Journal of Lumbini Medical College (JLMC)
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COVID-19 in the West Indies: Trinidad and Tobago Experience
Get PDFTrinidad and Tobago (T+T) is a small twin-island state in the Caribbean, eight miles off the coast of Venezuela. It has an area of approximately 5431 square kilometres and population of 1.4 million. At the present time, there are 116 coronavirus disease (COVID-19) cases and eight deaths, with no new cases or deaths for the last 21 days (May 17, 2020). Its COVID-19 story is one of the prompts, with early control and great success. There has beenno such instance where the health services were stretched or unable to cope. Even before the first case was identified, the T+T Government restricted entry to travelers from China, Japan, Singapore, South Korea and several European countries.The first case of COVID-19 identified in T+T was on March 12, 2020. The patient had returned from Switzerland. The next day, a second positive case was a person who had returned from USA
COVID-19 Pandemic: An Unseen’s Evolution War
Get PDFThis is a new beginning. It started just like a fiction movie.In December 2019, a new cluster of pneumonia caused by the 2019 novel coronavirus (2019-nCoV) was first identified in Wuhan, China. Without any mercy, it became a pandemic and left no time for grief. It was not only life-threatening but also challenged our healthcare system, economy, culture, lifestyle and belief. It forced us to make changes. We need to evolve, and we must evolve. Malaysia, a multi-ethnicity and multireligiouscountry which is located in Southeast Asia, has a population of 32 million with a median age of 28.9 years in 2019. According to the Observatory of Economic Complexity, Malaysia has experienced rapid globalization and is the 19th leading exporter in the world. It is an upper-middle-income country with a gross domestic product (GDP) of 370 billion USD in 2019, of which 4.5% is funded to the healthcare system
Principles, Utility and Limitations of Pulse Oximetry in Management of COVID-19
Get PDFPulse oximetry is an essential component of the standard care of COVID-19 patients. In the context of the spreading COVID-19 pandemic for which no targeted therapy or vaccines are yet available, early identification of the severe cases or cases with high risk of severe disease and appropriate supportive treatment are of paramount importance to save lives. Pulse oximetry is a cheap, fast, easy to use, noninvasive, painless and accurate tool that allows real-time monitoring of hypoxemia. As the primary target of the disease is the respiratory system pulse oximetry provides an unparalleled way to assess the severity of the disease, guide supportive therapies and monitor the clinical status and response to treatment with greater benefits in the low-resource settings. All settings from the quarantine facilities at the ground level to the ICUs in the highest level hospitals can utilize it to achieve their goals. To get the best of this tool, it needs to be used properly and the findings interpreted carefully. Role of basic understanding of the physiological principles and technology behind its use and awareness of its limitations cannot be overemphasized. The pulse oximetry readings are interpreted in the context of blood hemoglobin concentration, tissue perfusion, arterial blood carbon dioxide concentration and oxygen supplementation status
The The Impact of COVID-19 on Immunization Services
No full textThere was a time when epidemics were of interest only to historians. In spite of the knowledge of the risks of emergent infectious diseases, Coronavirus disease of 2019 (COVID-19) managed to disrupt the entire world. This new virus has the capacity to evade, adapt, diversify and persist. Human factors such as global travel, human-animal contact, urban crowding and ecological changes have helped favor the rapid spread. Epidemics are known to eventually resolve, whether succumbing to societal action or having exhausted the supplyof susceptible victims. COVID-19 too will be contained but it will leave a trail of devastating health consequences for low- and middle-income countries (LMIC) including Nepal.When governments responded in the hopes of slowing the course of the pandemic and reducing the total mortality, stringent controls were implemented, including school closures, bans on public gatherings, and other forms of isolation or quarantine. In Nepal, a nationwide complete lockdown commenced on the 24th March, 2020. This brought about a drastic decrease in demand for hospital services, mainly due to inaccessibility orthe health care seekers’ apprehension of contracting the virus during a hospital visit. Elective surgeries and procedures were temporarily discontinued and preventive care such as antenatal and well-baby visits came to a complete halt in majority of the institutions nationwide. Although mortality rates for COVID-19 appeared to be low in children and in women in the reproductive age, these groups might be disproportionately affected by thedisruption of routine health services, particularly in LMICs
Intensive Physiotherapy Interventions in Speedy Recovery of Sub-acute Stroke: A Case Series
Get PDFIntroduction: Intensive physiotherapy interventions have shown good recovery in stroke if applied to stable patients who can tolerate it. Influence of enriched environment on intensive physiotherapy interventions after acute care has not been studied in low-resource contexts, and therefore, we reported outcome of the interventions in multiple cases with stroke in Nepalese context and cultural background. Case reports: Three patients in sub-acute stage of stroke were admitted in intensive physiotherapy treatment unit where the environment was therapeutically enriched. The therapist-administered interventions were intensive for each domain of impairment and activity limitations, every day for six days a week. Patients were trained to carry out caregiver-assisted practice or self-practice in enriched environment. Training demonstrated visible and measurable outcome in all cases. Conclusion: Intensive physiotherapy interventions in an enriched environment promoted good recovery in short period in stroke. The interventions applied, and the principles adopted were based on the established evidence, and therefore findings of this study may support for its feasibility and applicability
Healthcare Workers and Burnout During COVID-19 Pandemic
Get PDFHave you ever felt stuck? Or rather unmotivated and unsatisfied at your work? Maybe you do not feel like being a doctor anymore, but the fear of what will you do after; scares you more. Or maybe, you do wish to continue your medical practices but feel rather tired and let down at most times. In either scenario, you are not alone.Several healthcare workers feel underappreciated and suffer from lack of enthusiasm for work, feelings of cynicism towards life and low sense of personal accomplishment, in short, they feel “Burnt outâ€.
Burnout is on the rise in medical fraternity. Established professionals, residents in training, to young medical school trainees beginning their careers in medicine, none can escape from the brunt of burnout. Long working hours and increasing burden of bureaucratic tasks make the medical profession a tedious one. Continued exposure to human suffering and death introduces cynicism towards life and its purpose. Constant need to becompassionate to patients and their family members require immense mental and emotional fortitude.However, with an increase in violence against the medical fraternity,[5] a typical doctor begins to question the sanctity of the profession and feels unappreciated
Sexual Dimorphism of Maxillary Sinus: A Morphometric Analysis using Computed Tomography
Get PDF Introduction: Gender determination is the important aspect of forensic science. Most of the bones used for sex determination are badly disfigured and found in incomplete state, thus bones recovered intact are used. Maxillary sinus being recovered intact can be used for gender determination by measuring maxillary sinus dimension through computed tomography (CT). The aim of this study was to assess sexual dimorphism using morphometric maxillary sinus measurements through CT scan. Methods: This analytical cross-sectional study included CT scan images of 80 patients (40 males and 40 females). Maxillary sinus mediolateral (ML), superoinferior (SI), anteroposterior (AP) linear dimensions and volume were measured. All the measured parameters were then subjected to Student’s t-test to determine mean difference between males and females and discriminative statistical analysis to determine gender. Results: The mean value of maxillary sinus length, width, height and volume in males on both right and left sides were (3.80±0.175, 3.74±0.209) cm, (2.57±0.317, 2.51±0.295) cm, (3.55±0.338, 3.5±0.286) cm and (17.49±3.909, 16.54±3.274) cm3 respectively and in females (3.67±0.250, 3.64±0.256) cm, (2.37±0.297, 2.34±0.3222) cm, (3.29±0.280, 3.23±0.254) cm and (14.42±2.935, 13.81±2.779) cm3 respectively. The discriminative analysis showed that the accuracy of maxillary sinus measurements was 72.5% in females and 75% ofmales (overall accuracy = 73.8%). Conclusion: The maxillary sinus measurements are valuable guide for sex determination with relatively good accuracy rate
Risk Factors for Obesity in Nepalese Women: A Cross-sectional Study
Get PDFIntroduction: Obesity is defined as abnormal or excessive fat accumulation that may impair health. It ison the rise worldwide, not sparing developing countries. Both demographic and socioeconomic factors playan important part in its causation. Body mass index is a simple index of weight-for-height that is commonlyused to classify overweight and obesity in adults. This study was done with objectives of assessing the prevalence of overweight and obesity and its associated factors among adult women attending selected outpatient departments of tertiary care center in western region of Nepal. Methods: A descriptive cross-sectionalthe study was conducted for six months. A total of 160 female respondents aged more than 20 years attending outpatient departments were included in the study using non-probability convenient sampling technique. Data on socio-demographic status, dietary pattern, health risk behavior and presence of chronic illness were collected and anthropometric measurements were taken for all the respondents. Results: The prevalence of overweight and obesity were 31.8% and 3.8% respectively. There was a statistically significant association between obesity and overweight with age (p=0.044), educational status (p=0.017), frequency of consumption of fruits (p=0.029), dietary pattern (p=0.023), frequency of consumption of dairy products (p=0.019), marital status (p=0.020) and drinking alcohol (p=0.022). Conclusion: Age, educational status, frequency of consumption of dairy products, dietary habits, marital status and drinking habits were strongly associated with obesity and overweight among adult women
Prevalence and Associated Risk Factors of Hypertension Among Adults in Palpa District, Nepal
Get PDFIntroduction: Hypertension mostly remains asymptomatic when controlled, however, there is always an increased risk of heart disease, stroke, and renal failure. The higher the blood pressure, the higher the likelihood of harmful consequences to the heart, blood vessels, eyes, brain, and kidneys. Methods: A community-based cross-sectional study was conducted in the adult population. The blood pressure was measured from the left arm, the respondents in sitting posture and arm support at the heart level. Results: The prevalence of hypertension was 22% and higher in people above 60 years of age. The prevalence of hypertension was more in people who had elevated waist to hip ratio (65%) and positive family history (40.8%). The prevalence of hypertension was observed high among diabetics (63.2%) and in smokers (33.3%). Conclusion: The prevalence of hypertension was seen positively associated with increasing age, smoking, alcohol sedentary lifestyle, diabetes, stress, central obesity and >25 BMI
Risk Factors and Perinatal Outcome of Meconium Stained Amniotic Fluid
Get PDFIntroduction: Meconium Stained Amniotic Fluid (MSAF) is a frequent finding during deliveries and is a cause for perinatal morbidity and mortality. Meconium Aspiration Syndrome (MAS) in neonates is an association in these deliveries with some infants requiring mechanical ventilation. This study was done with the aim of finding the risk factors for MSAF and its perinatal outcome. Methods: This was a hospital based, cross-sectional study. All the inborn babies delivered with MSAF were included in the study. Antenatal risk factors and perinatal outcomes like mode of delivery, Apgar score, NICU admission and neonatal morbidities mainly MAS were noted. Results: MSAF was seen in 202 (13.6%) neonates out of which 30 (15%)developed MAS. Antenatal risk factors were present in 97 (48%) cases. Mode of delivery was caesarean section in 78 (39%) and instrumental in 25 (13%) cases. Twenty three percent of the neonates required resuscitation at birth while 34% required respiratory support. Morbidities observed were meconium aspiration, pneumonia, septicaemia, perinatal asphyxia, shock, meconium gastritis and persistent pulmonary hypertension. Neonatal mortality amongst all neonates with meconium was 1.5%.Conclusion: Meconium stained amniotic fluid leading to aspiration is a significant cause of neonatal mortality and morbidity. Most of the risk factors for MAS are preventable