Climate plays a dominant role over land management in governing soil carbon dynamics in North Western Himalayas.

The soil carbon (C) dynamics is strongly influenced by climate and land-use patterns in the Himalayas. Therefore, soils under five prominent land use [e.g., maize (Zea mays), horticulture, natural forest, grassland, and wasteland] were sampled down up to 30 cm depth under two climatic conditions viz., temperate and subtropical to assess the impacts of climate and landuse on soil C dynamics. Results demonstrated that irrespective of land use, temperate soil contains 30.66% higher C than subtropical soils. Temperate soils under natural forests had the higher total organic carbon (TOC, 21.90 g kg-1), Walkley-Black carbon (WBC, 16.42 g kg-1), contents, and stocks (TOC, 66.92 Mg ha-1 and WBC, 50.24 Mg ha-1), and total soil organic matter (TSOM, 3.78%) concentration as compared to other land uses like maize, horticulture, grassland, and wasteland. Under both climatic conditions, maize land use had the lowest TOC 9.63, 6.55 g kg-1 and WBC 7.22, 4.91 g kg-1 at 0-15 and 15-30 cm soil depth, respectively. Horticulture land use had 62.58 and 62.61% higher TOC and WBC over maize-based land use under subtropical and temperate climatic conditions at 0-30 cm soil depth, respectively. However, soils of maize land use under temperate conditions had ∼2 times more TOC than in subtropical conditions. The study inferred that the C-losses is more in the subtropical soil than in temperate soils. Hence, the subtropical region needs more rigorous adoption of C conservation farming practices than the temperate climatic setting. Although, the adoption of C storing and conserving practices is crucial under both climatic settings to arrest land degradation. Horticultural land uses along with conservation effective soil management practices may be encouraged to restore more soil C and to improve the livelihood security of the hill populace in the North Western Himalayas.

Pattern of Male Hypogonadism and Outcome of Treatment in South Rajasthan.

Male reproductive functions are governed by hypothalamic pituitary testicular axis. If any component of this axis malfunctions, then hypogonadism will develop which is characterized by ill-defined secondary sexual features and low serum testosterone. The common patterns seen are primary and secondary testicular failure in the young; and late onset hypogonadism in the elderly. All such cases can be virilized and managed by androgen supplementation. Spermatogenesis can be induced by use of appropriate gonadotropins in selected cases. The aim of the study was to find out the pattern, management and outcome of male hypogonadism. MATERIAL: It was a prospective questionnaire based observational study, carried out on infertile hypogonadic males, attending medicine outdoor at medical college hospital from January 2015 to December 2020. There were 50 males with hypogonadic features, cases of late onset of hypogonadism were excluded. Sexual maturity rating, semen analysis, serum testosterone and FSH level were estimated in all patients at baseline and at 6 months duration of treatment. Testicular biopsy, Karyotyping and MRI brain were performed in selected cases. Azoospermic patients having hypogonadotropic hypogonadism were treated with long-acting testosterones and gonadotropins. OBSERVATION: The study subjects were infertile azoospermic males. On the basis of serum FSH and testosterone levels, they were classified into two groups. Group A (n=42) cases were hypergonadotropic hypogonadism or primary testicular failure; of these 32 were Klinefelter syndrome (XXY), 7 chronic orchitis and 3 empty scrotal syndrome including one case of anorchia. These patients also developed other systemic illnesses in addition to hypogonadism. Group B (n=8) hypogonadotropic hypogonadism or secondary testicular failure; of these 2 were Kallman syndrome and the rest were idiopathic. After testosterone replacement all patients were virilized and there was marked improvement in libido and androgenization. CONCLUSION: The study brings out that primary testicular failure is more common than secondary testicular failure. Both pattern of hypogonadism should receive lifelong androgen replacement therapy; otherwise, they will be a basket of multiple systemic disorders. Presently testosterone undecanoate once in every three months is the agent of choice.

Lead, cadmium and nickel removal efficiency of white-rot fungus Phlebia brevispora.

Widespread of heavy metals contamination has led to several environmental problems. Some biological methods to remove heavy metals from contaminated wastewater are being widely explored. In the present study, the efficiency of a white-rot fungus, Phlebia brevispora to remove different metals (Pb, Cd and Ni) has been evaluated. Atomic absorption spectroscopy of treated and untreated metal containing water revealed that all the metals were efficiently removed by the fungus. Among all the used metals, cadmium was the most toxic metal for fungal growth. Phlebia brevispora removed maximum Pb (97·5%) from 100 mmol l-1 Pb solution, which was closely followed by Cd (91·6%) and Ni (72·7%). Scanning electron microscopic images revealed that the presence of metal altered the morphology and fine texture of fungal hyphae. However, the attachment of metal on mycelia surface was not observed during energy-dispersive X-ray analysis, which points towards the intracellular compartmentation of metals in vacuoles. Thus, the study demonstrated an application of P. brevispora for efficient removal of Pb, Cd and Ni from the metal contaminated water, which can further be applied for bioremediation of heavy metals present in the industrial effluent.

Extended Spectrum ß-lactamase (ESBL) Producing Multi Drug Resistant (MDR) Urinary Pathogens in a Children Hospital from Nepal.

Background Multidrug resistant in clinical bacterial isolates has increasingly been reported through out the world and is associated with high morbidity, mortality and increased health care costs. It is important to determine the status of multidrug resistance pattern to understand the current resistance trend so that appropriate antibiotics can be used in practice. Objective To determine the antibiotic resistant profile and prevalence of extended spectrum ß-lactamase producing multidrug resistant strains in pediatric patients of Kanti Children's Hospital, Kathmandu, Nepal. Method Urine sample was cultured by standard microbiological techniques and bacterial isolates were identified using different biochemical tests. Antibiotic susceptibility testing was performed by Kirby Bauer disc diffusion method and extended spectrum ß-lactamase detection was carried out using combined disc method as recommended by Clinical Laboratory Standard Institute guidelines. Result All together 65 different bacteria were isolated and subsequently identified. E. coli was the most common isolate with 46 (71%) isolates 63% of these isolates were multidrug resistant. Gram negative isolates were most resistant to nalidixic acid (81.97%) followed by ampicillin (69.35%) and co-trimoxazole (69.35%). The extended spectrum ß-lactamase producing isolates were 43% among total isolates. Conclusion Higher rate of Extended Spectrum ß-lactamase production among multidrug resistant isolates suggested routine extended spectrum ß-lactamase testing in clinical isolates.

Variability studies for needle and wood traits of different half sib progenies of Pinus roxburghii Sargent.

Genetic variability studies for needle and wood traits were carried out for the different half sib progenies of Chir pine, raised in 1985 at the main campus of University. There existed a significant variation for these traits among the different half sib progenies, viz., needle length (18.1-24.6 cm), needle thickness (0.53-0.71 mm), number of stomata per mm of a row (7.3-12.0), specific gravity of wood (0.36-0.46), tracheid length (1.51-1.85) and moisture content of wood (47.76-58.81). This variability was found under genetic control, as all these progenies are growing under same environment, and are of same age. Traits having high heritability and genetic gain like, needle thickness, wood specific gravity, tracheid length and others, indicate high genetic control. This variability can be exploited in tree improvement programs through selection and breeding approaches for development of advanced generations. Correlation studies for different traits at genotypic and phenotypic levels provided the basic knowledge of association to chalk out efficient breeding strategy for higher productivity through indirect selection.

Evaluation of intubating conditions in children after sevoflurane induction using propofol or rocuronium bromide--a randomised, prospective, double blind study.

BACKGROUND: The use of sevoflurane without muscle relaxant for tracheal intubation has been widely investigated in children. Non-depolarizing neuromuscular blockers have long duration of action and do not provide rapid return of spontaneous ventilation. Use of suc-cinylcholine has been found to be associated with various side-effects especially in children. Therefore, we aim to evaluate the effect of propofol 1.5 mg/kg without muscle relaxant, on intubating conditions in children 2-8 yrs of age and we compare them with those achieved with rocuronium 0.6 mg/kg, at moderate sevoflurane concentration. METHODS: Fifty children between 2-8 yrs, ASA I or II scheduled for elective surgery were randomly allocated to either Group P (propofol) or group R (rocuronium). After premedication with oral midazolam 0.5 mg/kg 30 min before surgery, anaesthesia was induced with 8% sevoflurane in oxygen. Intravenous fentanyl 1 µg/kg was administered after securing intravenous access and dial concentration of sevoflurane was reduced to 4%. At one minute with regards to time T0, the patients received the drug which was either intravenous rocuronium 0.6 mg/kg or an equal volume of 0.9% saline (D) and at three minutes (two minutes after D1), second drug (D2) was given, which was either propofol 1.5 mg/kg or an equal volume of 0.9% saline according to the group allocated. At four minutes, laryngoscopy was done and intubation performed with appropriate sized uncuffed endotracheal tube. Incidence of acceptable and excellent intubating conditions, time to intubation and hemodynamic parameters were recorded. RESULTS: Incidence of acceptable or excellent intubating conditions was similar in both groups (p = 1.00). The difference in time to intubation was statistically not significant (25.03 ± 6.05s in Group P and 24.38 ?5.58s in Group R, p = 0.694), at similar end-tidal concentration of sevoflurane (3.2 ± 0.20% in Group P and 3.1 ± 0.20% in Group R, p = 0.12). CONCLUSION: Propofol (1.5 mg/kg) and rocuronium (0.6 mg/kg) produced similar intubating conditions in children induced with sevoflurane.

Malnutrition in children aged 6-59 months in Mugu district.

BACKGROUND: Malnutrition is one of the leading causes of child morbidity and mortality. The severity of hunger in mountain and hill districts of Mid- and Far-Western Development Regions is a serious concern. Mugu, is one of the most remote and least developed districts of Nepal, periodically facing food insufficiency. This study was carried out to evaluate the malnutrition status of the most vulnerable group of children (6-59 months age group) in Mugu district. METHODS: This study conducted in Mugu district was prospective and observational. Nutritional status of children aged 6-59 months were assessed by measuring mid-upper arm circumference by using MUAC tape and data was collected by interviewing caretakers. The data were analyzed and compared to the national figure. RESULTS: Altogether 198 children aged 6-59 months were recruited for this study. Among them 49% were boys and 51% were girls. According to MUAC criteria, 1% of children had suffered from Severe Acute Malnutrition (SAM), 17% had Moderate Acute Malnutrition (MAM) and 82% had adequate nutritional status. CONCLUSIONS: The prevalence of Acute Malnutrition is high in Mugu district. The important factors, among numerous others are food scarcity, poor hygiene and environmental practices, lack of care of the mother towards her child due to priority given to work and lack of knowledge about proper child feeding/care.

Towards a benchmarking tool for minimizing wastewater utility greenhouse gas footprints.

A benchmark simulation model, which includes a wastewater treatment plant (WWTP)-wide model and a rising main sewer model, is proposed for testing mitigation strategies to reduce the system's greenhouse gas (GHG) emissions. The sewer model was run to predict methane emissions, and its output was used as the WWTP model input. An activated sludge model for GHG (ASMG) was used to describe nitrous oxide (N(2)O) generation and release in activated sludge process. N(2)O production through both heterotrophic and autotrophic pathways was included. Other GHG emissions were estimated using empirical relationships. Different scenarios were evaluated comparing GHG emissions, effluent quality and energy consumption. Aeration control played a clear role in N(2)O emissions, through concentrations and distributions of dissolved oxygen (DO) along the length of the bioreactor. The average value of N(2)O emission under dynamic influent cannot be simulated by a steady-state model subjected to a similar influent quality, stressing the importance of dynamic simulation and control. As the GHG models have yet to be validated, these results carry a degree of uncertainty; however, they fulfilled the objective of this study, i.e. to demonstrate the potential of a dynamic system-wide modelling and benchmarking approach for balancing water quality, operational costs and GHG emissions.

Integrated modelling of sewer system and wastewater treatment plant for investigating the impacts of chemical dosing in sewers.

Chemicals are often dosed to control the production and accumulation of hydrogen sulfide in sewers. The biological and/or chemical actions of these chemicals have profound impacts on the composition of wastewater entering a WWTP, thereby affecting its performance. In this paper, an integrated modelling methodology for simultaneously investigating the effects of dosing of chemicals in sewer network and N and P removal at the downstream WWTP is reported. The sewer system is modelled using a sewer model (SeweX), and the WWTP is modelled using ASM2d model with some modifications. The importance of integrated modelling in sewer management is also demonstrated.

Dental caries prevalence and treatment needs among 12- and 15- Year old schoolchildren in Shimla city, Himachal Pradesh, India.

CONTEXT: Dental caries is one of the commonest oral diseases in children. Despite this fact, not many studies have been done on this issue among school children in Shimla. AIM: To assess the prevalence of dental caries and treatment needs among schoolchildren aged 12 years and 15 years in Shimla city, Himachal Pradesh, India. With this study we also aimed to establish reliable baseline data. DESIGN: Cross-sectional study. MATERIALS AND MATERIALS: This study was conducted among 12 - and 15 - year old schoolchildren in Shimla city, Himachal Pradesh-India. A sample of 1011 schoolchildren was selected by a two-stage cluster sampling method. Clinical recording of dental caries, was done according to WHO diagnostic criteria (1997). STATISTICAL ANALYSIS: The statistical tests used were the t- test, and the Chi-square test. RESULTS: The prevalence of dental caries was 32.6% and 42.2% at 12 years and 15 years respectively. At 12 years of age, the mean Decayed Missing Filled Teeth was 0.62 ± 1.42 and it was 1.06 ± 2.93 at 15 years of age. Females had higher level of caries than males at both the ages. Dental caries was higher in children from government schools as compared to those from private schools. The 'decayed' component was the biggest contributor to the DMFT index. The highest treatment need at both ages was one surface restoration. CONCLUSION: The caries experience of 12- and 15- year-old children was low compared to WHO - 'recommended' values. Effective oral health promotion strategies need to be implemented to further improve the dental health of school children in Shimla city.

Prevalence of malocclusion and orthodontic treatment needs among 16 and 17 year-old school-going children in Shimla city, Himachal Pradesh.

BACKGROUND: Many studies have been conducted in India to know the prevalence of malocclusion and the orthodontic treatment needs using dental aesthetic index (DAI), but no study so far has been conducted in Shimla city, Himachal Pradesh. OBJECTIVE: To know the prevalence of malocclusion and orthodontic treatment needs among 16- and 17 year-old school-going children in Shimla city, Himachal Pradesh. MATERIALS AND METHODS: The study was carried out on 622 (365 boys and 257 girls) school children, aged 16 and 17 years, from February 2009 to May 2009. Type III examination was conducted and the assessment of malocclusion was done according to the DAI. RESULTS: 20.28% of the male and 24.52% of the female students in the sample were affected with malocclusion. The mean DAI scores of the male and female children were 22.26 and 21.79, respectively. Distribution of the four DAI grades was as follows: DAI-I (no abnormality or minor malocclusion) 79.58%, DAI-II (definite malocclusion) 16.39%, DAI-III (severe malocclusion) 3.69%, DAI-IV (very severe/handicapping malocclusion) 0.34%. CONCLUSION: The present study shows that 20.42% of the children examined had malocclusion which required treatment.

Lingual thyroid in children.

Lingual thyroid is a rare embryological anomaly and originates from failure of the thyroid gland to descend from the foramen caecum to its normal eutopic pre-laryngeal site. The ectopic gland located at the base of the tongue is often asymptomatic but may cause local symptoms such as dysphagia, dysphonia with stomatolalia, upper airway obstruction and haemorrhage, often with hypothyroidism. One case is presented, in a 5 year-old girl patient, who complained of sensation of a foreign body and progressive dysphagia and dyspnoea caused by ectopic lingual thyroid. The diagnosis of lingual thyroid is usually made clinically and radionuclide scanning is used to confirm the diagnosis. In this case report, presentation, diagnosis and management of this condition is highlighted.

Multipoint incremental motor unit number estimation as an outcome measure in ALS.

BACKGROUND: Improved outcome measures are necessary to reduce sample size and increase power in amyotrophic lateral sclerosis (ALS) clinical trials. Motor unit number estimation (MUNE) is a potentially attractive tool. MUNE methods previously employed in multicenter trials exhibited excessive variability and were prone to artifact. OBJECTIVE: To evaluate a modification of standard incremental MUNE in a multicenter natural history study of subjects with ALS. METHODS: Fifty healthy subjects were evaluated twice and 71 subjects with ALS were studied repeatedly for up to 500 days. Side and nerve studied was based on clinical examination findings. Nerves were stimulated at 3 specified locations and 3 increments were obtained at each location. Average single motor unit action potential (SMUP) amplitude was calculated by adding the amplitude of the third increment at each location and dividing by 9; SMUP was divided into maximum CMAP amplitude to determine the MUNE. RESULTS: Test-retest variability was 9% in normal subjects. Average MUNE for normal subjects was 225 (±87), and was 41.9 (±39) among subjects with ALS at baseline. Subjects with ALS showed clear decrements over time, with an overage rate of decline of approximately 9% per month. SMUP amplitude increased with time in a fashion consistent with the known pathophysiology of ALS. CONCLUSION: Multipoint incremental MUNE has a number of attributes that make it attractive as an outcome measure in ALS and other diseases characterized by motor unit loss. It can be rapidly performed on any EMG machine and has repeatability and rates of decline that favorably compare to other previously described methods.

Treatment of pseudo Class III malocclusion by modified Hawleys appliance with inverted labial bow.

Pseudo Class III malocclusion is characterized by an anterior crossbite with functional forward mandibular displacement. Various appliances have been devised for early treatment of a pseudo Class III. The aim of this article is to highlight the method of construction and use a simple removable appliance termed as "Modified Hawleys appliance with inverted labial bow" to treat psuedo class III malocclusion in the mixed dentition period. It also emphasizes the importance of differentiating between true Class III and pseudo Class III. This appliance in this type of malocclusion enabled the correction of a dental malocclusion in a few months and therapeutic stability of a mesially positioned mandible encouraging favorable skeletal growth.

Dental prosthetic status, prosthetic needs in relation to socioeconomic status of the state government employees in Shimla city (Himachal Pradesh) - A cross sectional study.

OBJECTIVE: To know the dental prosthetic status, prosthetic needs in relation to socioeconomic status (SES) of the state government employees in Shimla city, Himachal Pradesh. MATERIALS AND METHODS: The study was carried on 1008 (705 males and 303 females) state government employees in Shimla city between February 25, 2009 and April 10, 2009. Type III examination was conducted and the prosthetic status and prosthetic needs were recorded on W.H.O. format 1997. Modified Kuppuswamy scale, with readjustment of the per capita income to suit the present levels, was used for SES classification. RESULTS: 10.3% of the subjects in the study had prosthesis of some kind. The prosthetic status was better in the upper middle and upper SES category as compared with the other categories and the findings were statistically significant. Prosthetic need in the study population was 33.2%, which was maximum for the subjects in the lower SES category and minimum for the higher SES category. Awareness on the provision of reimbursement for dental care was highest among the upper class and negligible in the lower SES category. CONCLUSIONS: Present study shows a direct relationship between SES and percentage of the subjects having prosthesis of some kind. SES shows an inverse relationship with prosthetic need and awareness on the provision of reimbursement of dental care.

Failure of subarachnoid block in caesarean section.

Subarachnoid block is the most convenient and safe anaesthesia during caesarean section. But there are incidences where subarachnoid block does not work and other methods of anaesthesia have to be employed. This study was done in 2039 female patients who underwent caesarean Section at Paropakar Maternity and Women's Hospital, Thapathali, Kathmandu Nepal from 1st October 2005 to end of September 2006 to find the rate of failure of subarachnoid block in Caesarean Section and look for the causes of failure. Patients of age 17 years to 43 years (mean age 25.40 years) and ASA I and II were included in the study. Spinal needle (Sprotte) of 26 Gauze with Quincke's bevel was used. Solution injected was 2.20 ml of 0.5% hyperbaric Bupivacaine. Of the total 2039 patients who received subarachnoid block with the above mentioned methods, 6.0% (n=123) needed further anesthetic agents. Conversion to general anesthesia was needed in 87 (4.3%) patients. Rest 1.8% (n=36) could be operated with further administration of intravenous agents (Ketamine, Diazepam and/or Pentazocine) only.

Impact of nitrate addition on biofilm properties and activities in rising main sewers.

Anaerobic sewer biofilm is a composite of many different microbial populations, including sulfate reducing bacteria (SRB), methanogens and heterotrophic bacteria. Nitrate addition to sewers in an attempt to control hydrogen sulfide concentrations affects the behaviour of these populations, which in turn impacts on wastewater characteristics. Experiments were carried out on a laboratory reactor system simulating a rising main to determine the impact of nitrate addition on the microbial activities of anaerobic sewer biofilm. Nitrate was added to the start of the rising main during sewage pump cycles at a concentration of 30 mg-N L(-1) for over 5 months. While it reduced sulfide levels at the outlet of the system by 66%, nitrate was not toxic or inhibitory to SRB activity and did not affect the dominant SRB populations in the biofilm. Long-term nitrate addition in fact stimulated additional SRB activity in downstream biofilm. Nitrate addition also stimulated the activity of nitrate reducing, sulfide oxidizing bacteria that appeared to be primarily responsible for the prevention of sulfide build up in the wastewater in the presence of nitrate. A short adaptation period of three to four nitrate exposure events (approximately 10 h) was required to stimulate biological sulfide oxidation, beyond which no sulfide accumulation was observed under anoxic conditions. Nitrate addition effectively controlled methane concentrations in the wastewater. The nitrate uptake rate of the biofilm increased with repeated exposure to nitrate, which in turn increased the consumption of biodegradable COD in the wastewater. These results provide a comprehensive understanding of the impact of nitrate addition on wastewater composition and sewer biofilm microbial activities, which will facilitate optimization of nitrate dosing for effective sulfide control in rising main sewers.

Clinical and electromyographic deep tendon reflexes in polyneuropathy: diagnostic value and prevalence*.

BACKGROUND: Evidence is accumulating that patients with polyneuropathy may present with normal clinical deep tendon reflexes (C-DTR). There are few studies that assessed the diagnostic utility of electromyographically recorded DTR (Er-DTR) in patients with polyneuropathy. OBJECTIVES: The objectives of this study were twofold: (i) to evaluate the prevalence of preserved C-DTR in polyneuropathy; (ii) diagnostic value of Er-DTR latency measurement in patients with polyneuropathy. METHODS: We prospectively studied 38 controls and 185 patients with polyneuropathy. All subjects had evaluation of C-DTR, Er-DTR obtained from right biceps brachii (BR), right patellar (PR) and bilateral ankle reflexes (AR). RESULTS: Of these 185 patients, 118 (63.8%) had chronic axonal neuropathy (CAN), 49 (26.5%) demyelinating polyradiculoneuropathy (DPN) and 18 (9.7%) small fiber neuropathy (SFN). The C-DTR were normal in 65 patients whereas 39 of these 65 (60%) patients had abnormalities of Er-DTR at one or more sites. Er-DTR latencies in patients with polyneuropathies were prolonged at all sites compared with controls (P < 0.01). Among patients with various types of polyneuropathies the Er-DTR, mean latencies at all the sites and latency indicative of demyelination (>150% of the normal mean) were higher in patients with DPN than that of CAN or SFN (P < 0.01). CONCLUSIONS: We conclude that C-DTR are preserved in 35.1% of the patients with polyneuropathies and Er-DTR should be performed in such patients in order to provide electrophysiological evidence of a polyneuropathy. Er-DTR are useful in distinguishing axonal from demyelinating disorders of peripheral nerve, and detection of subclinical involvement of large fibers in SFN.

A prospective randomised double blind study to evaluate the effect of peribulbar block or topical application of local anaesthesia combined with general anaesthesia on intra-operative and postoperative complications during paediatric strabismus surgery.

We studied 45 ASA I/II children aged between 2 and 13 years scheduled for elective strabismus surgery, randomly allocated to receive either a peribulbar block or topical lidocaine 2% combined with general anaesthesia, or general anaesthesia alone. The incidence and severity of the occulocardiac reflex, the requirement for atropine, the occurrence of arrhythmias and incidence of postoperative nausea and vomiting following surgery at 1, 2 and 4 h were studied. We found the incidence and severity of occulocardiac reflex intra-operatively was significantly reduced in children who received a peribulbar block. The incidence of postoperative nausea and vomiting was significantly reduced in patients receiving either peribulbar block or topical local anaesthesia combined with general anaesthesia, compared to general anaesthesia alone (p = 0.008).

Comparative study of epidural administration of 10 ml of 0.1% bupivacaine with 2 mg butorphanol and 10 ml of 0.25% plain bupivacaine for analgesia during labor.

Analgesia during labor provided by two epidural drug regimens was compared in a double blind, randomized, prospective study. Group A (n = 12) received 10 ml bolus doses of 0.1% bupivacaine with butorphanol 2 mg while Group B (n = 8) received 10 ml of 0.25% plain bupivacaine. The objectives of this study was to compare, between the quality of an epidural labor analgesia using initial loading dose of 0.1% bupivacaine and 2 mg butorphanol with a initial loading dose of 0.25% bupivacaine. In Group A, incidence of motor block was 8.3% and that of prolong 2nd stage of labor was 16.7%, both were decreased in comparison with Group B, although they were not statistically significant. Hemodynamic variables were stable and no adverse neonatal and maternal outcome was observed in both groups. Addition of butorphanol to bupivacaine may be safe alternative to reduce motor block and decrease prolong 2nd stage for epidural labor analgesia.