The objective of this study was to assess the production and economics of potato in Achham district, Nepal. Sampling was conducted among the total of 90 registered farmers by simple random sampling method. The respondents were categorized into small and large scale farm holders based on the mean of the land holding under potato cultivation. The data were analyzed using SPSS, Stata and Microsoft excel. Cobb Douglas production function was used to find out the technological relationship between inputs used and output produced and to estimate and analyze the return to scale. The result of sociodemographic characters showed that the average household size, dependency ratio and area under potato cultivation was 7.53, 1.05 and 0.081 ha respectively. About 58% of respondents were growing potato in summer season. Human labor was the major input followed by seed, manure and bullock labor in both large and small farms. The production per household (kg), productivity (mt/ha) and price of yield (NRs. /kg) were 937.17, 12.287 and 30.33 respectively and there was significant difference in production (kg) per household between small scale farms (408.70) and large scale farms (1729.86). The total average cost, gross revenue and gross margin per hectare were estimated as NRs. 256,285.293, NRs. 373384.449 and NRs. 117099.156 respectively. The findings showed significant difference of variable cost between small and large scale farm which was due to the significant difference in use of inputs i.e. human and bullock labor mainly. Despite of adoption of improved potato production practices in most farms the average benefit cost ratio was 1.47. From the analysis of Cobb Douglas production function the inputs; human labor, seed and manure had positive relationship with income while bullock labor use had negative relation with the total income. The return to scale value was computed to be 1.033 indicating increasing return to scale in potato production in Achham district. Therefore, the findings suggest that, the production and income can be maximized if existing problems of irrigation, insect-pests, storage and marketing are solved and the inputs are made available in time and used properly. Keywords: Potato, Production, Cost, Economics, Production function

DOI: http://dx.doi.org/10.2126/joim.v35i1.8895 Journal of Institute of Medicine, April, 2013; 35:32-38

Bilateral clavicle fractures are uncommon and are mostly associated with polytrauma. The presence of concurrent serious injuries diverts the doctor's attention and causes the clavicular injury to be overlooked. Our report presents a 39-year-old male patient with bilateral clavicle fracture whom we managed surgically by open reduction and internal fixation.

Melioidosis, also called Whitmore's disease, is an infectious disease caused by the bacterium Burkholderia pseudomallei. It is predominantly a disease of tropical climates, especially in Southeast Asia and northern Australia. Due to a wide range of signs and symptoms that can be mistaken for other diseases such as tuberculosis or common forms of pneumonia, patients can be frequently misdiagnosed, which can have adverse consequences and can make management more complicated. This case report elaborates on the clinical course of a middleaged nondiabetic male patient who presented to our hospital with fever for two months and painful swelling of the right proximal leg for 10 days, following a previous diagnosis of disseminated abdominal tuberculosis made at a different healthcare center. Preliminary investigations confirmed multiple diagnoses of acute osteomyelitis and septic arthritis complicated by multiple hepatic and splenic abscesses. Given the patient was in a state of septic shock at the time of presentation, he was managed as an emergency case and an arthrotomy of the knee joint was performed followed by decompression and drainage of the right proximal tibia. As per standard hospital protocol, the pus and synovial fluid were sent for microbial culture and sensitivity, at which point B. pseudomallei was isolated and the diagnosis was confirmed. Diagnosis of melioidosis requires a high degree of suspicion among clinicians and microbiologists, especially in individuals that have frequent exposure to contaminated soil and water and have a travel history to endemic countries.

Osteochondroma, the most frequent benign bone tumor, develops in the metaphysis of long bones including the proximal humerus, tibia, and distal femur. The involvement of talus is found only in a few patients. Here, we present a case of osteochondroma of the talus in a 52‐year‐old woman who presented with ankle pain and edema.