Journal of Lumbini Medical College (JLMC)
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Antenatal to Postnatal: Assessing the Continuum of Maternal Health Service Utilization in Palpa, Nepal.
Get PDFIntroduction: One of the most prioritized programs of Government of Nepal is maternal health. Optimum utilization of maternal health services during pregnancy, delivery and post-natal period is an effective approache to reduce the maternal morbidity and mortality that helps us achieve the sustainable development goals target. This study aimed to assess the utilization of maternal health services including antenatal, intranatal and postnatal services among women in the Palpa district of Nepal. Methods: A descriptive cross-sectional study was conducted among 168 mothers in their reproductive age using a convenient sampling method. The study included those mothers who had a delivered a child in the past two years, in Palpa district. The data collection commenced from March to September 2023. The data analysis was conducted using Statistical Package for Social Sciences software (v 21.0). Results: A remarkable finding in the present study was 88.1% of mothers had utilized a minimum of four antenatal check-ups, as recommended by the Government of Nepal. Out of 168 mothers included in the present study 89.9% had institutional delivery while the remainder had home delivery. Post-natal check-ups following delivery was surprisingly uncommon as it was observed that only 28% mothers sought such care. Adequate utilization of maternal health services is influenced by factors such as proximity of health facilities, education level, and knowledge of maternal incentives. Conclusion: While service utilization for pregnancy and delivery in Palpa district aligns with national standard, further research is needed to identify factors contributing to underutilization of postnatal services
Study of Neck Circumference as a New Anthropometric Indicator for Prediction of Diabetes Mellitus
Get PDFIntroduction: Overweight and obesity are the risk factors for metabolic syndrome. This study aimed to show that neck circumference is a simple tool to identify the overweight and obesity as a new anthropometric index and association with type 2 diabetes. Methods: This was a cross-sectional study with a total of 246 participants, 123 of whom had diabetes mellitus, and the same numbers were non-diabetics, adjusted for weight and height in both groups. Means with standard deviation were used for neck and waist circumferences, body mass index, and blood sugar, and the Pearson correlation test was applied to identify the association. A comparison of means was done by the student ‘t\u27 test in parametric data within the two groups. Results: The mean neck circumference, body mass index of diabetes and non-diabetes participants were 38.0±3.0 cm, 28.5±2.6 and 36.6±3.2 kg/m2, 27.4±3.1 kg/m2 respectively. In diabetic patients, mean neck and waist circumference, blood sugar were higher than in nondiabetic patients and was significantly correlated with body mass index (r=0.747, p<0.001), waist circumference (r=0.635, p<0.001), systolic and diastolic blood pressure (r=0.740, p<0.001 and r=0.619, p<0.001 respectively), fasting and post prandial blood sugar (r=0.275, p=0.002 and r=0.307, p<0.001respectively) and glycated hemoglobin (r=0.220, p=0.014, n=123). In nondiabetic patients, glycated hemoglobin was negatively correlated. Conclusion: This study suggested that neck circumference is a simple, reliable, and appropriate new anthropometric tool to evaluate obesity, overweight, and the risk of metabolic disorders. 
Drug Utilization Pattern for Conjunctivitis in a Tertiary Care Hospital
Get PDFIntroduction: Assessment of drug utilization pattern of conjunctivitis is an important activity that promotes the rationale use of drugs. Thus, the aim of the study is to understand the drug use pattern for conjunctivitis in a tertiary care hospital. Methods: A cross-sectional observational study was conducted in the out-patient department of Ophthalmology of Nobel Medical College Teaching Hospital from October 2021 to September 2022. Patients diagnosed with conjunctivitis irrespective of age and gender were included in the study. A structured proforma was designed that contained the demographic profile of participants, types of conjunctivitis and different drugs used in conjunctivitis. Data were expressed in frequency and percentage. Results: A total of 385 patients were enrolled in the study. Conjunctivitis was more common in male (55.8%). Viral conjunctivitis was the most common (49.8%). A total of 745 drugs were used. Average number of drugs per prescription was 1.9. The most commonly prescribed drugs were topical antibiotics (40.9%) followed by tear drops (27.5%). Ciprofloxacin (36.1%) was the most commonly prescribed topical antibiotic. Conclusions: Topical antibiotics were commonly used in most cases of conjunctivitis. Among topical antibiotics, ciprofloxacin was commonly prescribed
A Students’ Perception in Learning Human Anatomy Towards Dissection or Prosection
No full textIntroduction: Cadaveric dissection has been used as a traditional method of teaching and learning for many years. With time, changes in the medical curriculum have reduced the time for anatomy learning and seeking alternative methodologies moving away from traditional learning. With the introduction of new methodology and technology, the question arises whether it is still effective enough to follow the old traditional mode of teaching and learning. With ever-changing medical education, it is important to recognize students\u27 perceptive and attitudes toward learning different methods. Therefore, this study aimed to determine students’ perception towards prosection and dissection in learning anatomy. Methods: The first-year medical students were included in the study. The study was carried out after a series of lectures as per the curriculum. The students were divided into four groups. Each group dissected the cadaver followed by observation of the prosected cadaver explained by the faculty. Questionnaires were prepared related to dissection and prosection and sent to the students using google form. The students\u27 perception towards dissection and prosection was recorded. The results were tabulated and subjected to statistical analysis. The percentage of students opting for dissection and prosection was calculated. Results: The majority of students (82.5%) preferred dissection over prosection, 2.6% opted for prosection over dissection and 14.9% were still not sure which method of teaching and learning is favorable. Conclusion: The study reflected the traditional method of dissection was more favorable to students while alternative methods can also provide better insight to learning
Antihypertensive Drug Use Pattern in a Tertiary Care Hospital of Western Region of Nepal: A Cross-Sectional Study
Get PDFIntroduction: Assessing antihypertensive drug use pattern always plays an important role to mitigate the burden of hypertension and also helps doctors to prescribe the drugs rationally. This study was conducted to assess antihypertensive drug use pattern in a tertiary care hospital. Methods: An observational cross-sectional study was conducted in the Internal Medicine department of Lumbini Medical College and Teaching Hospital from July 2021 to December 2021 for the duration of five months after ethics approval. Hypertensive patients who were prescribed one or more antihypertensive drugs irrespective of age and gender were included. Socio-demographic profiles, clinical characteristics, and antihypertensive drug use-related data were collected. A convenience sampling technique was used. Categorical variables were expressed as frequency and percentage while continuous variables were reported as mean ± standard deviation. Results: A total of 224 patients were included. The average number of antihypertensive drugs per patient was 1.7 ± 0.8. Combination drug therapy (54.5%) was commonly used. Calcium channel blockers (Amlodipine) were commonly prescribed (66.5%). Moreover, 98.7% and 41.5% patients were prescribed drugs from Essential Drug List of Nepal (Revised 2016) and in Fixed Dose Combination respectively. Use of combination drug therapy was higher among male patients (p = 0.003) and patients with stage II hypertension (p < 0.001). Conclusion: Calcium channel blockers were commonly used as monotherapy and in combination therapy as well. In approximately all of the patients, antihypertensive drugs were used from the essential drug list of Nepal which is an essential component of rational use of medicine
Risk Factors Associated with Frozen Shoulder among Nepalese Population: A Hospital-based Comparative Study
Get PDFIntroduction: Frozen shoulder is one of the common musculoskeletal disorders characterized by pain and restriction of motion of the shoulder joint. It is also considered a common self-limiting regional skeletal problem. This study aimed to evaluate related risk factors for frozen shoulders. Methods: This was a hospital-based comparative study involving 60 patients with a diagnosed frozen shoulder in the out-patient department as cases and 60 patients hospitalized during the same period with non-shoulder-related complaints as controls. A face-to-face interview was taken. Univariate and multivariate logistic regression analyses were performed. Results: A total of 120 consecutive subjects (60 patients with frozen shoulders and 60 controls) were taken. The mean age of cases was 54.7±3.21 years and that of controls was 42.08±2.74 years. Among the frozen shoulder patients, 33.3% had diabetes and 15% had a history of thyroid disorder. Multivariate logistic regression analysis showed age, diabetes mellitus, and thyroid dysfunction as independent risk factors for frozen shoulder (p<0.05). The frozen shoulder patients also had a higher prevalence of cardiac diseases and cervical spondylosis than the controls. No significant difference was found in body mass index, cholecystitis, history of surgical intervention, and uric acid level between the frozen shoulder group and the control group. Conclusions: The study findings indicated that diabetes, thyroid disease, and advanced age have been significantly associated with increased frozen shoulders
Burden Imposed by Diabetes Mellitus on Elderly Patients Visiting a Teaching Hospital: A Cross-sectional Study
Get PDFIntroduction: Diabetes Mellitus, a chronic metabolic disorder, has become an alarmingly major health issue worldwide. This study aimed to assess the burden imposed by diabetes mellitus on elderly patients visiting Lumbini Medical College and Teaching Hospital. Methods: A descriptive cross-sectional study was conducted purposively among 178 diabetic elderly patients visiting medicine out-patient department of Lumbini Medical College. The Elderly Diabetes Burden Scale was used to assess the burden imposed by diabetes. Results: The mean (SD) age of the participants was 67.38 (6.92) years, more than half (52.2%) were male, 46.6% were Janajati and 77.5% were from Palpa district. Most (84.3%) had diabetes for duration of one to 10 years, 45.6% had normal body mass index, 47.2% had good glycemic control (HbA1C <7%), and 74.2% were on oral hypo-glycemic agents. Dietary restrictions (10.32±2.97) and worry about diabetes (10.30±2.85) had imposed high burden level and burden by tablets/insulin (7.02±2.12) as lower burden amongst the six domains. Age, education and body mass index were found to be statistically significant with the treatment dissatisfaction domain (p=<0.001). Likewise, duration of diabetes (p=<0.001) was statistically significant with burden by tablets/insulin and symptom burden domain. Conclusion: Dietary restrictions and worry about diabetes were found to have dominant burden whereas, burden by tablets or insulin was the least. Duration of diabetes and body mass index were found to have association with the overall burden. Likewise, age, education and body mass index had high influence on the perceived burden due to treatment dissatisfaction
Peripheral Neuropathy and Foot Care Practices Among Patients with Diabetes Mellitus Attending a Tertiary Care Hospital: A Cross-sectional Study
Get PDFIntroduction: Peripheral neuropathy is the most common microvascular complication of diabetes mellitus. Foot care is an important part of diabetes management. This study aimed to identify the prevalence of peripheral neuropathy and foot care practices among diabetic patients. Methods: A descriptive cross-sectional study was conducted on 178 patients diagnosed with diabetes mellitus and attending out-patient and in-patient departments of Internal Medicine at Kathmandu University Hospital, Dhulikhel. The participants were conveniently selected. Face-to-face interviews and a foot examination were used to collect data. The Michigan Neuropathy Screening Instrument and the Nottingham Assessment of Functional Foot Care were used to determine the prevalence of peripheral neuropathy and to assess foot care practices. Results: The prevalence of peripheral neuropathy was 41% among the participants, and it was associated with increasing age. The majority (75.8%) of the participants had good foot care practices. Male gender was significantly associated with good foot care practices [AOR = 5.973, 95% CI (2.037-17.515)], whereas past smokers [AOR = 0.296, 95% CI (0.111-0.791)] and not receiving diabetes education [AOR = 0.367, 95% CI (0.151-0.892)] were significantly associated with poor foot care practices. Conclusion: The prevalence of peripheral neuropathy was found to be high, and it was linked to an increased age group. The majority of the participants had good foot care practices. However, in comparison, females were found less likely to practice foot care than males
Prevalence of Abnormal PAP Smear in Pregnancy: A Hospital-Based Study in Western Nepal
Get PDFIntroduction: Cervical carcinoma is the third most common malignancy worldwide. The World Health Organization in 2014 reported the crude incidence rate of cervical cancer in Nepal as 24.2 per 100,000 women per year. This study was carried out with the aim of finding out the prevalence of cervical smear abnormality in pregnancy. Methods: An observational study was conducted in the department of Obstetrics and Gynecology of a tertiary center for a period of one year from May 2021 to April 2022. All pregnant women up to 28 weeks of gestation who had National Health Insurance coming for antenatal check-ups underwent PAP smear test. The cytological results were reported based on the Bethesda classification system 2001. Results: Of 200 pregnant women enrolled in the study, the Pap smear report revealed that 32% of the study subjects had inflammatory smear showing candidiasis and bacterial vaginosis with reactive inflammatory changes. However, 66.5% of the subjects showed negative for intraepithelial lesion or malignancy and only 0.5% of subjects had signs related to carcinoma cervix in which the subject had a low-grade squamous intraepithelial lesion. No satisfactory sample was reported in 1% of the subjects. Conclusion: Pap smear during pregnancy not only gives the opportunity to screen but also helps to create awareness
Evaluation of Intra-operative and Post-operative Complications of Non Descent Vaginal Hysterectomy: A Single-center Hospital-based Prospective Study
Get PDFIntroduction: Globally, hysterectomy is the most common major gynecological procedure. Patients opting for hysterectomy for benign non-prolapse cases may be offered non-descent vaginal hysterectomy with quicker recovery, shorter hospital stay, and less intra- and post-operative morbidity compared to the abdominal route. Vaginal approach for hysterectomy is desirable in Nepal due to limited health resources. This study aimed to evaluate the intra- and post-operative complications of non-descent vaginal hysterectomy (NDVH). Methods: A prospective study was conducted at College of Medical Sciences over one-year period. A total of 50 cases were selected for NDVH on the basis of inclusion and exclusion criteria. Data regarding age, parity, uterine size, estimated blood loss, length of operation, complication and hospital stay were recorded. Results: The majority of women were in the age group of 41-45 years (mean age: 44.7±5.6 years) and multiparous (38%). The common indications for NDVH were fibroid uterus (66%) and adenomyosis (14%). The mean volume of blood loss was 121.5ml±110.94 and 3% required blood transfusion. The mean drop in hemoglobin level was statistically significant post surgery [1.05gm/dl]. The mean surgical time was 69.54±19.32 minutes. In the post-operative period, 10% women had UTI and 2% had fever. The mean duration of hospital stay was 4.06±0.24 days. Conclusion: Non-descent vaginal hysterectomy is a major surgery suitable in low-and middle income countries like Nepal with good outcomes and low complication rates.