Journal of Lumbini Medical College (JLMC)
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Chondromyxoid fibroma of patella: a rare case
Get PDFIntroduction: Chondromyxoid fibroma is a rare benign tumor with aggressive behavior accounting for less than 0.5% of all bone tumors. There are several case-reports of this tumor occurring in different bones. Case report: Here we report a case of 19 years old male with the tumor arising from the inferior pole of right patella which was treated by complete excision of the lesion. The histopathology report was consistent with chondromyxoid fibroma. Conclusion: Chondromyxoid fibroma is a benign but locally aggressive tumor which may occur at unusual sites
Validation of a Preoperative Scoring System to Predict Difficult Laparoscopic Cholecystectomy: A Nepalese Perspective
Get PDFIntroduction: Preoperative prediction of the factors leading to difficulty or conversion in cholecystectomy could help plan the surgical strategies and possible outcomes beforehand. The present study aimed to predict and analyze risk factors using a scoring system deemed responsible for surgical difficulties in patients undergoing cholecystectomy for symptomatic cholelithiasis. Methods: This hospital based prospective study was conducted at Department of Surgery, Lumbini Medical College and Teaching Hospital, Nepal. Various factors considered preoperatively were gender, age, previous history of hospitalization, impacted stone, obesity, gall bladder wall thickness, pericholecystic collection, previous abdominal scar and palpable gall bladder. Results: Among 177 cases operated, the mean age ±SD of the patients was 47.72±17.54 years. Conversion rate was 7.9 %. At preoperative score of 5; sensitivity, specificity, positive predictive value and negative predictive value were 89.40% (CI: 83.36%-93.82%), 69.23% (CI: 48.21 %-85.67%), 94.41%(CI: 90.44%-96.79%) and 52.94% (CI: 39.85%-65.64%) respectively{Area under curve– 0.74, p=0.0001, CI (0.637-0.846)}. Multivariate analysis showed abdominal scar {p=0.02, OR (CI): 5.2 (1.2-21.8)}, previous hospitalization {p=0.001, OR(CI): 6.8(2.2-20.8)} and thickened gall bladder wall {p= 0.03, OR(CI): 3.6(1.1-11.5)} to be statistically significant risk factors. Conclusion: With possible prediction beforehand, high risk group of patients can be identified and dealt accordingly to generate good surgical outcome avoiding complications
COVID-19: Emerging Challenges for Students in Medicine and Schools in the United States
Get PDFThe coronavirus pandemic has changed the world everywhere, including the lives of high schoolers in America. The sudden sharp rise in coronavirus cases forced the closure of schools in Mid-March to curb the further spread of the virus. Several end-of-the-year celebrations, school activities, and examinations were canceled. At the same time, the cancellations gave a chance for the youth to adapt to uncertain situations and learn adifferent perspective of life. Living in Florida, a state that battles hurricanes for almost half a year, school closures have become the norm: it is not rare for students to be reminded to keep their textbooks and notes home for a week or two. Prepared from past closures due to hurricanes, the school district board already had a virtual school platform, and the principal instructed all students to shift to Zoom and alternative eLearning. However, when the coronavirus pandemic led to the indefinite closure of high schools across the country, thiswas something new, different, and unexpected that school communities had to face
Dermatological Aspects of COVID-19
Get PDFOn 31 December 2019, Wuhan, the capital city of Hubei Province in China reported World Health Organization(WHO) about cases of pneumonia which were caused by a severe acute respiratorysyndrome coronavirus 2 (SARS-CoV-2) currently designated coronavirus disease (COVID-19). The infection rapidly spread throughout the world escalating the situation and WHO eventually declared COVID-19 as a global pandemic on 11 March 2020. It has already affected almost all aspects of health and society globally. With the current pandemic, dermatologists should be aware of dermatological aspects of SARS-CoV-2, its skin manifestations and general skin care. 
Sex Determination from Radiological Assessment of the Sacrum in Nepalese Population: A Cross-sectional Study
Get PDFIntroduction: Human skeleton shows variable degree of sexual dimorphism, but definitive inference can be obtained from only a few bones, sacrum being one of them. The morphometric differences of the bone will be helpful to obstetricians, as it shows special adaptations in females for child bearing. It is also important for physical anthropologists and forensic scientists for sex determination. The aim of this study was to find out whether sex could be determined by using sacral parameters from X-ray images of pelvis. Methods: The study included antero-posterior X-ray images of pelvis with clearly visible 680 sacra (311 of males and 369 of females) obtained by computer generated random numbers from records in the Department of Radiodiagnosis of a medical college in Nepal. X-ray images with the sacrum suspected for fractures and pathological diseases were excluded. Inbuilt software “CR Konica Minolta Aero DR/CR CS7†was used for measurements. Results: The mean sacral length and mean transverse diameter of S1 vertebra were higher in males; whereas, mean sacral breadth, mean left ala length, mean right ala length, mean ala length, mean sacral index and mean alar index were higher in females. These differences in sacral parameters between the two sexes were statistically significant (p<0.05). The percentage of bones identified by demarking points of sacral index was 15.17% and 0.32% respectively in the males and the females. Conclusion: The result of the present study supported determination of sex of an individual from radiological assessment of sacrum
Anthropometric Measurement of Hand Dimension and Their Correlation with Height in Undergraduate Students of a Medical College in Nepal
Get PDFIntroduction: Height is important for determination of basic energy requirement, standardization and identification. It is also useful for measuring physical capacity and adjusting drug dosages. Sometimes the exact height cannot be determined directly because the patient is unable to stand as a result of neuromuscular weakness, deformities of axial skeleton, loss of lower limbs and in case of amputation. Forensic investigations of skeletal remains also face the problems. Under such circumstances, height can be estimated by hand dimensions.Methods: Hand dimensions and height were measured on 239 medical students in the Department of Anatomy using standard instruments. Among them 120 were females and 119 were males. Correlation between height and hand dimensions was studied. Regression equation was derived for estimation of height from hand dimensions. Results: The correlations between height and hand dimension were statistically significant in both genders (p<0.05). The Pearson correlation between height and hand length was 0.616 and between height and hand breadth was 0.353 in males. Those coefficients for females were 0.706 and 0.198 respectively. Regression equations were formulated for height with hand length in males and females. Conclusion: Height can be predicted from hand length. Hand length showed moderate (males) to strong (females) positive correlation with statistical significance whereas hand breadth showed weak positive correlation with statistical significance
Six-Minute Walk Test in Healthy Nepalese Young Adults Aged 18 to 25 Years: A Cross- Sectional Study
Get PDFIntroduction: The six-minute walk test is a simple test used to assess the exercise capacity. Variability is noted in the six-minute walk distance in different populations. Obesity also affects the six-minute walk test results. The aims of the study were to examine the relationship between body mass index and post exercise oxygen saturation and to establish a reference equation for the six-minute walk distance in young adults. Methods: A cross-sectional study was conducted with 106 subjects of age 18-25 years. The participant walked as fast as possible on a flat surface for six minutes. After a six-minute walk test, oxygen saturation and the distance walked were recorded. Results: Body mass index was negatively correlated with oxygen saturation (r=-0.587,p<0.001). Mean six-minute walk distance for males was 584.43±23.71 m and for females 469.85±30.38 m (p<0.001). Multiple linear regression analysis revealed sex and height as independent predictors of six-minute walk distance. The contributions of sex and height were statistically significant and explained 87.3% variance in the six-minute walk distance. Conclusion: Although the correlation between body mass index and oxygen saturation was statistically significant, the oxygen saturation values were still within normal range. Sex and height were the most significant predictors of the six-minute walk distance
Need for Prioritizing Health: An Old War-Cry Reiterated By COVID-19
Get PDFThe poor state of health care in Nepal will be burdened further following the SARS-CoV-2 pandemic. The government failed in timely stockpiling of medical supplies and equipment, development of health infrastructure, including laboratories and quarantine centres, restriction and screening of international travel and information dissemination to the general public. While efforts have now been made to increase the capacity for diagnostic test for SARS-CoV-2, the government still needs to further increase the availability and accessibility throughout the country. This would be the first step in fighting the pandemic. However, it is also important to prepare for the worst case. Similarly, advocacy programs should be developed to inform the general public and alleviate their fears about the disease. These measures would not only help Nepal’s capability to respond to the COVID-19 outbreak but could lay the foundations to improve the health of the citizens in general, even after this epidemic is controlled and could go a long way in developing trust of the government in the populace
Prevalence and Risk Factors of Hypertensive Retinopathy in Hypertensive Patients in a Tertiary Hospital of Gandaki Province of Nepal
Get PDFIntroduction: Hypertensive retinopathy is one of the major complications of hypertension. The presence of hypertensive retinopathy may be an indicator of the presence of other complications too. This study aimed to determine the prevalence and risk factors of hypertensive retinopathy in hypertensive patients in a tertiary care hospital in Nepal. Methods: This was a hospital-based cross-sectional study conducted among 95 hypertensive patients aged 30 years and above. Standard proforma was used to collect socio-demographic and clinical variables of the patients. Detailed eye examination including fundus evaluation under mydriasis was done on all patients and hypertensive retinopathy was graded according to Keith-Wagener-Barker classification. Statistical analysis was carried out using Epi-info 7. Results: The mean age of the study sample was 59.74±15.11 years. The prevalence of hypertensive retinopathy was 38.95%. Among the patients with hypertensive retinopathy, the prevalence of grade I, II, III, and IV retinopathies were 7.36%, 17.89%, 10.52%, and 3.15% respectively. There was a statistically significant association between hypertensive retinopathy and controlled blood pressure and treatment of hypertension. However, there was no statistically significant association between hypertensive retinopathy and gender, duration of hypertension, residence, family history, history of smoking, and diet. Conclusion: Uncontrolled blood pressure and untreated patients of hypertension were the significant risk factors for hypertensive retinopathy. Early diagnosis and treatment of hypertension are essential to prevent loss of vision
The Role of Aspartate Aminotransferase to Platelet Ratio Index as a Non-Invasive Predictor of Variceal Etiology of Upper Gastrointestinal Bleeding
Get PDFIntroduction: Non-invasive strategies to predict variceal from non-variceal bleeding will be highly beneficialfor preemptive management of Upper Gastrointestinal Bleeding (UGIB). This study aimed to assess the roleof aspartate aminotransferase (AST) to platelet ratio index (APRI) as a non-invasive predictor of varicealetiology of UGIB. Methods: This was a retrospective descriptive study conducted at Endoscopy Departmentof Dhulikhel Hospital between January 2017 and December 2019 in patients presenting with acute UGIB.We assessed the diagnostic utility of the APRI score relative to other objective measures by Area Under theReceiver Operating Characteristic (AUROC) curve analysis. Results: A total of 158 patients with historyof UGIB were included in the study. There were total 123 males (77.8%) and the mean age of the patientswas 50.3±16.1 years. The APRI score performed well in predicting a variceal etiology of acute UGIB, withAUROC 0.9. When APRI was used at cut-off of 1.3, it had a sensitivity of 84.1% and specificity of 76.8%,a positive predictive value of 70.7% and a negative predictive value of 89.9% while predicting varicealetiology of UGIB at presentation. The relative risk of varices at an APRI cut-off of 1.3 is 17.5 with a p-valueof <0.0001. Conclusion: The present study highlighted that APRI score can be used as an objective metricthat helps to predict a variceal etiology of acute UGIB