Journal of Lumbini Medical College (JLMC)
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Endoscopic Transcanal Type I Cartilage Tympanoplasty for Anterior Perforation of Tympanic Membrane: A Cross-sectional Study
Get PDFIntroduction: Repair of anterior perforation of the tympanic membrane is difficult mainly due to inadequate exposure, minimal tympanic membrane remnant, impaired vascular supply, and delayed healing. Methods: This analytical cross-sectional study was done in a tertiary center over a period of 12 months from 25 April 2021 to 24 April 2022. There were 47 patients who underwent endoscopic transcanal type I cartilage tympanoplasty for anterior perforation. All operations were performed using an underlay technique and by transcanal approach. In all the cases, perichondrium with tragal cartilage was used as a graft for the reconstruction of the tympanic membrane. The evaluation was done after three months post-operatively in terms of graft uptake and post-operative hearing status. Results: The overall graft uptake success rate after three months post-operatively was 89.4%. The pre-operative mean pure-tone average was 34.72 ± 6.45 dB, (range 17 dB to 43 dB). The mean postoperative pure-tone average was 22.09 dB ± 9.30 (range 10 to 41 dB). The mean difference between the preoperative pure tone average and the postoperative pure tone average was 12.63 dB ± 8.96 (p < 0.05). The mean preoperative air-bone gap average was 23.38 dB ±7.98 (range 6 to 40 dB) and the mean postoperative air-bone gap of 13.45 ± 6.89 (range 5 to 32 dB). This resulted in improvement in the air-bone gap by 9.93 dB (p < 0.05). Conclusion: Endoscopic transcanal tympanoplasty is a minimally invasive procedure, which provides complete exposure of anterior tympanic membrane perforation thus avoiding external incisions and canaloplasty
Ocular Manifestations in Patients with Extrapulmonary Tuberculosis
Get PDFIntroduction : The study was done to find out the ocular manifestation in patients with extrapulmonary tuberculosis visiting a tertiary eye centre. Methods: A hospital based descriptive observational study was done among newly diagnosed extrapulmonary tuberculosis cases after approval from the institutional review board. After a detailed ocular evaluation, findings including patient demographics, presenting complaints, best corrected visual acuity, colour vision, contrast sensitivity, Goldman visual field and Optical Coherence tomography Retinal nerve fibre layer analysis of the optic nerve head were recorded in a semi-structured proforma. Data were expressed in frequency and percentage. Results: Out of 50 eyes of 25 patients included in the study, the mean age was 26.92±14.2 years (11-73 years). Sixty four percent were female. Two cases had ocular findings at the time of diagnosis. One case of tuberculous lymphadenitis had phlyctenular conjunctivitis and one case of tubercular meningitis had diplopia with right lateral rectus muscle paresis secondary to raised intracranial pressure. All the patients had best corrected visual acuity better than 6/12 at presentation. Color vision was normal in 72% cases in both eyes. Goldman visual field done at presentation were normal in both eyes in 88% cases while retinal nerve fibre layer thickness and contrast sensitivity were normal in all cases. Conclusion: The prevalence of ocular findings in patients with extrapulmonary tuberculosis was 8% in this study. Ocular examination is important in cases with extrapulmonary tuberculosis since a significant number of cases have ocular findings
Evaluation of Alcazar Scoring System to Differentiate Between Benign and Malignant Ovarian Masses- A Nepalese Perspective
Get PDFIntroduction: Ovarian cancer is the fifth most common cancer in Nepalese females and the tenth overall, accounting for 5% of the total new cases of cancer in females in 2020. Ultrasonography (USG) remains the primary tool for the diagnosis and characterization of ovarian masses in which many grey-scale and Doppler characteristics are evaluated. Various scoring systems have been described incorporating different USG parameters to differentiate the benign and malignant nature of ovarian masses. Alcazar scoring system includes both grey-scale as well as Doppler characteristics of the ovarian masses and is one of the more widely used systems worldwide. Methods: This was an observational cross-sectional study based on 52 consecutive patients who were clinically suspected to have ovarian mass and referred for USG evaluation and who subsequently underwent surgery.Results:As confirmed by histopathology, 37 cases were benign and 15 were malignant masses. Alcazar system of scoring identified 34 out of 37 benign cases and 15 out of 15 malignant cases with sensitivity and specificity for diagnosing malignant cases of 83.3% and 91.1% respectively. Conclusion: Alcazar system of scoring is a highly effective tool to differentiate between benign and malignant ovarian masses and can be of great help in diagnosis, characterization and effective preoperative planning
Self-Assessed Time Span of Focused Attention During a Breath Focus Test Task as a Measure of Mindfulness: A Preliminary Evaluation
Get PDFIntroduction: An easy task-based measure of mindfulness that can be self-administered in a daily life setting is still not available. We aimed to perform a preliminary evaluation of the Breath Focus Test Task to measure mindfulness. Methods: A quantitative observational study was performed among medical students. Each participant was instructed to focus attention to the participant’s own breath and count each breath with awareness until the participant noticed mind wandering. The last breath count attended before losing awareness of the task (breath count with awareness) was recalled and self-reported by each participant. Three such breath focus sessions were planned for each participant. The mean ‘breath count with awareness’ of each participant was then converted to time span of focused attention using the rate of breathing. This time span of focused attention was reported as the proposed measure of mindfulness. Each participant also completed the \u27Mindful Attention Awareness Scale questionnaire\u27. Results: Out of 101 participants, 76 completed at least one breath focus session satisfactorily. The median time span of focused attention was three minutes (first quartile = 1.9 minutes and third quartile = 4.5 minutes). The Mindful Attention Awareness Score was 3.9 (SD = 0.6). The results did not show a significant correlation between the time span of focused attention and the Mindful Attention Awareness Score (r s = 0.04, p = 0.74). Conclusion: This study shows the feasibility of the proposed test task. However, the measure obtained from the current form did not correlate with the Mindful Attention Awareness Score
Adverse Pregnancy Outcomes in Overweight and Obese Pregnant Women in a Tertiary Care Center of Western Nepal: A Prospective Cohort Study
No full textIntroduction: Maternal obesity is an established risk factor for various adverse pregnancy outcomes. Increased chances of labour induction, prolonged labour, instrumental and cesarean deliveries, medical disorders of pregnancy, post partum haemorrhage, preterm deliveries, macrosomia, low Apgar score etc. are well recognised risks of maternal obesity. This study aimed to evaluate these maternal and fetal outcomes in relation to the body mass index (BMI) of parturients. Methods: A prospective cohort study involving 115 overweight and obese women was conducted. Various maternal and fetal outcomes were studied and compared with those of 115 postpartum women with normal BMI. Statistical analysis was done using student\u27s t-test and Chi square test. Binomial logistic regression analysis was carried out to examine the magnitude and significance of the independent effect of BMI. Results: The three groups were comparable in terms of maternal age and gestational age at delivery. The total blood loss was significantly higher in the obese group as compared to the normal BMI (p=0.001) or overweight groups (p=0.005). Vaginal delivery was 69% less common in obese group in comparison to normal BMI group. The prevalence of meconium stained liquor, labour induction, preterm labour, and admission to neonatal intensive care unit were not significantly different across the three groups. Conclusion: This study highlighted the increased risk of total blood loss and birth weight >3500 grams with increasing BMI of pregnant women. A multicentric prospective study with larger sample size would shed further light on the strength of association between maternal BMI and various outcomes
Satisfaction of Online Learning among Nursing Students during COVID-19 Pandemic in Pokhara
Get PDFIntroduction: The outbreak of COVID-19 pandemic across the world has profoundly altered almost all aspects of life, including education. Conducting online learning was necessary to continue academic activities across all schools worldwide. The objective of this study was to assess satisfaction of online learning among nursing students. Methods: A descriptive cross-sectional study was carried out among 191 nursing students of PCL and B.Sc nursing programme. An enumerative sampling technique was used to select the sample. The self-administered web based questionnaire was used to collect data. The collected data was analysed by using descriptive and inferential statistics. Results: More than half (56%) of students were satisfied with online learning. A majority (95.8%) agreed that they need to be updated with the latest technology, 93.2% agreed on self-discipline is necessary during online class, 78% students agreed that they feel practical/clinical simulation exercises through online class is difficult, and 73.3% agreed the instructors organization and preparation for class provides comfortable online learning environment. However, only 23.56% of them agreed that they feel lazy and disinterested during online classes. There was significant association between level of satisfaction and type of residence, monthly family income, and academic level. Conclusion: More than half students are satisfied in online learning. Students\u27 satisfaction is one of important factors for effective outcome from online learning. So, E-learning is a good opportunity to continue education in future
Impact of Lockdown of COVID 19 Pandemic in Pregnancy Outcomes in a Tertiary Care Centre: What to expect?
Get PDFIntroduction: Corona Virus Disease 19 (COVID-19) was declared a "pandemic" in March 2020 by WHO and advocated lockdown measures with the use of mask, frequent hand washing and social distancing for decreasing the transmission of disease. In Nepal where antenatal coverage is just 50% and institutional deliveries 54%, this lockdown has further reduced the regular antenatal visits, institutional deliveries posing an increased adverse effect in pregnancy outcome. This study aimed to reveal the impact of lockdown in pregnancy outcomes in a tertiary care center. Methods: It was a cross-sectional, analytical study done in the Department of Obstetrics and Gynecology, Manipal Teaching Hospital for three months lockdown period (March 2020 to June 2020) and total deliveries along with maternal and perinatal complications were studied in the lockdown period and compared with those in non-lockdown period. Results: During the lockdown period, there were total 1070 deliveries and maternal complication was seen in 17.38% of deliveries. In the non-lockdown period, there were total of 982 deliveries and maternal complication was present in 18.43% of deliveries (p= 0.53). In the study, more cases of early pregnancy complications were seen in lockdown period than in non-lockdown period. Regarding obstetric complications, hypertensive disorder was the most common one observed during lockdown period whereas preterm labor was common in non-lockdown period. There was no increase in perinatal complications during lockdown period on comparing to non-lockdown period. Conclusion: There was no increase in adverse pregnancy outcomes during lockdown of COVID 19 pandemic in a tertiary care center. 
Relationship among Sex, Pattern of Weakness and Treatment Outcomes of Post-Stroke Patients: A Register-Based Longitudinal Study
Get PDFIntroduction: Differences in stroke care and health outcomes between males and females are debated globally. Sex differences in functional outcomes after stroke rehabilitation are poorly investigated in the context of Nepal. This study aimed to explore the relationship among patients’ sex, side of weakness, and post-stroke health outcomes after rehabilitation in a hilly western region of Nepal. Methods: A register-based longitudinal study was conducted in a rehabilitation center including all consecutive patients with stroke who came for rehabilitation ( ayurvedic, homeopathic, acupuncture, and physiotherapy ) from March 2018 to March 2020. Modified Rankin Scale score at a three-month follow-up after a visit to the center was the main outcome measure. It was reported using relative risk and 95% confidence intervals. Results: The study included 384 stroke patients, among them 241 (62.8%) were males. Right-sided weakness was 1.262 times (RR =1.262, 95% CI = 1.016-1.567) more likely in males than in females. Male stroke patients were 1.104 times more likely to achieve a good outcome than females (RR=1.104, 95% CI = 1.007-1.211) and these findings were statistically significant. There was no association between the side of weakness and the outcome. Conclusion: More males, compared to females, visited for rehabilitation and achieved a good outcome (mRS0-2) after three months. Right-sided weakness was more common in males than in females
Prevalence and Associated Factors of Overweight and Obesity in Reproductive Women of a Municipality in Western Nepal
Get PDFIntroduction: Overweight and obesity are major health-related problems causing an economic burden on societies around the world. This study aimed to estimate the prevalence of overweight and obesity and to determine the associated factors among reproductive women in a municipality in western Nepal. Methods: A community-based cross-sectional study was performed and data was collected by convenience sampling method including 353 women aged 15-45 years. Chi-Square test was used to assess the factors associated with overweight and obesity. The odds ratio was computed using binary logistic regression analysis. Results: The prevalence of overweight and obesity was 55% . Age (p < 0.001), education (p = 0.02), occupation (p = 0.012), marital status (p = 0.008), presence of chronic disease (p < 0.001), dietary pattern (p = 0.01), restaurant visit (p = 0.002) and stress (p = 0.003) were significant associated factors for overweight including obesity. The odds of being overweight or obesity was higher but not statistically significant in women aged 25-35 years (OR = 2.57 ; 95% CI: 0.89-7.4, p = 0.082), in married women (OR = 1.54; 95% CI: 1.08-2.02), and in parous women (OR = 2.38; 95 % CI: 4.05-27.57). The odds of being overweight or obese were significantly higher in the respondents who had no chronic disease (OR = 6.81, 95% CI: 2.10-10.16). Conclusion: We observed a high prevalence of overweight and obesity in our sample. Age, education, occupation, marital status, presence of chronic disease, dietary pattern, restaurant visits, and stress were associated with overweight or obesity
Birth Preparedness and Complication Readiness among Husbands Whose Wives were Delivered Within the Last 12 Months: A Cross-sectional Study
Get PDFIntroduction: Birth preparedness and complication readiness (BPCR) is an essential element of the antenatal care package which promotes pregnant women and their families to effectively plan for normal births and prepares them for any complications that may arise. This study aimed to explore the husbands’ preparedness and their knowledge level of BPCR. Methods: A descriptive cross-sectional study was conducted among 117 husbands whose wives delivered within the last 12 months in the out-patient and in-patient wards of the Obstetrics and Pediatrics departments of a medical college. The data were collected from August to December 2021 using a non-probability purposive sampling technique and a pre-tested semi-structured interview questionnaire. The statistical analysis was made at 95% confidence level. The data were summarized and described using descriptive statistics such as proportion, percentage, ratios, frequency distribution, mean and standard deviation. Results: None of the respondents knew all the three key danger signs of the postpartum period. More than three-quarters (78.6%) of the husbands were prepared in the BPCR component. Conclusion: Few husbands knew all the key danger signs during pregnancy, labor, postpartum and newborn periods. Slightly more than three-quarters of husbands were prepared well for birth and complication readiness. Individual components of BPCR was also poor among the respondents