Introduction: Acute appendicitis is one of the most common acute surgical abdominal conditions requiring surgery. Ever since the inflamed appendix was demonstrated in the 1980’s by Ultrasonography, it has been used as an aid to clinically diagnose acute appendicitis. Tzanakis scoring system is a combination of clinical examination, Ultrasonography and inflammatory markers. Methods: A retrospective non-randomized observational study was conducted from April 2014 to March 2015 on all cases of acute appendicitis, which underwent preoperative ultrasound before appendectomy (open/laparoscopic) at the Department of surgery, Nepal Medical College Teaching Hospital. Ultrasound findings and Tzanaki score were compared in the cases. No studies could be found in literature comparing ultrasound diagnosis with Tzanaki score in appendicitis. Results: The sensitivity, specificity, positive predictive value and negative predictive value of ultrasound were 73%, 50%, 95% and 12% respectively. The sensitivity, specificity, positive predictive value and negative predictive value of Tzanaki were 87%, 50%, 96% and 23% respectively. Tzanaki score is better than ultrasound alone as a diagnostic test for acute appendicitis. Conclusion: Tzanaki score is better than ultrasound in diagnosis of acute appendicitis.
Rapid growth of environmental problems, economic volatilities, and social changes have increased the scopes of adopting environmentally friendly and resilient production systems. Regenerative farming and forestry practices are such systems appropriate for mountain communities in Nepal. They had performed better with indigenous resources, institutions, and social-ecological systems. Unfortunately, the assets have been degraded to extinction, mainly commencing works of national and international development agencies. Consequently, regenerative practices are disappearing. Despite appeals and commitments, the degradations of the assets are not halted and reversed. This study used secondary sources of data and work experiences and explained the working faults of the external agencies involved in the agriculture, forest, and wildlife sectors. It elucidated that most regenerative practices had sustained well in forest and farm resource-integrated production systems and a modest degree of natural and human inputs and production environments. The production environments degraded when the government agencies provided foreign agencies opportunities to be involved actively in policy formulation and implementation of agriculture and forestry-related sectors. The foreign agencies meddled in the national policies and community practices and modified the production environments for their interests and benefits. They intervened in policies and local communities to practice a farming system based on extremely human-made and imported inputs and institutions and to manage forest-related resources in extremely intact natural systems. In the policy discourses and decisions, the farming inputs, practices, and institutions popularly practiced in developed countries are considered superior whereas the indigenous ones are considered inferior. Agricultural plans and policies have overvalued yield, profit, or other direct returns and undervalued environmental friendliness, indirect economic benefits, and social advantages to prioritize support of the government and other agencies. The introduced farming inputs and institutions displaced or hampered the indigenous ones. The foreign agencies also meddled in forest policies and practices of the country to address environmental and economic problems of developed countries which resulted in adverse impacts on the indigenous assets. They intervened in the resource management policies with financial and technical inputs to destroy some of the assets and make the forest-related resource management that results in better benefits (offsetting GHG emission, enhancing tranquility and serenity of recreational sites, and potentially expanding agricultural markets) to the people of developed countries. This study has explained how the officials and experts of both government and foreign agencies abused and misused some strategic tactics and overused, poorly used and disused, others in their work process to address their self-centered interests and problems. In essence, intentional destructive interventions of the policy and development agencies have resulted in degradation to the extinction of the indigenous assets in the communities.
Many measures of international policies and support have dictated developing countries to upscale land areas of intact forestry, special biodiversity conservation site, and other wild reserves to half the land territory of the nation by 2050 for resulting environmental, and other benefits to global societies. The international initiations and work urged scholars to assess the potential impacts of the aggressive policy on forest-based communities and especially those living in institutionally and geo ecologically vulnerable areas. This study compiled the impacts of such international policy interventions on diverse affairs of the local community and national economies in Nepal and drew some conclusions on the well-being future of such forest-based communities. It explained that the international interventions in managing community-based resources induced serious disturbances in many local systems and resulted in vicious circles of emigration, income losses, social problems, psychological stresses, and food insecurities. The interventions have placed some communities and especially endogenous ethnic groups in the position either to be displaced from their ancestors’ homelands or suffer for generations. This study also explained some reinforcing phenomena that emerged from the external interventions which have placed situations of the resource impacting local communities adversely for years. It also investigated whether support of international agencies in policy formation and implementation for resource management safeguards the well-being of the resource-based communities. The agencies resulted in the best environmental and other benefits to foreign societies which have aggravated the misery of local communities, particularly the poor people, women, and indigenous ethnic communities. The adverse impacts on the societies are not repercussions (accidentally or unknowingly happened). All these findings infer that the international policies of upscaling forests and wilderness areas or making conservation areas in half of their land territory, especially in developing societies for the global benefit, may place the lives of the forest-based communities in peril of suffering for generations or extirpating.
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