final follow-up was at 12 months. All fractures healed within 12 weeks. Superficial pin tract infection occurred in 30 patients, and fracture united with a shortening of 14 mm (5-20) in 12 patients. No implant failures or limitation of knee movements were recorded. Five patients died within 1 year. External fixation is a valuable treatment alternative for trochanteric fracture of the femur in elderly patients.