Foot Care Knowledge and Practice among Diabetic Patients Attending General Outpatient Clinic in Tribhuvan University Teaching Hospital

Background: Diabetes Mellitus results in several serious complications and among them foot problem is one of the commonly ignored complications. This study is an attempt to find out the level of patient’s awareness and practice in Nepalese context. Objective: The aim of this study is to determine the knowledge and practice of foot care among patients with diabetes in Nepal. Methods: This is a six-month long cross-sectional study done in the General Practice Clinic of Tribhuvan University Teaching Hospital. Diabetic patients were given structure questionnaires on knowledge, foot care practices, and demographic information. Results: Illiteracy was found be significantly associated with poor knowledge and practice of foot care. Those who have no education are more likely to have poor knowledge and foot care practice. The odds of having poor knowledge is 6.414 (3.075, 13.379) in those who have no education/primary education compared to those who have education and the odds of poor foot care practice is 4.5180 (2.077, 8.411) in those who have no education/primary education compared to those who have education with significance of Conclusion: This study has highlighted the need of appropriate education intervention for the patients with diabetes who have no education background to prevent from foot complications. Health education materials such as graphics, photos are needed to make them comprehensible for the illiterate patients.

Seedling potential of trees species along the elevational gradient in temperate hill forest of central Nepal

Regeneration status of tree species along elevation gradient in temperate hill forest was not understood greatly.Present research examined the tree diversity and its regeneration patterns along an elevation gradient in temperate hill forest,central Nepal.Data were collected from 300 sample plots within vertical elevation bands of 10,ranging from 1365 to 2450 m asl.A random sampling method was used for data collection in three seasons,winter,pre-monsoon and post monsoon seasons.Diameter at breast height(DBH)was used to broadly categorize the plant individual into trees,saplings and seedlings.The tree species richness ranged from 12 to 25 with density of 350 to 1200 individuals per hectare.Species richness of tree and sapling showed statistically significant unimodal pattern,which peaked at mid-elevation.Elevation showed a strong and positive linear correlation with the seedling density(Deviance=0.99,p<0.001)and a significant hump-shaped relationship with sapling density(Deviance=0.95,p<0.001).Similarly,elevations showed a statistically significant negative hump-shaped relationship with all trees,saplings and seedling stages(Deviances=0.89,0.87 and 0.57).The highest values of the Shannon-Wiener index and the lowest value of the Simpson index were found at mid-elevation for all growth forms.Nearly 92%of tree species were found at regenerating stage;49%in a good renewal regeneration status,32%in fair renewal regeneration,and 11%at a poor regenerating condition.Nevertheless,4%of tree species were reported as non-regenerating stages and 4%were newly introduced species.Hence,the regeneration status of the study area was considered fairly well since sapling(78.5%)>seedling(10.6%)≤mature(10.9%).Among tested environmental variables,elevation and annual mean rainfall were the most influential factors in the regeneration of tree species.

Impacts of road on plant invasions in the Middle Mountain region of central Nepal

Biological invasion is triggered by human development activities such as the construction and expansion of road networks.Road verges serve as important habitats and corridors for the distribution of invasive alien plant species(IAPS)between geographically distant habitats.However,the trajectory of plant invasion and the data regarding the impact of roads on IAPS distribution are relatively poor in Nepal.Here,we surveyed two road types(main roads and feeder road)in the Middle Mountain region of central Nepal in order to investigate how different road types are driving the dispersal of IAPS along road verges and the adjacent natural habitats.Systematic sampling was conducted at ca 2.5 km intervals along the roads.At each sampling site,paired plots(25 m×4 m)were sampled:one adjacent to and along the road,and another 20 m away and parallel to it in the interior habitat.Our results revealed that the main road verges had a higher cover(33%)and a larger number of IAPS(14 species)than the feeder road(25%;10 species).The IAPS cover and richness were significantly higher along verges than in the adjacent interior habitats for both road types,indicating that roads are contributing as corridors for the dispersal of IAPS in the Middle Mountain areas of central Nepal.Further,elevation,tree canopy,and disturbances(grazing/mowing/trampling)were found to be the key factors that determine spatial distribution of IAPS along road verges.We emphasize that regular monitoring of vegetation along the road verges can help with the early detection and control of potential IAPS in the region before they become problematic.

Depression and anxiety among cancer patients visiting a tertiary care cancer hospital

BACKGROUND Cancer patients frequently experience psychological problems related to reactions to cancer diagnosis,cancer type and stage,treatment effects,recurrence,fear of end-of-life,survivorship,and financial burden.Depression and anxiety are both psychological and physiological disturbances among cancer patients.AIM To assess the prevalence of depression and anxiety among cancer patients attending a tertiary care cancer hospital.METHODS A cross-sectional study was conducted at Bhaktapur Cancer Hospital in Kathmandu Valley among 220 cancer patients aged from 18 years to 70 years.Ethical approval was taken from the Institutional Review Committee of CiST College.Convenient sampling was used to interview patients with the standardized Patient-Health Questionnaire(PHQ-9)for Depression and Hospital Anxiety and Depression sub-scale(HADS-A)for anxiety.Epi-Data was used for data entry and transferred to SPSS Version 25 for analysis.RESULTS The study revealed that of 220 patients,most of the respondents belonged to the age group 51-60 years.More than half 131(59.6%)of the respondents were female,most of them had depression,and one-third had anxiety.Among the respondents,124(56.4%)had mild depression,70(31.8%)had moderate depression,and 3(1.3%)had severe depression;79(35.9%)had mild anxiety,64(29.1%)had moderate anxiety,and 4(1.8%)had severe anxiety.CONCLUSION Most respondents were depressed and one-third had anxiety.More than half and nearly one-third had mild and moderate depression,respectively,and nearly one-third had mild and moderate anxiety,which is higher than other studies.

Strengthening Active Aging through Older People’s Association and Economic Activity of the Older People in Nepal

Aging is a natural lifelong process ending in death. Many older people are living in poverty. Older people are generally considered dependent on others as they grow older. The purpose of this article is to explore the entrepreneurship activities of Nepalese older adults. Data for this study were collected from the project Help Age International (HAI) implemented in Nepal. Qualitative data observations and interviews were used to collect data. The findings of this study show the formation of the Older People’s Association (OPA) has supported many older people to participate outside the home in various social activities. Moreover, regular deposits through OPAs offer little help. OPAs support older people in their need of financial support to implement minor entrepreneurship. Older people who received support were pleased and were actively involved in their activities and also regularly deposited money in them. Subsequently, older people’s participation in social activities has increased and also helped to lower elderly abuse, loneliness, and depression. Local governments should promote such activities which will help with healthy aging.

Community perspectives on the effectiveness of watershed management institutions in the Himalayas

The sustainability of environmental management initiatives,such as watershed management programs,relies on the presence of effective institutions at the watershed level.However,there needs to be more empirical evidence from evaluating the effectiveness of watershed-level institutions.Therefore,this study presents a pioneering effort to evaluate the effectiveness of Nepal’s first watershed conservation committee at the watershed scale,focusing on the case of the Khageri Khola watershed in Central Nepal.The study involved conducting a household survey,key informant interviews,focus group discussions,and field observations to collect and analyze the data.Descriptive analysis,index value calculation,and chi-square statistics were then employed to summarize the results regarding local respondents’perceptions of twelve institutional characteristics,their rationalities,and their association with socio-demographic variables.The results reveal that the watershed conservation committee was perceived as performing well in managing the watershed.Specifically,good interaction,appropriate scale,technical,environmental,social,organizational,and government rationality were perceived as highly effective,with an average index value of less than 0.36.In contrast,clarity of objectives and economic rationality showed moderate effectiveness,with an average index value ranging from 0.36 to 0.65.However,the results suggested that adaptiveness,compliance capacity,and financial rationality merit increased attention,intending to improve their performance.Further,the results showed the association of socio-demographics with respondents’perceptions of various indicators of institutional characteristics and their rationalities.Therefore,the study provides valuable insights for policymakers,researchers,and development practitioners charged with designing sustainable and effective programs and institutions.To enhance the effectiveness and sustainability of watershed management programs,we recommend establishing a policy-guided institutional mechanism at the watershed scale.This mechanism should be based on various institutional characteristics and rationalities and should consider the extant variability in the socio-demographic and topographic characteristics of the watershed.

Betalains protect various body organs through antioxidant and anti-inflammatory pathways

Betalains are natural coloring pigments with betalamic acid as the core structure of all subclasses.Besides their coloring properties,betalains exhibit various biological activities,including antioxidant and anti-inflammatory properties,which are highly imperative.Further in-vivo studies reported that betalains protect various body organs,leading to health enhancement.Body organs,including the heart,liver,kidney,lung,etc.,are important for a healthy life.However,these organs can be affected or damaged by various stress factors,toxicants,and harmful substances.Recent studies have claimed that betalains could protect all vital organs of the body through antioxidant and anti-inflammatory mechanisms.This review article described the in-vivo antioxidant and anti-inflammatory activities of betalains in various cell-line or animal models.A comprehensive discussion has been provided on the mechanism of action of betalains in protecting various body organs,including cardio-protective effect,hepato-protective ability,renal protection capacity,repro-protective ability,neuro-protective effect,lung protection,and gut protection ability.Finally,future research directions and conclusions have been outlined.

Low-Cost Insulation for Energy Efficient Buildings in Terai Region of Nepal

There is a huge amount of energy savings potential in public building sector that has yet to be realized.By prioritizing energy efficiency in its own buildings and thus promoting the development of required knowledge in terms of new technology and construction methods,the public sector will lead the way in efforts to increase the rate of renovations.The low-cost insulation strategies and a comparison of cost with existing insulation materials has been described in this study.We have repeatedly faced energy crises and will continue to do so in the future if appropriate action is not taken in a timely manner.Properly implementing energy-saving initiatives in for achieving thermal comfort in buildings as well as reducing the energy costs would undoubtedly inspire the residential sector,resulting in significant reductions in energy usage.Simulations were carried out to study insulation layers on various building components like exterior walls,floor and roofs,generating different scenarios for a building as a base model,which were then compared and analysed to verify the literature used to develop the cases.The proposed recommendations,which have been validated,are certain to increase building energy efficiency,achieve thermal comfort in low cost than what is currently being used.

Probabilistic Analysis of Slope Using Finite Element Approach and Limit Equilibrium Approach around Amalpata Landslide of West Central, Nepal

The stability study of the ongoing and recurring Amalpata landslide in Baglung in Nepal’s Gandaki Province is presented in this research. The impacted slope is around 200 meters high, with two terraces that have different slope inclinations. The lower bench, located above the basement, consistently fails and sets others up for failure. The fluctuating water level of the slope, which travels down the slope masses, exacerbates the slide problem. The majority of these rocks are Amalpata landslide area experiences several structural disruptions. The area’s stability must be evaluated in order to prevent and control more harm from occurring to the nearby agricultural land and people living along the slope. The slopes’ failures increase the damages of house existing in nearby area and the erosion of the slope. Two modeling techniques the finite element approach and the limit equilibrium method were used to simulate the slope. The findings show that, in every case, the terrace above the basement is where the majority of the stress is concentrated, with a safety factor of near unity. Using probabilistic slope stability analysis, the failure probability was predicted to be between 98.90% and 100%.

Advances in Zika virus vaccines and therapeutics:A systematic review

Zika virus(ZIKV)is the causative agent of a viral infection that causes neurological complications in newborns and adults worldwide.Its wide transmission route and alarming spread rates are of great concern to the scientific community.Numerous trials have been conducted to develop treatment options for ZIKV infection.This review highlights the latest developments in the fields of vaccinology and pharmaceuticals developments for ZIKV infection.A systematic and comprehensive approach was used to gather relevant and up-to-date data so that inferences could be made about the gaps in therapeutic development.The results indicate that several therapeutic interventions are being tested against ZIKV infection,such as DNA vaccines,subunit vaccines,live-attenuated vaccines,virus-vector-based vaccines,inactivated vaccines,virus-like particles,and mRNA-based vaccines.In addition,approved anti-ZIKV drugs that can reduce the global burden are discussed.Although many vaccine candidates for ZIKV are at different stages of development,none of them have received Food and Drug Authority approval for use up to now.The issue of side effects associated with these drugs in vulnerable newborns and pregnant women is a major obstacle in the therapeutic pathway.

秦巴山地气候变化特征与旱涝区域响应

[目的]气候变化对自然环境和人类活动产生重要影响,厘清全球变化背景下极端气候灾害发生的频次和强度对于维护人民生命财产安全具有重要意义。[方法]根据1970-2017年秦巴山地内102个气象站点的逐日数据,运用线性回归、Mann-Kendall非参数检验、反距离权重法(IDW)、Z指数法和Morlet小波变换等方法,分析近48年秦巴山地气候变化特征及西部大起伏高山区、秦岭大起伏高中山区、大巴山大起伏中山区和豫西汉中中山谷地4个地貌单元上的区域旱涝灾害响应研究。[结果]近48年来秦巴山地气温以0.3℃/10 a增加,降水以0.87 mm/10 a的速率增加,全区气候朝暖湿化趋势发展。研究时段内,不同地形区气温都呈上升趋势,但增加速率不同,大巴山大起伏中山区增速最大(0.7℃/10 a)、豫西汉中中山谷地最低(0.2℃/10 a),从降水量及变化趋势来看,大巴山大起伏中山区降水量明显高于其他地形区,变化倾向率最大(13.45 mm/10 a),西部大起伏高山区变化倾向率最低为0.06 mm/10 a。秦巴山地旱涝灾害发生的程度年际差异明显,且1970-2017年有加剧的趋势,4个区域旱涝灾害对气候变化的响应存在差异:大巴山大起伏中山区旱涝灾害对气候变化的响应表现为总体偏涝,涝灾出现的频率与强度均有加剧态势;豫西汉中中山谷地、秦岭大起伏高中山区及西部大起伏高山区总体表现为偏旱,旱灾频率和强度明显高于涝灾。[结论]1997-2017年秦巴山地呈暖湿化现象,极端气候事件的频率和强度呈增加趋势,研究结论为不同区域分类、分级制定水土保持规划提供依据。

Evolution and bathymetry of glacial lake at the lowest elevation in Nepal Himalaya

One of the prominent impacts of climate change induced glacier retreat in the Himalayas is the formation and expansion of glacial lakes. The newly formed glacial lakes are mostly located in higher altitudinal regions(4200-5800 m) of Himalaya,however, a new glacial lake(Kapuche, 28.446° N and 84.116° E) have been reported to be emerged in the relatively low elevation area of ~2450 m above sea level(masl) in the Nepal Himalaya. This short communication presents the remote sensing-based evolution and field-based bathymetry of Kapuche lake, and further discusses its formation process and lake type for being a glacial lake at the lowest elevation in Nepal Himalaya.

Seasonal variations and health risk assessment of trace elements in the Badigad River,lesser Himalayas,Nepal

The consumption of contaminated river water can have severe effects on human health.This study aims to investigate the trace elements(TEs)content and their health risk assessment in the Badigad River Basin in the lesser Himalayas of Nepal.In total,44 water samples were collected from 22 different sites during the pre-monsoon and monsoon seasons,and 25 TEs were analyzed.Correlation matrix and principal component analysis(PCA)were used to analyze the potential relationship between the measured TEs and their source tracking.Furthermore,the water quality index(WQI),metal index(MI),and cancer index(CI)were evaluated.The TEs content in all samples were found to be within the WHO recommended guideline for drinking and domestic purposes.The dominancy order of the TEs was observed as Sr>Ba>Li>Rb>Zn>Cr>Sc>Mn>Ti>Cu>As>Ni>Co>U>V>Pb>Cs>Ga>Y>Tl>Th>Zr>Bi>Cd>Nb.The PCA analysis suggested that TEs could have natural,anthropogenic,and mixed origins.The WQI indicated that the river water is safe from a human health perspective.The MI suggested that Badigad River can be considered safer for drinking purposes,and the cancer index(CI)showed that all the reported TEs are at low-risk levels.The findings of this study could be useful for government agencies in developing more sustainable water management policies in the region.However,it is suggested that further investigations should be conducted in terms of other hydrogeochemical variables,including major ions,at spatiotemporal levels for the sustainability of the river basin.

Rainfall erosivity and sediment dynamics in the Himalaya catchment during the Melamchi flood in Nepal

Rainfall erosivity is an indicator of rainfall potential to cause soil erosion.The Melamchi extreme flood occurred on June-15 and recurred on July-31,2021 in Nepal.During these flooding events,a large volume of sediments were eroded,transported and deposited due to the high rainfall erosivity of the basin.In this study,the temporal and the spatial distribution of rainfall erosivity within the Melamchi River Basin was estimated and further linked to sediment discharge and concentration at various sites along the river segments.The daily rainfall data for the event year 2021 of the entire basin were used.Validation was performed by post-flooding grain size sampling.The result showed that rainfall and rainfall erosivity exhibit pronounced intensity within the Melamchi River basin,particularly at Sermathang and Tarkeghang,both located in the middle section of the basin.The average annual rainfall in the Melamchi region was 3140.39 mm with an average annual erosivity of 18302.06(MJ mm)/(ha h yr).The average daily erosivity of the basin was 358.67(MJ mm)/(ha h)during the first event and 1241(MJ mm)/(ha h)for the second event.In the upper section of sampling,the sediment size ranged from 0.1 mm to>8 mm and was poorly graded.However,the lower region had smaller sediment ranging from 0.075 mm to>4.75 mm and also well graded.The smaller size(<1 mm)sediment passing was much higher in the Chanaute(78%)and Melamchi(66.5%)river segments but the larger size(>100 mm)sediments were passed relatively higher from the Kiwil(8.20%)and Ambathan(8.39%)river segments.During premonsoon and monsoon seasons,the highest sediment concentration was found to be 563.8 g/L and 344.3 g/L in Bhimtar and the lowest was 238.5 g/L and 132.1 g/L at the Ambathan,respectively.The sediment concentration during the pre-monsoon was found to be higher than the sediment concentration during the monsoon season in the Melamchi River.The more erosive regions in the basin were associated with the presence of highly fractured rock,weathered rocks and a thrust(weak)zone.The higher rainfall erosivity at upstream and the higher sediment concentration at downstream during flooding events have coincided well in the basin.Thus,the estimation of rainfall erosivity at the catchment scale and its influences on sediment concentration in the river are crucial for erosion control measures during flooding times in the Himalaya.

Aging Trend and Situation in Nepal

Aging is a natural lifelong process until death. The proportions of the older population are increasing rapidly in Nepal too. There are 2.97 million older people in Nepal as of the 2021 census which is a 38.2% increase compared to the previous census of 2011. The proportion of the older population reached 10.21% of the total population of Nepal. During this decade, Nepal’s average population growth rate is 0.92% and the older population growth rate is 3.29% per year. On the other hand, Nepal’s total fertility is below replacement level, infant mortality is around 23 per thousand live births and average life expectancy is now around 71 years. The median age of Nepal is 25 years and the index of aging increased rapidly from 23.3 in 2011 to 36.7 in the 2021 census of Nepal. These indicators show aging is taking place rapidly and the caregiving burden may increase rapidly in the coming days due to the tendency of migration of the young population to other countries. In this context, the Nepal government needs to focus on how to manage the population and provide quality services and social security for the growing older people of Nepal.

The Influence of Alluvial Mining on the Morphology and Ecological Health of the Jhimruk River in Pyuthan, Nepal

Historically, alluvial rivers have been a desirable source of sediment for various industrial purposes. However, the demand for sand is rapidly increasing, leading to environmental concerns associated with its extraction. The extraction of sediment from riverbeds has both visible and invisible effects. This research aims to investigate the dynamics of the Jhimruk River’s morphology and its impacts by evaluating the river’s quality and studying its changing morphology. To assess morphological changes, satellite images from different years were compared using Geographic Information System (GIS). Physical assessments were conducted by calculating a Habitat score based on various parameters. Water quality assessments involved measuring factors such as pH, temperature, nitrate levels, and alkalinity. A water quality map of the river was generated using color coding to indicate different conditions. The Habitat score demonstrated variations in the data collected from all sites, with factors such as instream cover, bottom substrate stability, riparian vegetation, and aesthetic of the river stretch playing crucial roles in influencing the total score. The Water Quality Index value for the disturbed site indicated moderate pollution, falling under class II. Aquatic macroinvertebrates displayed natural responses to increasing levels of stressors across their life stages, as observed through the analysis of the GRS-BIOS/ASPT index. With the exception of the disturbed site, all other sites were classified under water quality class II, while the disturbed site belonged to class III, indicating a moderate to critically polluted state for most of the Jhimruk River. Furthermore, an increase of 180.87 meters in the river width at the disturbed site provided evidence of morphological changes occurring over the specified period. Mining activities were identified as a significant contributor to the alteration in river morphology.

Prevalence of Preoperative Anemia in Elective Rheumatic Valve Surgery at a Tertiary Care Center in Nepal

Background: Rheumatic Valvular Heart disease (RVHD) is common in developing countries often associated with anemia;however its burden is often overlooked. Anemic patients undergoing surgery are likely to receive blood transfusion, increasing morbidity and mortality. Prevalence of anemia in cardiac surgical patients are studied extensively, however its burden in RVHD is lacking. This study attempted to investigate the prevalence of preoperative anemia in RVHD and its effect on blood transfusion, morbidity and mortality in patients undergoing valve surgery. Methods: This is a retrospective observational study conducted at a tertiary care hospital in Nepal. We considered 340 patients who underwent Rheumatic valve replacement surgery from 2014 January to December 2016 and data on their socio-demographic and clinical characteristics were extracted from the patient’s records. The analyses meeting the study objectives were conducted using IBM SPSS v25 for Windows (IBM Statistical Package for Social Sciences, 2015IBM Corporation, New York, United States). Results: The prevalence of no anemia, mild, moderate, and severe anemia was 34.1%, 57.7%, 39.6%, 2.5%, respectively. The units of Red Blood Cell used for transfusion were 1.2 units, 2.0 units, 2.3 units, and 1.6 units in patients without anemia, and those with mild, moderate and severe anemia respectively. The incidence of reexploration was higher in patients with severe anemia as compared to the non anemic with an incidence of 66.6%. A proportion of the patients with no anemia, mild, moderate and severe anemia with less than 7 days stay in the intensive care unit were 89%, 82%, 84.7% and 100% respectively. The length of hospital stay more than 10 days was seen in 58.9%, 71.6%, 63% and 100% in patients with no anemia, mild, moderate and severe anemia. An overall incidence of mortality in anemic patients was 11% while in non anemic patients was 5.3%. Conclusions: The prevalence of anemia was high in the Nepalese patients with Rheumatic valvular heart disease planned for elective surgery. There was an increased incidence of blood transfusion, longer hospital stay, and increased mortality in anemic patients compared to their non anemic counterparts.

Functional composition of tall-statured trees underpins aboveground biomass in tropical forests

The influences of trait diversity(i.e.,the niche complementarity effect)and functional composition(i.e.,the mass ratio effect)on aboveground biomass(AGB)is a highly debated topic in forest ecology.Therefore,further studies are needed to explore these mechanisms in unstudied forest ecosystems to enhance our understanding,and to provide guidelines for specific forest management.Here,we hypothesized that functional composition would drive AGB better than trait diversity and stem size inequality in the(sub-)tropical forests of Nepal.Using data from 101 forest plots,we tested 25 structural equation models(SEMs)to link elevation,stem DBH inequality,trait diversity(i.e.,trait richness,evenness,dispersion and divergence),functional composition[i.e.,community-weighted of maximum height mean(CWM of Hmax),specific leaf area(CWM of SLA),leaf dry matter content(CWM of LDMC),and wood density(CWM of WD)]and AGB.The best-fitted SEMs indicated that CWM of Hmax promoted AGB while overruling the impacts of trait diversity indices on AGB.However,low trait diversity indices were linked with higher AGB while overruling the effects of CWM of SLA,LDMC and WD on AGB.In addition,AGB decreased with increasing elevation,whereas stem size inequality did not influence AGB.Our results suggest that divergent species’functional strategies could shape AGB along an altitudinal gradient in tropical forests.We argue that forest management practices should include plant functional traits in the management plan for the co-benefits of biodiversity conservation and carbon sequestration that underpins human wellbeing.

Microbiological and Antibiotic Susceptibility Patterns in Cardiothoracic and Vascular Intensive Care Unit of a Tertiary Level Hospital in Nepal

Background: Sepsis has been one of the most important conditions for morbidity and mortality of Intensive care unit (ICU) patients. Antibiotics remain one of the major combating factors for it. Indiscriminate antimicrobial usage and poor prescription practices have contributed to the development of multidrug resistant (MDR) organisms. Therefore, the current study was designed to evaluate the spectrum, and susceptibility patterns of pathogens isolated from patients admitted to our Cardiothoracic and Vascular Intensive care unit. Materials and Methods: The study was conducted in Cardiothoracic and Vascular ICU of a tertiary care teaching hospital from February 2019 to March 2021. Samples (blood, urine, wound swab, tracheal aspirate, and central venous catheter tip) for culture were taken from all the patients in Sepsis admitted in Cardiothoracic and Vascular ICU above 18 years of age during the study period. The culture reports (microbiological profile and their susceptibility pattern) were collected and data collection of all enrolled patients was done. Results: Out of the total 128 samples studied 75 (58.5%) were culture positive. The predominant organisms isolated were Gram negative organisms (Klebsiella, Pseudomonas, Acinetobacter, followed by E. coli). The highest prevalence of microbial growth was found in tracheal aspirate (46.8%), followed by blood (21.8%). Antibiotic susceptibility results showed the highest sensitivity of those common pathogens towards higher antibiotics only (especially Polymyxin B and Colistin). Conclusion: The emergence of multidrug resistant organisms and lesser availability of a higher group of antibiotics is a major concern. So there is a need for regular hospital based antibiograms, strict infection control programs, and implementation of antimicrobial stewardship programmes for guiding clinicians in choosing appropriate therapy and preventing the surge of multidrug resistant organisms.

The effects of climate and land use change on the potential distribution and nesting habitat of the Lesser Adjutant in Nepal

Climate change and land use change pose a threat to the world’s biodiversity and have significant impacts on the geographic distribution and composition of many bird species,but little is known about how they affect threatened large-sized waterbird species that rely on agricultural landscapes.To address this gap,we investigated how climate and land use changes influence the distribution and nesting habitats of the globally vulnerable Lesser Adjutant(Leptoptilos javanicus) in Nepal.Between 2012 and 2023,we collected distribution data from 24 districts and nesting site information from 18 districts.In a nation-wide breeding survey conducted in 2020,we documented a total of 581 fledglings from 346 nests in 109 colonies.The ensemble model predicted a current potential distribution of 15%(21,637 km2) and a potential nesting habitat of 13%(19,651 km2) for the species in Nepal.The highest predicted current suitable distribution and nesting habitat was in Madhesh Province,while none was predicted in Karnali Province.The majority of this predicted distributional and nesting habitat falls on agricultural landscapes(>70%).Our model showed a likely range expansion of up to 15%(21,573 km2) for the distribution and up to 12%(17,482 km2) for the nesting habitat under SSP5-8.5 scenarios for the 2070s.The range expansion is expected to occur mainly within the current distribution and breeding range(Tarai and some regions of Siwalk),particularly in Lumbini and Sudurpashchim provinces,and extend to the northern portions(Siwalik and Mid-hill regions) in other provinces.However,the current Protected Areas and Important Bird and Biodiversity Areas are inadequate for providing optimal habitats for the species.Although the model suggests range expansion,the use of such novel habitats is primarily contingent on the availability and protection of large-sized trees(particularly Bombax ceiba,observed in 65% of colonies) in agricultural regions where nesting occurs.Therefore,our research suggests that agricultural landscapes should be prioritized in management plans for the conservation of the Lesser Adjutant in Nepal.