Connecting to the disaster risk reduction (DRR) studies, community-based initiatives are found to be more effective in both developed and developing countries, with a specific focus on the empowerment of local communities to build resilience. Building on social capital theory, the paper investigates on local knowledge (LK) practices experienced by the actors in an emerging economy using the community-based flood risk management (CB-FRM) approach. The qualitative research method was used by collecting data from focused group discussions, and interviews with the key informants including actors from local governments and non-government organizations. Additionally, informal discussions, field visits, and desk studies were undertaken to support the findings. The findings reveal that the local communities carry out various local knowledge experiences to respond during disaster management phases. They own a creative set of approaches based on the LK and that empowers them to live in the flood-prone areas, accepting the paradigm shift from fighting with floods to living with that. The local actor's involvement is recognized as an essential component for CB-FRM activities. Yet, their program's implementation is more oriented towards humanitarian assistance in emergency responses. Even, they often overlook the role of LK. Additionally, the results show a high level of presence of local communities during the preparedness and recovery phases, while NGOs and local governments have a medium role in preparedness and low in recovery phase. The lack of local ownership has also emerged as the major challenge. The research provides valuable insights for integrated CB-FRM policies by adopting to LK practices.

Background and Aims: Chronic pancreatitis is a condition characterized by chronic inflammatory and fibrotic changes in the pancreas leading to irreversible parenchymal damage and loss of glandular function. This retrospective study was conducted to study the clinic-epidemiologic profile of chronic pancreatitis in eastern Nepal. Methods: All adult patients admitted with chronic pancreatitis from June 2014 to June 2016 were included in this study. Data pertaining to demographics and clinical profile was obtained by retrospective chart review. Results: A total of (n=55) patients were enrolled in the study with a median age of 28 years. Idiopathic pancreatitis was the most common form of chronic pancreatitis (n= 37, 67.3%) and alcoholic chronic pancreatitis accounted for about a third of cases (n=18, 32.7%). Abdominal pain was a presenting symptom in all the cases (n=55,100%). Thirty-seven patients (67.3%) had diabetes mellitus. Ductal dilatation (n=55,100%) and calculi (n=43, 83.6%) were the most common findings on imaging using ultrasonography and Computed tomographic scan of abdomen). All the patients were receiving medical therapy. Most patients receiving medical therapy were on opioids (n=37, 67.3%) or pancreatic supplements (n=18, 32.7%). Complications were seen in only nine patients (16.4%). All of them had pseudocyst. Conclusions: In this study, idiopathic chronic pancreatitis (CP) was observed as the most common etiologic form of CP unlike CP related to alcohol use in other similar studies. CP related to alcohol use was seen as the second most common etiologic form. Diabetes was the most commonly associated comorbidity in our CP cohort. This study was performed in a small study population and is limited by several factors including statistical power. Larger studies are warranted to study the etiologic forms and outcomes of CP in Nepalese population.

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BackgroundHepatorenal Syndrome (HRS) is a serious complication of liver cirrhosis with critically poor prognosis with treatment currently based on vasopressors. We aimed to study the safety and effects of Intravenous Noradrenaline in patients with Type 1 HRS and also to define factors predictive of a response. Materials and MethodsIt was a prospective observational study conducted in a tertiary care hospital in Eastern Nepal enrolling patients withType 1 HRSfrom 2014 to 2015. All patients received Noradrenaline (0.5-3 mg/hr, intravenously) and albumin (1 g/kg followed by 20-40 g/day). Primary outcome was improvement of renal function. Results 60 Type 1 HRS patients were enrolled in the study -37 males (61.7%) and 23 females (38.3%), mean age 58.18±9.33 years. The therapy was well tolerated as only 6.7% of patients withdrew treatment. Reversal of HRS was observed in 38 patients (63.3%) with the mean duration of 6.39±1.33 days. Of the baseline variables, higher urine output, higher mean arterial pressure and lower serum creatininewere predictive of response. Multivariate analysis showed Mean arterial pressure to be an independent variable of response (adjusted odds ratio 0.588, 95% CI-0.393-0.880, P>0.05). Finally mean arterial pressure had a negative correlation with serum creatinine and a positive correlation with Urine output. Conclusion Noradrenaline and albumin are safe and effective in improving renal function in patients with Type 1 HRS.There is a need for studies with larger sample size to correlate improvement in renal function with overall survival.

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