Background and Aims: Incidence of ST-elevation myocardial infarction (STEMI) is increasing in Nepal. We aim to describe the presentation, management, complications, and outcomes of patients admitted with a diagnosis of STEMI in Shahid Gangalal National Heart Centre (SGNHC), Nepal. Methods: Shahid Gangalal National Heart Centre-ST-elevation registry (SGNHC-STEMI) registry was a cross sectional, observational, registry. All the patients who were admitted with the diagnosis of STEMI from January 2018 to December 2018 were included. Results: In this registry, 1460 patients out of 1486 patients who attended emergency were included. The mean age of patients was 60.8±13.4 years (range: 20 years to 98 years) with 70.3% male patients. Most of the patients (83.2%) were referred from other hospitals and 16.8% of patients directly attended the SGNHC emergency. During the presentation, smoking (54%) was the most common risk factor, followed by hypertension (36.6%), diabetes mellitus (25.3%), and dyslipidemia (7.8%). After admission, new cases of dyslipidemia, HTN, Impaired Fasting Glucose (IFG), and Type 2 DM were diagnosed in 682 (51.3%), 182 (20.1%), 148 (10.3%) and 95 (8.9%) respectively. At the time of presentation, 73.3% were in Killip class I and 26.3% were above Killip class II with 5.1% in cardiogenic shock. Thirty-one percent of the cases received reperfusion therapy (Primary percutaneous intervention in 25.2% and fibrinolysis in 5.8%). Inferior wall MI was the most common type of STEMI. Among the patients who underwent invasive therapy, the multi-vessel disease was noted in 46.2% cases and left main coronary artery involvement in 0.7% cases. In-hospital mortality was 6.2% with cardiogenic shock being the most common cause. Aspirin (97.8%), clopidogrel (96.2%), statin (96.4%), ACEI/ARB (76.8%) and beta-blocker (76.8%) were prescribed during discharge. Conclusion: The SGNHC-STEMI registry provides valuable information on the overall aspect of STEMI in Nepal. In general, the SGNHC-STEMI registry findings are consistent with other international data.

Background and Aims: Diabetic patients are at increased risk of developing coronary artery disease. This study was conducted with the aim to compare the extent and severity of coronary artery disease in patients with and without diabetes presenting with non ST segment elevation myocardial infarction (NSTEMI). Methods: This was a single center, hospital based, cross sectional, observational comparative study in which total 172 patients presenting with NSTEMI were divided into two groups of 86 patients each based on presence or absence of diabetes mellitus. Demographic, laboratory and angiographic data were analysed and compared between two groups. Results: Among 86 patients enrolled in each group demographic characteristics and risk profile were not significantly different except for smoking status. Significant number of non-diabetics were current smoker (26.7% vs. 9.3%; p < 0.01). Hypertension was the most common risk factor in both groups. Non-diabetic patients had significantly high single vessel disease when compared to diabetics (11.6% vs 24.4%; p=0.03) while multivessel disease was significantly higher among diabetics (80.2% vs 59.3%; p<0.01). Diabetics had severe coronary artery disease with significantly high Gensini score (71.18±39.03 vs 59.84±33.68; p=0.04). There was no difference in terms of type of vessel affected. Conclusions: Diabetic patients presenting with NSTEMI are likely to have more severe and extensive coronary artery disease compared to non-diabetic patients.

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The agriculture sector has been facing challenges due to climate change particularly increasing global water scarcity which threatens irrigated low land rice production. Alternate Wetting and drying (AWD) is a water management system where rice fields are not continuously submerged and the fields are allowed to dry intermittently during the rice-growing period. AWD technique is a necessity for modern farming of rice as it is profitable over the continuous flooding irrigation system which prevents the wastage of scarce and vital water resources, irrigation cost and protects the environment from degradation. It also protects human health from diseases like Malaria as there is an absence of continuous flooding for the mosquito to lay eggs. It helps to enhance food security by increasing the production, nutrient content, and minimizing the toxic elements in rice. However, if this technique is not done properly in the field from time to time, we can also get negative impacts. It varies according to soil condition, irrigation timing, environment, etc.

Background and Objectives: Possible reasons for different factors and presentations in depression may be sex related Methods: A total of 100 (53 female and 47 male) depression cases (as per the ICD-10 DCR) who came to the out-patient clinic and admitted to the ward of department of Psychiatry of a teaching hospital in eastern Nepal were enrolled after obtaining informed consent during the study period. Patients with severe physical co-morbidity, mental retardation making unable to participate and the age younger than 18 and older than 65 years were excluded. Socio-demographic information, clinical profile and co-morbidities were recorded. Three scales: Hamilton Rating Scale for Depression (HAM-D), Social Readjustment Scale by Holmes and Rahe and Eysenck's Personality Inventory were used to see the severity of depression, the life events and the personality traits respectively. Chi-square test was applied to find out the difference between the genders in different variables. Results: Most of the depressive patients were of age 18-50, with most males educated and females educated to middle level. Source of income for majority of females (45%) was family-income and for males (21%) their own income (p= 0.000). More females had family history of depression, suicide and other psychiatric co-morbidities. More females presented with changes in biorhythm including libido and suicide attempt. Males presented more with mood, physical and behavioral changes. More females had co-morbidity of Anxiety, Migraine and substance use disorder. Prevalence of stressor was similar among males and females though the nature and type varied.This is a hospital based descriptive study conducted among the patients with primary diagnosis of clinical depression coming in psychiatric service of BPKIHS, a multi-specialty teaching hospital in eastern Nepal within 1 year of study period.Out of the life events, value of pregnancy (p= 0.014) and trouble with in-laws (p= 0.000) were more in female; and that of losing spouse (p= 0.408), and sex difficulty (p= 0.044) more in male patients with depression. More male patients were found extroverted and neurotic and female patients socially desirable (p= 0.001). Conclusion: Gender differences are seen in depression cases in bio-psycho-social factors. Identification of particular factorsguides management of all levels in general and in particular in female and male patients.

Background and Aims: ACEF score is simple risk score which uses only three parameters for predicting mortality and postcontrast acute kidney injury (PC-AKI). This study was designed to look into various risk factors and ACEF score for patients undergoing Percutaneous Coronary Intervention (PCI). Methods: This is single-centre, observational, cross-sectional study. The patients were divided into tertiles.Bivariate analysis of various risk factors and ACEF score was done for PC-AKI as well as In-hospital and 30-day mortality. Results: Total 257 patients were included.The total mortality among PCI patients were low: In-hospital (0.8%) and 30-day (1.9%). The risk factor for increased mortality were higher Killip class and reduced Ejection Fraction (EF). PCAKI occurred in one-fifth. The risk factors for PC-AKI were increasing age, higher Killip class, diabetes, reduced EF, emergency PCI procedure and higher contrast volume. Hydration with NS was protective against PC-AKI. Mean ACEF score was higher among those who died within 30 days (p=0.35) and who developed PC-AKI (p<0.001). ACEF-low had trend toward better outcome with no mortality (p=0.17) and had low risk of PC-AKI (p=0.026). ACEF-moderate had reduced risk of PC-AKI (p=0.029), however was not associated with increased odds of 30-day mortality (p=0.66). ACEF-high showed significantly increased odds of mortality (p=0.04) and PC-AKI (p<0.001). Discriminatory capacity of ACEF score to detect 30-day mortality was good (AUC 0.82, p= 0.016) and goodness of fit=0.70. Discriminatory capacity of ACEF score to detect PC-AKI was fair (AUC 0.7, p<0.001) and goodness of fit=0.62. Conclusions: ACEF score fairly predicts the short-term mortality and PC-AKI in patients undergoing PCI.

Background and Aims: Among the various biomarkers, high sensitivity C-Reactive Protein (hs-CRP) has been widely studied and is easy to use in the prognostication of patients with acute ST elevation myocardial infarction (STEMI). This study aimed to associate serum level of hs-CRP with in-hospital mortality in patients presented with acute STEMI. Methods: This was a hospital-based prospective observational study conducted in Shahid Gangalal National Heart Centre among patients presented to the emergency department with chest pain of less than 24 hours duration, who were diagnosed subsequently to have STEMI. Patients who had known chronic inflammatory diseases, septic foci and chest pain of over 24 hours were excluded from the study. Blood sample for Hs-CRP was sent from the emergency department and was measured with Finecare TM FIA system; Model number: FS-112. The study was conducted from April 2019 to March 2020. Patient outcomes were stratified as per the four groups of serum level of hs-CRP and among them the relationship between mortality and hs-CRP level was tested with chi-square test. The p-value across the groups was again tested for inter-group significance using the Bonferroni adjusted significance level. Results: 140 patients (112 males and 28 females) with mean age of 58.1±14.86 years were enrolled in the study. There was no increased in-hospital mortality in acute STEMI patients who had serum level of hs-CRP below 3 mg/l. In-hospital mortality showed an increasing trend above this level but it reached statistical significance beyond 10 mg/l only. Thirty five percent of our patients of acute STEMI were found to have serum level of hs-CRP above this threshold. The total in-hospital mortality was 13 (9.28%). Conclusion: The increased serum level of hs-CRP was associated with increased in-hospital mortality in patients with acute STEMI.

Climate change has caused serious effect on agriculture production. The global population is increasing and to meet their demand for fuel, food, and fiber, Farmer should adopt sustainable agriculture practices which provides resilience to climate change and uplifts the farmers’ livelihood. Climate-smart agriculture practices are taken as eco-friendly practices that help to enhance production sustainably with minimum effect on resources and environments. These practices include No-tillage, reduced tillage, Intercropping, integrated pest management, Rainwater harvesting, use of information and communication technology, etc. As women are an integral part of agriculture production and are more vulnerable to climate change, the Gender-responsive approach needs to be addressed which helps to close the gender gap in agriculture. Nepal, as a vulnerable country in terms of climate change, is adopting different programs and policies at the national and local level to tackle climate change. Climate-smart villages(CSV) in Nepal are practicing different CSA practices at the farm level to secure foods and livelihoods.