SummaryNinety ASA 1 and 2 pregnant women with term singleton pregnancies and no maternal and fetal complications, scheduled for elective or emergency Caesarean section, were randomly allocated to group LT (15°left lateral table tilt, n = 45) and group MD (leftward manual displacement, n = 45). Subarachnoid block was established with a 25-gauge spinal needle at the L3-L4 interspace using 1.5 ml of 0.5% hyperbaric bupivacaine. A median sensory level of T6 was observed in both groups but the incidence of hypotension was markedly lower in group MD when compared to group LT (4.4% vs 40%; p < 0.001) with a significant reduction in mean (SD) ephedrine requirement (6 (0) vs 11.3 (4.9) mg; p < 0.001). The mean (SD) fall in systolic blood pressure was 28.8 (7.3) mmHg in group LT and 20 (12.7) mmHg in group MD. The time to maximum fall in systolic blood pressure was similar in both groups (4.5 min). We conclude that manual displacement of the uterus effectively reduces the incidence of hypotension and ephedrine requirements when compared to 15°left lateral table tilt in parturients undergoing Caesarean section. Supine hypotension that develops in pregnant women near term has been attributed to aortocaval compression by the enlarged gravid uterus, which decreases venous return to the heart. Use of subarachnoid block compounds the problem of hypotension in the supine parturient by causing vasodilation and venous pooling of blood in the lower limbs. The relative hypovolaemia caused by the combination of aortocaval compression and subarachnoid block may lead to placental insufficiency. The incidence of hypotension seems to be unexpectedly high despite preloading with crystalloids (47.4-83%) [1,2] or colloids (17-38%) [3,4] and the use of prophylactic vasoconstrictors (35-80%) [5].The universal practice of employing a 15°left lateral tilt using an obstetric wedge under the right hip [6] or tilting the table leftwards [7] might help to decrease the degree of aortocaval compression but does not guarantee its absence [8]. Maximum displacement of the uterus is best achieved by mechanical displacers. Hypotension was witnessed in only one out of the 300 patients by Colon-Morales [9] in his series. A similar magnitude of uterine displacement can be accomplished by the anaesthetist placing their right hand beneath the right costal margin to attain a maximum fundal push towards the left until the baby is delivered. Mechanical displacement of the gravid uterus seems to be a more logical and effective approach to managing hypotension as it helps in directly relieving the aortocaval compression by dislodging the gravid uterus. This study was therefore designed to evaluate the role of manual leftward uterine displacement in preventing hypotension for parturients undergoing lower segment Caesarean section (LSCS) under subarachnoid block. MethodsNinety pregnant women, ASA physical status 1 or 2, with full term singleton pregnancies and scheduled to undergo elective or emergency LSCS under subarachnoid block were included in the study followin...

Organic agriculture is a holistic food production management system, which results in sound agroecological health, combat climate change, enhanced biodiversity and soil biological activities. There is an increasing interest in organic production all over the globe. With certification, there adds the confidence in the marketplace. Nepal government has authorized an organization called Organic Certification Nepal (OCN), who offers internationally accredited inspection and certification services to local operators. There are many other international organizations like NAASA (Australia), ECOCERT (France), One Cert Asia (USA), IMO (Switzerland), Control Union (Netherlands), CertAlletc. are also active in Nepal, with their agents. There are a number of methods to certify if a product is organic or not organic. This paper is an effort to find out potentials and development of organic agriculture and certification for hilly areas. Organic Valley which comprises of five VDCs out of which two VDCs is in Kavrepalanchok district and three VDCs is in Lalitpur district was surveyed by various means to assess the status of organic agriculture and certification. Through interaction with farmers, it was found 81.61% people are aware of organic farming while 68.96% are not aware of the organic certification. The major organic crop exported from the valley is coffee. Presently Internal Control System (ICS) found applicable for the certification of coffee. There is more scope of parallel cultivations in the valley, and that can be certified by using Participatory Guaranteed System (PGS). Organic farming is must since it improves environmental and human health, export possibilities and market place, discourage toxic chemical near human settlement, provide job space to youth and enhanced lifestyle.

Water in Nepal is a key strategic natural resource, which has potential to leads all round development and economic growth of the country. Integrated Water Resource Management (IWRM) is a holistic management approach, integrating land water interaction, socio-economic groups, upstream downstream relations, indigenous knowledge, and institutions built up, along the temporal dimensions based on an agreed set of principles. It is a Bottom-up decentralized approach for the management of water resources. IWRM is a challenge to conventional practices, attitudes and professional certainties. It confronts entrenched sectoral interest and requires that the water resources are managed holistically for the benefits of all.The broad objective of the multidisciplinary study was to assess the possibilities of human dimensions of water resource development and its management. Water resource accounting is done by the collection of water resources data through participatory group formation. Scientific data of hydro and metrological stations was also acquired. Hydrological modeling tools were also used. Feasibility of hydropower plant and potential of power production in the basin was readily estimated.Total daily discharge of the Durlung Watershed was estimated on an average as 157 Million Liters. Rivers of the watershed are turbulent, unsteady and flowing with very high current, which can be utilized by local people for low cost drinking water, tourism, irrigation and hydropower generation. Micro-hydropower production possibilities in Ratan and Deuta River has shown multidimensional positive impacts on socio-economic development of the region level of community partnership in IWRM and synchronization with the Local, District and National level institutional framework for Basin Management was observed to be satisfactory. Participatory research was carried out to identify water resource base with school and community partnership. Community motive, their difficulties and gaps in community level organization were identified. Capabilities of community, to take over the responsibilities of IWRM concept, there is a lot more need of training and capacity building for now.

Limited understandings of the impacts of climate change and lack of local research have proven to be major challenges for the Nepalese agricultural sector. A study was carried out in Latikoili VDC of Surkhet district aiming to identify impacts of climate change, examine people's perception, and assess existing adaptation measures practiced on agriculture. Qualitative and quantitative analysis was done to the data collected from primary and secondary sources. The climatic data revealed; the trend of temperature has increased and rainfall has substantially decreased over past 29 years. The results showed most of the respondents perceived change in climate and farming system such as delay of monsoon, erratic rainfall pattern, increased temperature resulting drought associated with decrease in water sources, shifting cultivation, planting and flowering time. The adaptation measures such as adapting improved seed varieties with change in planting time, IPM practices, and plastic pond to store waste water have been practiced to combat climate change. Sharing information and raising awareness among people can be done to enhance livelihood.