Introduction: Intentional pesticide poisoning is a major clinical and public health problem in agricultural communities in low and middle income countries like Nepal. Bans of highly hazardous pesticides (HHP) reduce the number of suicides. We aimed to identify these pesticides by reviewing data from major hospitals across the country and from forensic toxicology laboratories. Methods: We retrospectively reviewed medical records of 10 hospitals for pesticide poisoned patients and two forensic laboratories of Nepal from April 2017 to February 2020. The poison was identified from the history, referral note, and clinical toxidrome in the hospitals and from gas chromatography analysis in the laboratories. Data on demographics, poison, and patient outcome were recorded on a data collection sheet. Simple descriptive analysis was performed. Results: Among hospital cases (n ¼ 4148), the commonest form of poisoning was self-poisoning (95.8%) while occupation poisoning was rare (0.03%). Case fatality was 5.3% (n ¼ 62). Aluminum phosphide (n ¼ 38/62, 61.3%) was the most commonly identified lethal pesticide for deaths. Forensic toxicology laboratories reported 2535 deaths positive for pesticides, with the compounds most commonly identified being organophosphorus (OP) insecticides (n ¼ 1463/2535; 57.7%), phosphine gas (n ¼ 653/ 2535; 25.7%; both aluminum [11.8%] and zinc [0.4%] phosphide) and organochlorine insecticides (n ¼ 241/2535; 9.5%). The OP insecticide most commonly identified was dichlorvos (n ¼ 273/ 450, 60.6%). Conclusion:The data held in the routine hospital medical records were incomplete but suggested that case fatality in hospitals was relatively low. The pesticides identified as causing most deaths were dichlorvos and aluminum phosphide. Since this study was completed, dichlorvos has been banned and the most toxic formulation of aluminum phosphide removed from sale. Improving the medical record system and working with forensic toxicology laboratories will allow problematic HHPs to be identified and the effects of the bans in reducing deaths monitored.

The World Organization of Family Doctors (WONCA) is a not-for-profit organization and was founded in 1972 by member organizations in 18 countries. WONCA now has 118 Member Organizations in 131 countries and territories with a membership of about 500,000 family doctors and more than 90 percent of the world's population. WONCA has seven regions, each of which has its own regional Council and run their own regional activities including conferences. WONCA South Asia Region is constituted by the national academies and colleges and academic member organizations of this region namely India, Pakistan, Bangladesh, Nepal, Sri Lanka, Bhutan, and the Maldives. In the background of the ongoing COVID 19 pandemic, the office bearers, academic leaders, practitioners, and researchers of primary care from the South Asia Region have issued a solidarity statement articulating the role of primary care physicians.

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Introduction:  Diabetes is one of the major public health problems in Nepal. Very few studies on correlation between waist hip ratio and random blood sugar have been done in remote areas of Nepal particularly in minor ethnic groups like Thami. This study attempted to compare waist hip ratio and blood sugar level in Thami community of Nepal.Methods: This cross sectional study was conducted in sub-health post of Lapilang village of Dolakha district of Nepal. A total of 243 local inhabitants from Thami Tribe participated in the study. Waist hip ratio was calculated after taking measurements of waist and hip using flexible measuring tape; and, blood glucose level was measured by glucometer.Results: The mean age of the participants was 46.02 years; among participants 126(51.9%) were males and 117(48.1%) were females. Mean waist hip ratio was 0.87, mean blood sugar level was 124.5mg%.Increase in Waist hip ratio correlated significantly with increase in  random blood sugar level both in males(p=0.008) and females(p=0.007).Conclusions:  Increase in waist hip ratio is associated with increase in random blood sugar level. Therefore, there is a need of public awareness program to reduce waist circumference thus reducing weight of people to prevent development of diabetes mellitus in long run.Keywords: blood sugar level; diabetes; Thami community; waist hip ratio

in urban areas. In this circumstances, specialist GPs (MDGP) are effectively providing surgical services at district hospitals. This paper analyses one year data from Surkhet hospital, which is the rural training center of post graduate program in General Practice (MDGP). METHODOLOGYThis is retrospective study of all cases at district hospital, Surkhet, (25 beds) of western part of Nepal during the period of one year (March 2000 to February 2001, that were managed The curriculum of the post graduate program in General Practice in Nepal is designed to develop comprehensive and effective health care as well as timely life-saving surgical services in the District Hospital. District hospitals in rural Nepal encounter many surgical emergencies. Most of the times, the patient can not afford to go to higher centers. General Practitioners (GPs) are effectively providing surgical services at district hospitals. The aim of this study is to focus the types of surgical cases that were managed by GP and establish the role and utilization of General Practice (GP) specialist as a surgeon at district, zonal and regional hospitals in developing countries. This is retrospective study of all cases at district hospital, Surkhet, (25 beds) of western part of Nepal during the period of one year (March 2000 to February 2001), that were managed by GPs. The surgical services provided by GP specialist at the district hospital were analyzed. A total of 16,975 cases were attended in the hospital during above period. Out of this, a total of 2,327(13.7%) were hospitalized. The total numbers of surgical cases were 1,205(51.8%). Out of this, 514(42.7%) cases had undergone surgery. The general surgery cases comprise 447(87.0%), Gynae / Obstetric and Orthopedic cases 67(13.0%). All surgeries were performed in limited resources by GPs. GP specialist can effectively manage the surgical cases and perform surgery at the district hospital competently. In country like Nepal, where number of surgical specialist are less and not available in majority hospitals, GPs can substitute the surgical specialist and provide emergency surgical services in urban areas (zonal and regional hospitals).